Older adult US Medicare beneficiaries with untreated obstructive sleep apnea are heavier users of health care than matched control patients

Abstract

Study Objectives: To examine the effect of untreated obstructive sleep apnea (OSA) on health care utilization (HCU) and costs among a nationally representative sample of Medicare beneficiaries. Methods: Our data source was a random 5% sample of Medicare administrative claims data for years 2006-2013. OSA was operationalized as (1) receipt of one or more International Classification of Disease, Version 9, Clinical Modification diagnostic codes for OSA in combination with (2) initiation of OSA treatment with either continuous positive airway pressure or oral appliance (OA) therapy. First, HCU and costs were assessed during the 12 months prior to treatment initiation. Next, these HCU and costs were compared between beneficiaries with OSA and matched control patients without sleep-disordered breathing using generalized linear models. Results: The final sample (n = 287,191) included 10,317 beneficiaries with OSA and 276,874 control patients. In fully adjusted models, during the year prior to OSA diagnosis and relative to matched control patients, beneficiaries with OSA demonstrated increased HCU and higher mean total annual costs

Prevalence of Sleep Disorders and Association With Mortality: Results From the NHANES 2009–2010

“…Given this presumed high prevalence of undiagnosed and therefore untreated sleep disorders, there are potentially very significant societal implications in terms of reduced performance/productivity in school and the workplace 12 . Furthermore, the sleep disorders that are correlated with long‐term health consequences have been shown to significantly increase the burden on the healthcare system 13,14 …”

Proof of principle study: diagnostic accuracy of a novel algorithm for the estimation of sleep stages and disease severity in patients with sleep-disordered breathing based on actigraphy and respiratory inductance plethysmography

“…If adding those with low-grade sleep apnea, the prevalence figures are 59.4% and 33.2% respectively [3]. However, therapy for mild sleep apnea is only necessary in the case of cardiovascular risk or associated daytime sleepiness [4]. Due to limited diagnostic capacities, a high number of unrecognized cases have to be assumed.…”

Greater health care utilization and cost associated with untreated sleep apnea

“…Wickwire and colleagues, using administrative data have shown the economic impact of obstructive sleep apnea (OSA) in older people. 1 Prior research has shown OSA confers an increased risk for cardiovascular and metabolic disease, [2][3][4][5] stroke, 6 psychiatric conditions 7 and death. 8 A growing literature has also documented greater economic burden for individuals with untreated OSA compared with matched controls without OSA.…”

“…17 To build upon prior investigations that have found OSA to be associated with substantial economic burden, Wickwire et al has presented a rigorous analysis of the impact of untreated OSA on HCU among older adults in this issue of the Journal of Clinical Sleep Medicine. 1 Using data from a random sample of Medicare administrative claims for years 2006-2013, the authors demonstrated that untreated OSA in older adults was associated with increased HCU and higher costs across all points of service. 1 This study is notable for several reasons.…”

“…1 Using data from a random sample of Medicare administrative claims for years 2006-2013, the authors demonstrated that untreated OSA in older adults was associated with increased HCU and higher costs across all points of service. 1 This study is notable for several reasons. First, it is the largest analysis to date of the economic impact of OSA, and its sophisticated analyses confirms prior research showing that untreated OSA is associated with increased HCU and costs.…”