Undiagnosed sleep apnea tied to increased medical spending in older adults
Click Here to Manage Email Alerts
Older adults covered by Medicare with undiagnosed obstructive sleep apnea have significantly higher medical costs each year compared with healthy adults, according to a study published in the Journal of Clinical Sleep Medicine.
“Obstructive sleep apnea is a progressive disease that worsens physical and mental health and incurs substantial economic burden,” Emerson Wickwire, PhD, associate professor of psychiatry and medicine at the University of Maryland School of Medicine, told Healio Primary Care. “Our analysis of a national sample of Medicare claims data suggests that untreated OSA costs about $20,000 per year.”
In what they called the largest economic analysis of obstructive sleep apnea (OSA), Wickwire and colleagues examined data from a random 5% sample of Medicare administrative claims from 2006 to 2013. OSA was identified by diagnostic codes and initiation of continuous positive airway pressure or oral appliance treatment. Researchers compared health care utilization costs from inpatient, outpatient, ED and prescription claims for 12 months prior to diagnosis between those with and without OSA.
A total of 287,191 adults aged 65 years and older were included in the final sample. Of those, 10,317 had OSA and 276,874 were controls who did not have sleep-disordered breathing. On average, patients with OSA were younger than controls (72.4 vs. 76 years; P < .001).
Compared with controls, those with OSA had higher mean annual health care costs ($100,383 vs. $53,477), the researchers said.
In the year prior to diagnosis, an analysis adjusted for comorbidities and other characteristics showed that patients with OSA had significantly higher total medical costs than controls ($19,566; 95% CI, 13,239-25,894).
The highest difference in cost between those with OSA and controls was linked to inpatient care ($15,482; 95% CI, 8,521-22,443). The lowest difference in costs between the two groups was associated with prescriptions ($431; 95% CI, 339-522).
According to Wickwire and colleagues, older adults with OSA had a higher prevalence of most comorbid conditions compared with controls, including depression, heart failure, COPD and hypertension.
“Health care providers at all points of care should be attuned to recognizing signs or symptoms of obstructive sleep apnea in their patients, especially their older patients,” explained Wickwire, who is also the director of the insomnia program at the University of Maryland Midtown Medical Center. “Untreated OSA increases risk for heart attack, diabetes, stroke and death, and significantly diminishes quality of life. From a cost of care perspective, early recognition of OSA has great potential to not only improve health outcomes but also to reduce overall cost of care.”
In commentary published alongside the study, Qinglan Ding, MBBS, PhD, an assistant professor in the School of Nursing in the College of Health and Human Sciences at Purdue University and Meir Kryger, MD, a professor of medicine and a clinical professor of nursing at Yale School of Medicine, explained that early diagnosis of OSA is essential.
“Because early diagnosis and treatment of OSA would improve quality of life and functional ability in older adults and should reduce [health care utilization], policymakers and health care leaders should consider ways to improve OSA screening and treatment measures as well as education of clinicians in detection of OSA,” they wrote. – by Erin Michael
Disclosures: Ding and Kryger report no relevant financial disclosures. Wickwire reports serving as a scientific consultant to Day Zz, Eisai, Merck and Purdue, and being an equity shareholder in WellTap. Please see study for all other authors’ relevant financial disclosures.