Utilization of Healthcare Resources in Obstructive Sleep Apnea Syndrome: a 5- Year Follow-Up Study in Men Using CPAP
1Sleep Disorders Center, St. Boniface General Hospital, Section of Respiratory Diseases, and 2Manitoba Centre for Health Policy and Evaluation, University of Manitoba, Winnipeg, Manitoba, Canada
Study Objectives: Patients with untreated obstructive sleep apnea syndrome (OSAS) have higher healthcare utilization than matched controls. However, the long-term impact of continuous positive airway pressure (CPAP) use on healthcare utilization is unknown.
Design: Retrospective observational cohort study.
Subjects: There were 342 eligible men with OSAS and matched controls on whom there were utilization data for 5 years prior to initial OSAS diagnosis and for the 5 years on CPAP treatment of the cases.
Interventions: Patients were treated with CPAP. Results: Patients with OSAS were typical cases (mean±SD): age, 48.2±0.6 years; body mass index, 35.6±0.4 kg/m2; Epworth Sleepiness Scale score, 14.2±0.3; apnea-hypopnea index, 47.1±1.8 events per hour. The number of physician visits were higher by 3.46±0.2 (95% conﬁdence interval [CI]:2.57 to 4.36) in cases in the year before diagnosis, compared with the ﬁfth year before diagnosis, then decreased over the next 5 years by 1.03±0.49 (95% CI: -1.99 to -0.07)(P<.0001). Physician fees, in Canadian dollars, were higher by $148.65±$27.27(95% CI: 95.12 to 202.10) in cases in the year before diagnosis, compared with the ﬁfth year before diagnosis, and then decreased over the next 5 years by $13.92±$27.94(95%CI: -68.68 to 40.83)(P=.0009). Preexisting ischemic heart disease at the time of OSAS diagnosis predicted about a 5-fold increase in healthcare utilization between the second and ﬁfth year of treatment.
Conclusions: Treatment of OSAS reversed the trend of increasing healthcare utilization seen prior to diagnosis. Preexisting ischemic heart disease results in a negative impact on healthcare utilization. CPAP results in a long-term health beneﬁt, as measured by the use of healthcare services.
Keywords: Sleep, apnea, medical economics, epidemiology, healthcare utilization, CPAP compliance
Citation: Albarrak M; Banno K; Sabbagh AA et al. Utilization of healthcare resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP. SLEEP 2005;28(10): 1306-1311.