OBJECTIVES

Prior research has demonstrated an association between Obstructive sleep apnea (OSA) and Treatment Resistant Hypertension (TRH), defined as occurrence of overlapping use of ≥4 antihypertensives for a period of greater than 60 days. However, the risk of OSA in patients with TRH has not been quantified accurately. We sought to evaluate OSA risk in patients with TRH compared to those with treated, but non-resistant hypertension (non-TRH) using a time dependent exposure analysis.

METHODS

We conducted a retrospective cohort study of patients with treated hypertension (hypertension diagnosis + ≥2 antihypertensive drug claims within 1 year) using IBM MarketScan® commercial claims database from January 2008 to December 2018. We excluded beneficiaries without 12 months of continuous enrollment before the second antihypertensive fill date (index date of cohort entry) and those having the outcome (OSA: identified by ICD codes) in the 12-month pre-index period. Follow-up started from the index date until the earliest of: first occurrence of OSA, end of continuous enrollment, or study end date (December 31^st, 2018). The primary analysis was via Cox proportional hazard regression with OSA as the dependent variable, and time-dependent exposure (non-TRH vs. TRH) and baseline covariates (demographic, clinical comorbidities, prescription medication use and healthcare utilization patterns) as independent variables.

RESULTS

Of 2,354,346 patients with treated hypertension (mean-age: 50 years, 52% male), 49,542 met TRH criteria. The crude incidence rates of OSA were 34.2 and 17.7 per 1,000 person-years in TRH patients and non-TRH patients, respectively. In the adjusted Cox Proportional Hazard Regression model, TRH remained associated with a 72% increased risk of OSA (Hazard Ratio (HR): 1.72; 95% CI, 1.67-1.78) compared to non-TRH.

CONCLUSIONS

Our data suggests that patients with TRH are at higher risk of incident OSA. More frequent OSA screening and regular monitoring is needed in this population.