Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries

Wickwire, Emerson M.; Tom, Sarah E.; Scharf, Steven M.; Vadlamani, Aparna; Bulatao, Ilynn G.; Albrecht, Jennifer S.

doi:10.1093/sleep/zsz007

Cited by 102 publications

(75 citation statements)

References 39 publications

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“…Insomnia is a common sleep-wake disorder that is associated with substantial functional impairment and increased health care utilization [ 1 , 2 ]. Current pharmacologic options for insomnia include γ-aminobutyric acid type-A receptor agonists, such as sedative-hypnotic benzodiazepines and nonbenzodiazepine Z-drugs, melatonin receptor agonists, sedating antidepressants, sedating antihistamines, and dual orexin receptor antagonists [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term efficacy and tolerability of lemborexant compared with placebo in adults with insomnia disorder: results from the phase 3 randomized clinical trial SUNRISE 2

Kärppä

Yardley

Pinner

et al. 2020

Sleep

105

134

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Abstract Study Objectives To assess long-term efficacy and safety of lemborexant (LEM), a novel dual orexin receptor antagonist, versus placebo in adults with insomnia disorder. Methods This was a 12-month, global, multicenter, randomized, double-blind, parallel-group phase 3 study comprising a 6-month placebo-controlled period (reported here) followed by a 6-month active-treatment-only period (reported separately). A total of 949 participants with insomnia (age ≥18 years) were randomized, received treatment with an oral dose of placebo or LEM (5 mg [LEM5] or 10 mg [LEM10]) and were analyzed. Sleep onset and sleep maintenance endpoints were analyzed from daily electronic sleep diary data. Treatment-emergent adverse events (TEAEs) were monitored throughout the study. Results Decreases from baseline in patient-reported (subjective) sleep onset latency and subjective wake after sleep onset, and increases from baseline in subjective sleep efficiency, were significantly greater with LEM5 and LEM10 versus placebo. Significant benefits over placebo were observed at the end of month 6, and at most time points assessed over the 6-month period, indicating long-term sustained efficacy of LEM. A significantly greater percentage of sleep onset responders and sleep maintenance responders were observed with LEM treatment versus placebo. Participants treated with LEM reported a significant improvement in quality of sleep after 6 months versus placebo. The majority of TEAEs were mild or moderate. There was a low rate of serious TEAEs and no deaths. Conclusions LEM5 and LEM10 provided significant benefit on sleep onset and sleep maintenance in individuals with insomnia disorder versus placebo, and was well tolerated. Clinical trial registration ClinicalTrials.gov, NCT02952820; ClinicalTrialsRegister.eu, EudraCT Number 2015-001463-39

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Section: Introductionmentioning

confidence: 99%

Long-term efficacy and tolerability of lemborexant compared with placebo in adults with insomnia disorder: results from the phase 3 randomized clinical trial SUNRISE 2

Kärppä

Yardley

Pinner

et al. 2020

Sleep

105

134

View full text Add to dashboard Cite

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“…It has been estimated that the mean total healthcare costs were 75% higher for groups with moderate and severe insomnia compared to those with no insomnia, of a health plan sample in the USA [6]. Similarly, those with untreated insomnia have higher all-cause healthcare utilization [7], providing evidence for the economic burdens of (undiagnosed/untreated) sleep disturbances.…”

Section: Introductionmentioning

confidence: 99%

Sleep disturbances and the speed of multimorbidity development in old age: results from a longitudinal population-based study

