There is no question about it, sleep disorders increase health care costsCommentary on Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med . 2021;17(10):1981–1986. https://doi.org/10.5664/jcsm.9392
2021; American Academy of Sleep Medicine; Volume: 17; Issue: 10 Linguagem: Inglês
10.5664/jcsm.9606
ISSN1550-9397
Autores Tópico(s)Urban Transport and Accessibility
ResumoFree AccessCommentaryThere is no question about it, sleep disorders increase health care costs Emerson M. Wickwire, PhD, FAASM Emerson M. Wickwire, PhD, FAASM Address correspondence to: Emerson M. Wickwire, PhD, University of Maryland Sleep Disorders Center, 100 N Greene St, 2nd Floor, Baltimore, MD 21201; Tel: (410) 706.4771; Fax: (410) 706.0345; Email: E-mail Address: [email protected] Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland Published Online:October 1, 2021https://doi.org/10.5664/jcsm.9606Cited by:3SectionsEpubPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONIn the modern health economic climate of rising costs on the one hand and limited resources on the other, understanding the economic impact of sleep disorders and their treatments has never been more important. Patients, providers, payers, and policymakers are keenly attuned to economic implications of approaches to chronic disease management. A small body of scientific literature examining sleep health economics has steadily expanded over the past several decades. This research consistently demonstrates that sleep disorders are associated with massive economic burden borne by multiple stakeholders. Although many important questions remain unanswered, sleep disorder treatments are associated with positive economic benefit in terms of reductions in health care utilization and costs, gains in quality-adjusted life-years, and enhanced workplace productivity.1,2In the current issue of the Journal of Clinical Sleep Medicine, Huyett and Bhattacharyya3 report findings from the 2018 Medical Expenditure Panel Survey (MEPS), an annual national interview survey conducted by the Agency for Healthcare Research and Quality within the US Department of Health and Human Services. The MEPS facilitates evaluation of health care costs by linking survey results to an expenditures dataset. Sleep disorders were defined as International Classification of Diseases, Tenth Revision, diagnostic code G47.x. Between-group comparisons (ie, sleep disorder vs no sleep disorder) controlled for demographic characteristics and medical comorbidities via the Charlson comorbidity index. Results indicated that, relative to participants without sleep disorders, individuals with sleep disorders demonstrated increased Health care utilization (HCU) and costs across all points of service (office visits, emergency visits, and prescriptions). The total 2018 direct medical costs of sleep disorders in the United States were $94.9 billion.It is important to understand that direct medical costs represent the smallest component of total costs. Thus, the estimate ($94.9 billion) of Huyett and Bhattacharyya represents a very lower-bound estimate for the total costs of sleep disorders in the United States. First, this study documents only those sleep disorders that are diagnosed and does not reflect the impact of most sleep disorders, which remain undiagnosed and untreated. Second, the vast majority of sleep disorder costs are indirect costs such as diminished quality of life (borne by patients), reduced workplace productivity and increased risk for workplace accidents and errors (borne by employers), and increased accident risk (borne by society).4 Indeed, many sleep medicine specialists are surprised to learn that the brunt of sleep-related costs are borne by employers, with only a small fraction being associated with direct medical care.Overall, this study was well conducted and expands the evidence base regarding the economic value of sleep medicine. The operational definitions were clear, and the design was straightforward and appropriate to address the research questions of interest. One notable strength is the use of the national MEPS, which had not previously been used to study sleep disorders, and adds an important contribution of patient self-expenditures for sleep disorders. Broadly speaking, results are consistent with previous studies over the past 3 decades that demonstrate that sleep disorders are associated with increased direct medical costs. Another notable strength is the presentation of results into easy-to-understand, quantified units: relative to no sleep disorders, sleep disorders were associated with 8 additional office visits, 18 additional prescriptions, and nearly $7,000 greater total costs per year. It is incumbent on sleep medicine professionals to define and demonstrate the value of sleep using terms that matter to the constituents whom we serve.5 The study by