Sleep disorders linked to higher health care utilization, expenditures
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Researchers estimated that the health care costs of 13.6 million U.S. adults with a sleep disorder total approximately $94.9 billion annually.
Many patients suffer from at least one sleep disorder, “with wide-ranging degrees of short- and long-term health, workplace and quality of life implications,” Phillip Huyett, MD, a clinical instructor of otolaryngology–head and neck surgery at Harvard Medical School and the director of sleep surgery at Mass Eye and Ear, and Neil Bhattacharyya, MD, MA, FACS, a professor of otolaryngology–head and neck surgery at Harvard Medical School and physician and surgeon at Mass Eye and Ear, wrote in the Journal of Clinical Sleep Medicine.
“One of the knowledge gaps in the sleep literature is an objective assessment of the heath care utilization rates and overall financial burden of sleep disorders in the United States,” they added.
Huyett and Bhattacharyya used the 2018 Medical Expenditure Panel Survey, which is administered by HHS, to compare health care utilization and expenditures between adults with a diagnosed sleep disorder and those who did not have a sleep disorder. The analysis included 22,186 adults (46.9% men; average age, 48 years), representing a population of 242.5 million U.S. adults, according to the researchers.
The researchers found that 5.6% of adults (57.6% women; 79.2% non-Hispanic and white; mean age, 56.8 years) in the study sample had a sleep disorder diagnosis. Based on this, they conservatively estimated that about 13.6 million U.S. adults have at least one sleep disorder. The data showed that a significantly higher proportion of adults with sleep disorders had public insurance (35.2% vs. 21.2%) and higher Charlson Comorbidity Scores (3 or more, 4.1% vs. 14.8%).
Adults with sleep disorders had more office visits (16.3 vs. 8.7, P < .001), ED visits (0.52 vs. 0.37, P <.001) and prescriptions (39.7 vs. 21.9, P < .001) than adults without sleep disorders, according to Huyett and Bhattacharyya. They also had additional incremental health care expenses of $6,975 for total health care expenses, $1,694 for office-based expenditures, $2,574 for total prescription expenditures and $195 for total prescription self-expenditures.
Bhattacharyya told Healio Primary Care that the “estimates are likely conservative, and don’t factor in costs associated with missed work.”
“Greater recognition of sleep disorders and an early referral to a sleep specialist are necessary steps to stop this trend,” Bhattacharyya said. “Next steps for research in this area are to identify diagnostic and treatment algorithms that are cost effective such that they could reduce the incremental cost for sleep disorders, and to identify the comorbidities that increased costs related to sleep disorders.”
Perspective
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Camilo Ruiz, DO
These results are not surprising since we already know that many sleep disorders can exist independently or comorbid with other common diseases such as heart disease, pulmonary problems and psychiatric illness. When we take into account the prevalence of these medical problems among the U.S. population, it is only reasonable to surmise that sleep disorders will account for large expenditures as well.
The clinical implications are that PCPs and specialists both need to be better at recognizing and addressing the unmet health need in regard to sleep disorders in the U.S. Until we offer patients resources, testing and management in a coordinated and cost-effective manner, we will continue to see high expenditures not only with sleep disorders but other comorbid conditions as aforementioned.
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