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. Methods and Findings 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. Conclusion 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.

[1]  J. Choi,et al.  Genetic and Metabolic Characterization of Insomnia , 2011, PloS one.

[2]  S. Chokroverty,et al.  Daytime consequences of insomnia symptoms among outpatients in primary care practice: EQUINOX international survey. , 2010, Sleep medicine.

[3]  Pooja Budhiraja,et al.  Sleep-disordered breathing and cardiovascular disorders. , 2010, Respiratory care.

[4]  G. Pell,et al.  Changes in brain morphology in patients with obstructive sleep apnoea , 2010, Thorax.

[5]  K. Chien,et al.  Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. , 2010, Sleep.

[6]  S. Tufik,et al.  Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. , 2009, Sleep medicine.

[7]  S. Tufik,et al.  Sao Paulo Epidemiologic Sleep Study: rationale, design, sampling, and procedures. , 2009, Sleep medicine.

[8]  N. Marshall,et al.  Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study? , 2009, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[9]  M. Kryger,et al.  Expenditure on health care in obese women with and without sleep apnea. , 2009, Sleep.

[10]  T. Young,et al.  Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. , 2008, Sleep.

[11]  J. Concato,et al.  Obstructive sleep apnea as a risk factor for stroke and death. , 2005, The New England journal of medicine.

[12]  V. Somers,et al.  Day-night pattern of sudden death in obstructive sleep apnea. , 2005, The New England journal of medicine.

[13]  Jose M Marin,et al.  Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study , 2005, The Lancet.

[14]  Meir Kryger,et al.  Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. , 2004, Sleep.

[15]  C. Iber,et al.  Underdiagnosis of Sleep Apnea Syndrome in U.S. Communities , 2002, Sleep and Breathing.

[16]  S. Redline,et al.  The relationship between chronically disrupted sleep and healthcare use. , 2002, Sleep.

[17]  Maurice M Ohayon,et al.  Epidemiology of insomnia: what we know and what we still need to learn. , 2002, Sleep medicine reviews.

[18]  B M Psaty,et al.  The medical cost of undiagnosed sleep apnea. , 1999, Sleep.

[19]  G. Simon,et al.  Prevalence, burden, and treatment of insomnia in primary care. , 1997, The American journal of psychiatry.

[20]  David Watts.  Apnea , 1997, The Lancet.

[21]  M. Ohayon,et al.  Psychotropic Medication and Insomnia Complaints in Two Epidemiological Studies , 1996, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[22]  C. Bell.  DSM-IV: Diagnostic and Statistical Manual of Mental Disorders , 1994 .

[23]  R. Daroff.  The International Classification of Sleep Disorders , 1991, Neurology.

[24]  M. Roizen.  The Economic Burden of Insomnia: Direct and Indirect Costs for Individuals with Insomnia Syndrome, Insomnia Symptoms, and Good Sleepers , 2010 .

[25]  C. Morin,et al.  The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. , 2009, Sleep.

[26]  C. Shapiro,et al.  The socioeconomic impact of insomnia. An overview. , 1996, PharmacoEconomics.

[27]  H. Wiegand,et al.  Kish, L.: Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s. , 1968 .