Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients
Karla Diaz1, Paola Faverio2, Angela Hospenthal1, Marcos I Restrepo3, Megan E Amuan4, Mary Jo V Pugh5
1 Department of Respiratory and Critical Care Medicine, University of Texas, Health Science Center, Monza, Italy
2 Department of Respiratory and Critical Care Medicine, University of Texas, Health Science Center; Department of Health Science, University of Milan-Bicocca, Respiratory Unit, San Gerardo Hospital, Monza, Italy
3 Department of Respiratory and Critical Care Medicine, University of Texas, Health Science Center, Monza, Italy; VERDICT/South Texas Veterans Health Care System, San Antonio, TX, USA
4 Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers VA Hospital, Bedford, MA 01730, England, USA
5 VERDICT/South Texas Veterans Health Care System, San Antonio; Departments of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio; Department of Medicine Bryan, Texas A&M Health Science Center, College of Medicine, TX, USA
7400 Merton Minter Boulevard (11C6), San Antonio, TX 78229, USA
Source of Support: None, Conflict of Interest: Dr Restrepo was partly supported by grant K23HL096054 from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood
Institute, the National Institutes of Health, the Department of Veterans Affairs, or the University of Texas Health Science Center at San Antonio.
Background: Obstructive sleep apnea (OSA) is an important cause of morbidity in the elderly population. Limited data are available regarding the healthcare utilization and predisposing conditions related to OSA in the elderly. Our aim was to evaluate the healthcare utilization and the conditions associated with new and chronic diagnosis of OSA in a large cohort of elderly patients in the Veterans Health Administration (VHA).
Materials and Methods: This retrospective cohort study used inpatient and outpatient VHA data to identify the individuals diagnosed with OSA using ICD-9 codes during the fiscal years 2003-2005. Primary outcomes were emergency department (ED) visits and hospitalizations. Multivariable logistic regression analysis was performed to identify the demographic and clinical characteristics associated with new and chronic diagnosis of OSA.
Results: Of 1,867,876 elderly veterans having 2 years of care, 82,178 (4.4%) were diagnosed with OSA. Individuals with OSA were younger and more likely to have chronic diseases than those without OSA. Individuals with chronic OSA were more likely to have diagnoses of congestive heart failure (CHF), pulmonary circulation disorders, COPD, and obesity and less likely to have diagnoses of hypertension, osteoarthritis, and stroke than individuals with newly diagnosed OSA. The proportion of patients with new OSA diagnosis who required at least one ED visit was higher than the proportion of chronic OSA and no OSA patients (37%, 32%, and 15%, respectively; P-value <0.05). The proportion of new OSA patients who required at least one hospitalization was also higher than the proportion of chronic OSA and no OSA patients (24%, 17%, and 7%, respectively; P-value <0.05).
Conclusion: Patients with OSA had a higher incidence of healthcare utilization compared to patients without OSA. New OSA patients had a higher rate of healthcare utilization in the year of diagnosis compared to chronic patients and patients without OSA. Early OSA recognition may reduce healthcare utilization in these patients.