Sindi

Pérez

Vetrano

et al. 2020

BMC Med

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Background Sleep disturbances are prevalent among older adults and are associated with various individual diseases. The aim of this study was to investigate whether sleep disturbances are associated with the speed of multimorbidity development among older adults. Methods Data were gathered from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), an ongoing population-based study of subjects aged 60+ (N = 3363). The study included a subsample (n = 1189) without multimorbidity at baseline (< 2 chronic diseases). Baseline sleep disturbances were derived from the Comprehensive Psychiatric Rating Scale and categorized as none, mild, and moderate–severe. The number of chronic conditions throughout the 9-year follow-up was obtained from clinical examinations. Linear mixed models were used to study the association between sleep disturbances and the speed of chronic disease accumulation, adjusting for sex, age, education, physical activity, smoking, alcohol consumption, depression, pain, and psychotropic drug use. We repeated the analyses including only cardiovascular, neuropsychiatric, or musculoskeletal diseases as the outcome. Results Moderate–severe sleep disturbances were associated with a higher speed of chronic disease accumulation (ß/year = 0.142, p = 0.008), regardless of potential confounders. Significant positive associations were also found between moderate–severe sleep disturbances and neuropsychiatric (ß/year = 0.041, p = 0.016) and musculoskeletal (ß/year = 0.038, p = 0.025) disease accumulation, but not with cardiovascular diseases. Results remained stable when participants with baseline dementia, cognitive impairment, or depression were excluded. Conclusion The finding that sleep disturbances are associated with faster chronic disease accumulation points towards the importance of early detection and treatment of sleep disturbances as a possible strategy to reduce chronic multimorbidity among older adults.

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“…Yet sleep disorders are under-recognized and under-treated issues, especially in older adults. Untreated insomnia is leading to an increase in all-cause health care utilization among older Medicare beneficiaries [1].…”

Section: Introductionmentioning

confidence: 99%

“…About 9–12% of the general population and 25–40% of older adults may be diagnosed with sleep disorders [2]. In the United States, the prevalence of diagnosed insomnia increased by 150% between 2006 and 2013 [1]. Insomnia is more common in women, middle-aged and older adults, and individuals with coexisting medical and psychiatric disorders [2].…”

Section: Introductionmentioning

confidence: 99%

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

et al. 2019

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Background. Although psychosocial and health factors impact insomnia symptoms, less is known about these effects in economically disadvantaged African-American older adults. Aims. This study investigated social and health determinants of insomnia symptoms among economically disadvantaged African-American older adults. Methods. This survey enrolled 398 African-American older adults (age ≥ 65 years) from economically disadvantaged areas of South Los Angeles. Gender, age, educational attainment, financial difficulty, number of chronic diseases, self-rated health, pain intensity, and depression were covariates. Total insomnia, insomnia symptoms, and insomnia impact were our outcomes. Linear regression was applied for data analysis. Results. Based on linear regression, higher financial difficulty (B = 0.48, 95% CI = 0.35–0.61), smoking status (B = 1.64, 95% CI = 0.13–3.16), higher pain intensity (B = 0.39, 95% CI = 0.11–0.67), higher number of chronic diseases (B = 0.34, 95% CI = 0.05–0.64), and more depressive symptoms (B = 0.35, 95% CI = 0.12–0.57) were associated with a higher frequency of insomnia symptoms. Based on a logistic regression model, lower age (B = 0.91, 95% CI = 0.91–1.00) and high financial difficulty (OR = 1.15, 95% CI = 1.08–1.24), pain (OR = 2.08, 95% CI = 1.14–3.80), chronic disease (OR = 1.27, 95% CI = 1.07–1.51) and depression (OR = 2.38, 95% CI = 1.22–4.65) were associated with higher odds of possible clinical insomnia. We also found specific predictors for insomnia symptoms and insomnia impact. Conclusions. Among African-American older adults in economically disadvantaged areas of South Los Angeles, insomnia symptoms co-occur with other economic, physical, and mental health challenges such as financial difficulty, smoking, multimorbidity, pain, and depression. There is a need to address sleep as a component of care of economically disadvantaged African-American older adults who have multiple social and health challenges.

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Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries

Cited by 102 publications

References 39 publications

Long-term efficacy and tolerability of lemborexant compared with placebo in adults with insomnia disorder: results from the phase 3 randomized clinical trial SUNRISE 2

Long-term efficacy and tolerability of lemborexant compared with placebo in adults with insomnia disorder: results from the phase 3 randomized clinical trial SUNRISE 2

Sleep disturbances and the speed of multimorbidity development in old age: results from a longitudinal population-based study

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

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