The relationship between chronically disrupted sleep and healthcare use.
OBJECTIVE
To determine whether chronic sleep deprivation, sleep disruption, sleepiness, insomnia, and OSA are associated with increased healthcare use in a community-based population.


METHODS
Cross-sectional study.


METHODS
6440 Sleep Heart Health Study (SHHS) participants recruited from ongoing cohort studies.


METHODS
N/A.


METHODS
Polysomnography results (Apnea Hypopnea Index (AHI), percent of sleep time with oxyhemoglobin saturation below 90% (CT90), arousal index) as well as data on sleep related symptoms, medication use, and chronic illness. The indirect measure of predicted healthcare utilization was the modified Chronic Disease Score (CDS) calculated from medication data.


RESULTS
After adjustment for age, gender, BMI and study site, subjects in the highest quartiles of AHI, CT90 and Epworth score had CDS that were 6%-9% higher than the lowest quartiles. The adjusted mean CDS for subjects with sleep apnea was similar to that for subjects with hypertension, chronic bronchitis or asthma and 18% greater than the mean CDS for subjects without sleep apnea. Among subjects who did not have significant sleep-disordered breathing, complaints of insomnia, sleepiness, fatigue, and not getting enough sleep were associated with increased CDS.


CONCLUSIONS
This study demonstrated an association between subjective complaints of daytime sleepiness, inadequate sleep time, insomnia as well as objective measures of severity of SDB, and an indirect measure of healthcare utilization in a community-based sample. Though the percent increases in healthcare utilization observed were modest, the prevalence of these factors in the general population is high, and may therefore be associated with a substantial cost burden to the healthcare system.
Kapur
Vishesh K
VK
Department of Medicine, University of Washington, Seattle 98104, USA. vkapur@u.washington.edu
Redline
Susan
S
Nieto
F Javier
FJ
Young
Terry B
TB
Newman
Anne B
AB
Henderson
Jeffrey A
JA
D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017286:Polysomnography; D015995:Prevalence; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology; D012892:Sleep Deprivation / Q000175:diagnosis* / Q000453:epidemiology