Association of sleep-disordered breathing with total healthcare costs and utilization in older men: the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study

• Published in: Sleep (New York, N.Y.) Vol. 43; no. 1; p. 1
• Main Authors: Vo, Tien N, Kats, Allyson M, Langsetmo, Lisa, Taylor, Brent C, Schousboe, John T, Redline, Susan, Kunisaki, Ken M, Stone, Katie L, Ensrud, Kristine E
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 13.01.2020
• Subjects: Aged; Apnea; Body Mass Index; Comorbidity; Economic aspects; Editor's Choice; Female; Health care costs; Health Care Costs - statistics & numerical data; Health Status; Hospitalization; Humans; Legal fees; Male; Medical care utilization; Medical economics; Medicare; Medicare - statistics & numerical data; Odds Ratio; Oxygen - analysis; Patient Acceptance of Health Care - statistics & numerical data; Polysomnography; Prevalence; Prospective Studies; Respiration disorders; Sleep apnea; Sleep Apnea Syndromes - epidemiology; Sleep disorders; Sleep Wake Disorders - economics; Sleep Wake Disorders - therapy; Sleep, Health and Disease; United States; United States; Minnesota; older men; sleep-disordered breathing; Medicare; hospitalization; sleep apnea; healthcare costs and utilizations
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsz209

Abstract Study Objectives To determine the associations of sleep-disordered breathing (SDB) with subsequent healthcare costs and utilization including inpatient and post-acute care facility stays among community-dwelling older men. Methods Participants were 1,316 men (mean age 76.1 [SD = 5.7] years) in the Outcomes of Sleep Disorders in Older Men (MrOS sleep) study (from December 2003 to March 2005), who were enrolled in a Medicare Fee-For-Service plan. Primary SDB measures including apnea hypopnea index (AHI) and oxygen desaturation index (ODI) were collected using in-home level 2 polysomnography. Incident healthcare costs and utilization were determined from claims data in the subsequent 3-year period post-MrOS sleep visit. Results Five hundred and twenty-nine (40.2%) men had at least one hospitalization in the 3-year period. Compared with those without sleep apnea (AHI < 5/hour), men with moderate to severe sleep apnea (AHI ≥ 15/hour) had a higher odds of all-cause hospitalization (odds ratio [OR] adjusted for age and site 1.43, 95% confidence interval [CI]: 1.07–1.90). This association was slightly attenuated after further adjustment for traditional prognostic factors including education, body mass index, comorbid medical conditions, and health status (OR = 1.36; 95% CI: 1.01–1.83). Similar associations were observed for ODI. However, measures of SDB were not related to subsequent healthcare costs (total or outpatient) or odds of post-acute skilled nursing facility stay. Conclusions Older men with SDB have an increased risk of hospitalization, not entirely explained by the greater prevalence of comorbid conditions, but not higher subsequent total healthcare costs. These findings indicate a need to evaluate the impact of SDB treatment on subsequent healthcare utilization.