Huyett and Bhattacharyya succeeds notably in this regard.Among the most interesting findings of this study is that individuals with sleep disorders were more likely to receive public health insurance and also more likely to be White. A growing body of research demonstrates that individuals of lower socioeconomic status and members of racial minority groups are at increased risk for insufficient sleep as well as sleep disorders such as obstructive sleep apnea.6,7 Thus, the finding that individuals with sleep disorders were more likely to be White is perplexing. One possible explanation is the operational definition of sleep disorders, which required participants to interact with the health care system in order to be diagnosed or treated. Another possible explanation is the broad definition of sleep disorders used in the study, which included less-studied sleep disorders with unknown racial prevalence. Regardless, this interesting finding raises important questions about race and sleep and warrants further attention.Several missed opportunities also warrant mention. First, the authors were unable to examine specific sleep disorders, only sleep disorders "yes/no." Second, although the authors controlled for medical and psychiatric comorbidities using the Charlson Comorbidity Index (CCI), this measure fails to capture the nuance of certain medical comorbidities (eg, heart failure) known to be associated with sleep disorders. Third, the MEPS is unable to provide insight into the indirect costs of sleep disorders, which represent the vast majority of sleep-related expenditures. Fourth, the study was unable to examine the economic impact of sleep disorder treatments, limiting its impact.In summary, the study by Huyett and Bhattacharyya expands our knowledge base regarding costs of sleep disorders by including the MEPS, a previously unexamined data source that enabled examination of patient self-expenditures. Future research should examine indirect costs of sleep disorders, particularly from the employer perspective, as well as the economic impact of treating sleep disorders using various technologies and delivery formats. Such research is currently underway in our group and others.DISCLOSURE STATEMENTDr. Wickwire's institution has received research funding from the American Academy of Sleep Medicine Foundation, US Department of Defense, Merck, and ResMed. Dr. Wickwire has served as a scientific consultant for DayZz, Eisai, Merck, and Purdue and is an equity shareholder in WellTap.REFERENCES1. Wickwire EM, Shaya FT, Scharf SM. Health economics of insomnia treatments: the return on investment for a good night's sleep. Sleep Med Rev. 2016;30:72–82. CrossrefGoogle Scholar2. Wickwire EM, Albrecht JS, Towe MM, et al.. The impact of treatments for OSA on monetized health economic outcomes: a systematic review. Chest. 2019;155(5):947–961. CrossrefGoogle Scholar3. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981–1986. LinkGoogle Scholar4. Wickwire EM. Value-based sleep and breathing: health economic aspects of obstructive sleep apnea. Fac Rev. 2021;10:40. CrossrefGoogle Scholar5. Wickwire EM, Verma T. Value and payment in sleep medicine. J Clin Sleep Med. 2018;14(5):881–884. LinkGoogle Scholar6. Grandner MA. Sleep, health, and society. Sleep Med Clin. 2020;15(2):319–340. CrossrefGoogle Scholar7. Jackson CL, Redline S, Emmons KM. Sleep as a potential fundamental contributor to disparities in cardiovascular health. Annu Rev Public Health. 2015;36(1):417–440. CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byEconomic burden of comorbid insomnia in 5 common medical disease subgroupsWickwire E, Juday T, Kelkar M, Heo J, Margiotta C and Frech F Journal of Clinical Sleep Medicine, Vol. 19, No. 7, (1293-1302), Online publication date: 1-Jul-2023. Brazilian Thoracic Association Consensus on Sleep-disordered BreathingLuiz de Menezes Duarte1 R, Maria Guimarães Pereira Togeiro2,3, S, de Oliveira Palombini3 L, Paula Galhardo Rizzatti4 F, Chaves Fagondes5 S, José Magalhães-da-Silveira6a F, Montenegro Cabral7 M, Rodrigues Genta8 P, Lorenzi-Filho8 G, Cristina Silva Clímaco9 D, Ferreira Drager10 L, Martins Codeço11 V, Alberto de Assis Viegas12 C and Fouad Rabahi13 M Jornal Brasileiro de Pneumologia, 10.36416/1806-3756/e20220106, (e20220106) The association between sleep disorders, employment, and income among adults in the United StatesHuyett P and Bhattacharyya N Journal of Clinical Sleep Medicine, Vol. 18, No. 8, (1967-1972), Online publication date: 1-Aug-2022. Volume 17 • Issue 10 • October 1, 2021ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationAugust 5, 2021Submitted in final revised formAugust 5, 2021Accepted for publicationAugust 5, 2021Published onlineOctober 1, 2021 Information© 2021 American Academy of Sleep MedicinePDF download
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