title: Excessive daytime sleepiness is associated with increased health care utilization among patients referred for assessment of OSA.
abstract: OBJECTIVE
  Excessive daytime sleepiness is an important public health concern associated with increased morbidity and mortality. However, in the absence of sleep diagnostic testing, it is difficult to separate the independent effects of sleepiness from those of intrinsic sleep disorders such as obstructive sleep apnea (OSA). The objective of this study was to determine if excessive daytime sleepiness was independently associated with increased health care utilization among patients referred for assessment of OSA.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  2149 adults referred for sleep diagnostic testing between July 2005 and August 2007.
  
  
  METHODS
  N/A.
  
  
  METHODS
  Subjective daytime sleepiness was defined as an Epworth Sleepiness Scale score ≥10. Health care use (outpatient physician visits, all-cause hospitalizations, and emergency department visits) was determined from Alberta Health and Wellness administrative databases for the 18-month period preceding their sleep study. Rates of health resource use were analyzed using negative binomial regression, with predictors of increased health care use determined using logistic regression.
  
  
  RESULTS
  excessive daytime sleepiness was associated with an increased rate of outpatient physician visits after adjustment for demographic variables, sleep medication use, hypertension, diabetes, depression, and OSA severity (rate ratio [RR]: 1.09 (95% confidence interval [CI]: 1.01, 1.18, P = 0.02) compared to non-sleepy subjects. There was an interaction between severe OSA and sleepiness (RR: 1.22 [95% CI: 1.06, 1.41]), although OSA was not an independent predictor of health care use. Also, sleepy patients with treated depression had a lower likelihood of outpatient visits (RR: 0.95 [95% CI: 0.86, 1.05]). Finally, sleepiness was an independent predictor of increased health care use for outpatient physician visits (odds ratio [OR]: 1.25 [95% CI: 1.00, 1.57; P = 0.048]) and all-cause hospitalizations (OR: 3.94 [95% CI: 1.03, 15.04; P = 0.046]).
  
  
  CONCLUSIONS
  Excessive daytime sleepiness is associated with increased health care utilization among patients referred for assessment of OSA. Further investigation is required to determine whether the findings are related to direct effects of sleepiness, or in part, to interactions with other comorbidity such as OSA.
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Ronksley
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Heitman
authors.forename: W Ward
authors.initials: WW
authors.lastname: Flemons
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Peter
authors.initials: P
authors.lastname: Faris
authors.forename: Willis H
authors.initials: WH
authors.lastname: Tsai
mesh_terms: D016009:Chi-Square Distribution; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D017286:Polysomnography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D018709:Statistics, Nonparametric