Sleep disorders and demand for medical services: evidence from a population-based longitudinal study.
BACKGROUND
The aim of this study was to investigate whether insomnia and obstructive sleep apnea (OSA) were predictors of hospitalizations or emergency department visits during two years following the Sao Paulo Epidemiologic Sleep Study (EPISONO) sample.


RESULTS
All participants (n = 1,101) who underwent a baseline evaluation between July and December 2007 were contacted in December 2009 and asked to fill out a questionnaire about body weight changes, number of hospitalizations and visits to the emergency department. Participants lost during the follow-up period represented 3.2% (n = 35) and 7 subjects had died. Hospitalizations were reported by 116 volunteers (10.5%) and emergency department visits were reported by 136 participants (12.4%). The average body mass index (BMI) did not vary significantly between the first and the second assessment [26.7(95%CI:26.3-27.1) vs. 26.9(26.5-27.4) kg/m2]. After adjusting for confounders, a multiple logistic regression model revealed that female gender [1.4(1.0-1.9)], age ≥ 40 years, insomnia diagnosed according to the DSM-IV criteria [1.6(1.0-2.6)], and apnea-hypopnea index ≥ 15 [1.5(1.0-2.2)] were predictors of hospitalizations and/or demand for emergency services.


CONCLUSIONS
Our study of a probabilistic sample of the Sao Paulo inhabitants shows that over a period of two years, insomnia and OSA were both associated with health impairment. Considering the high prevalence and public health burden of sleep disorders, the consequences of untreated disease for both the individual and society are undeniable and should be addressed.
Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
Rogerio
R
Santos-Silva
Laura Siqueira
LS
Castro
Jose Augusto
JA
Taddei
Sergio
S
Tufik
Lia Rita Azeredo
LR
Bittencourt
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001835:Body Weight; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D011634:Public Health; D012727:Sex Characteristics; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D055815:Young Adult