Sleep Disorders Cost US $94.9 Billion Each Year, Study Finds

Sleep disorders may increase risk of health care utilization, with more than $90 billion in US health care costs associated with sleep-related issues each year, according to study findings published in the Journal of Clinical Sleep Medicine.

With prevalence of sleep conditions such as obstructive sleep apnea (OSA) and insomnia growing, study author Phillip Huyett, MD, of Massachusetts Eye and Ear at Harvard Medical School, said in an email exchange with The American Journal of Managed Care^®(AJMC^®) that the lack of sleep medicine physicians has often led many primary care doctors, pulmonologists, psychiatrists, neurologists, and other specialists to initiate the assessment and treatment for these disorders.

“Areas for improvement include training additional sleep medicine doctors and/or including more sleep disorders education in training programs for other specialties,” noted Huyett.

Recently, costs to manage these conditions have also risen significantly. In fact, prior research on Medicare beneficiaries with untreated OSA indicated that in the year prior to receiving their diagnosis, these populations’ health care utilization increased, with $19,566 in mean (SD) total annual costs observed during this time.

Seeking to determine the diagnostic prevalence of sleep disorders overall and how these issues impact cost in the health care system, Huyett and fellow study author Neil Bhattacharyya, MD, MA, FACS, also of Massachusetts Eye and Ear, used International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes to assess these associations in people with and without sleep conditions.

Participants with a sleep disorder diagnosis within the 2018 Medical Expenditure Panel Survey (MEPS) medical conditions file were compared with similar patients without a sleep disorder, according to ICD-10 diagnosis codes, for health care utilization and expenditures (raw n = 22,186 individuals within the MEPS dataset, representing an adult population of 242.5 million).

Of the study cohort, 5.6% were found to have a sleep disorder.

“When this sample estimate is applied to the 2010 US Census for age greater than 18 years, a projected 13.6 [0.6] million individuals in the United States have at least 1 sleep disorder,” noted the authors.

Those with sleep disorders were more likely be non-Hispanic, White, and female, with public insurance and higher Charlson Comorbidity Index scores.

After adjusting for demographics and comorbidities, multivariate analyses found that adults with sleep disorders had increased utilization of mean (SD) office visits (16.3 [0.8] vs 8.7 [0.3]; P < .001), emergency department visits (0.52 [0.03] vs 0.37 [0.0]; P < .001), and prescriptions (39.7 [1.2] vs 21.9 [0.4]; P < .001) compared with those without sleep disorders.

Furthermore, incremental mean health care costs were elevated in those with sleep disorders than without for each utilization measure (P < .001 for all):

• Total healthcare expenses: mean difference, $6975 ($800)
• Total office-based expenditures: mean difference, $1694 ($277)
• Total prescription expenditures: mean difference, $2574 ($364)
• Total self-expenditures for prescriptions: mean difference, $195 ($32)

“While the data can’t answer this directly, it stands to reason that early recognition and early treatment of sleep disorders would reduce the health care costs associated with them in the long term,” said Huyett. “This has been shown in some very specific examples, such as treating OSA with positive airway pressure therapy decreasing the need for revision cardiac ablations in patients with atrial fibrillation.”

Based on the incremental health costs observed for sleep disorders, $94.9 billion in health care costs was estimated to represent the overall US population, which they said is almost certainly an underestimate.

Speaking further on the study findings, Bhattacharyya said in an email exchange with AJMC^® that those with sleep disorders presented with more than double the increase in their Charlson Comorbidity Index scores than those without sleep disorders, indicating that treating these conditions earlier could prevent the development of comorbidities such as congestive heart failure and myocardial infarction.

“Decreases in comorbidities related to sleep disorders would likely have a tremendous cost benefit as well,” said Bhattacharyya.

Reference

Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. Published online May 4, 2021. doi:10.5664/jcsm.9392