FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2995607353> ?p ?o ?g. }

• W2995607353 endingPage "6" @default.
• W2995607353 startingPage "5" @default.
• W2995607353 abstract "Free AccessCommentaryGreater health care utilization and cost associated with untreated sleep apnea Qinglan Ding, MBBS, PhD, Meir Kryger, MD Qinglan Ding, MBBS, PhD College of Health and Human Sciences, Purdue University, West Lafayette, Indiana; Search for more papers by this author , Meir Kryger, MD *Address correspondence to: Meir Kryger, Division of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Medical Center, Yale School of Medicine, 20 York Street New Haven, CT, 06510; Email: E-mail Address: [email protected] Division of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Medical Center, Yale School of Medicine, New Haven, Connecticut Search for more papers by this author Published Online:January 15, 2020https://doi.org/10.5664/jcsm.8152Cited by:3SectionsAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTCITATIONDing Q, Kryger M. Greater health care utilization and cost associated with untreated sleep apnea. J Clin Sleep Med. 2020;16(1):5–6.INTRODUCTIONWickwire and colleagues, using administrative data have shown the economic impact of obstructive sleep apnea (OSA) in older people.1 Prior research has shown OSA confers an increased risk for cardiovascular and metabolic disease,2–5 stroke,6 psychiatric conditions7 and death.8 A growing literature has also documented greater economic burden for individuals with untreated OSA compared with matched controls without OSA.9–13 Several explanations have been offered. These differences may be associated with higher rates of comorbidities such as cardiovascular disease and obesity,9,11 increased health care resources used for psychotherapy or psychoactive drugs,12 or a greater likelihood that patients with OSA report poor self-perceived health status.13 To date, much of the literature on the economic impact of OSA has been in predominantly middle-aged men and with relatively small sample sizes; only few prior trials assessed health care utilization (HCU) in older adults using population-based data.11Greater understanding of the economic importance of OSA among older adults is needed because OSA is highly prevalent in adults aged older than 65 years.14,15 Older adults with OSA also are more likely to have multiple chronic diseases than those without OSA, which likely increase the contact of patients with OSA with the health care system.10 Furthermore, despite evidence suggesting that untreated OSA is associated with early mortality,16 up to 80% of individuals with OSA have gone undiagnosed despite adequate access to health care.17To build upon prior investigations that have found OSA to be associated with substantial economic burden, Wickwire et al has presented a rigorous analysis of the impact of untreated OSA on HCU among older adults in this issue of the Journal of Clinical Sleep Medicine.1 Using data from a random sample of Medicare administrative claims for years 2006–2013, the authors demonstrated that untreated OSA in older adults was associated with increased HCU and higher costs across all points of service.1 This study is notable for several reasons. First, it is the largest analysis to date of the economic impact of OSA, and its sophisticated analyses confirms prior research showing that untreated OSA is associated with increased HCU and costs. Second, while the analyses cannot determine causal association between OSA and elevated HCU or costs, they prompt discussion of underlying mechanisms and highlight the need to focus clinical attention on older adults and early diagnosis and initiation of OSA treatment. Finally, the authors demonstrate the importance of simultaneously considering the confounding effect of comorbid conditions and the modification effect by sex in analyses. In this commentary, we examine and expand upon the above three points.First, while the authors confirm the known economic importance of OSA, their work enhances prior analyses and adds a population health perspective to the literature. Wickwire et al identified patients with OSA not only by diagnosis but also by the initiation of treatment.1 In order to ensure comprehensive assessment of HCU and costs from the payer perspective, the authors successfully captured a broad range of health expenditures spanning 8 years, providing sufficient statistical power to evaluate the association between OSA and HCU and cost.1 The study results can be generalized to the majority of older adults in the US because of random sampling from Medicare administrative claims. Additionally, the authors conducted a series of sensitivity analyses to evaluate robustness of study results.Despite these strengths, the authors noted several limitations, including bias results concerns due to possible inclusion of undiagnosed cases in the control group; lack of OSA-related characteristics such as severity and body mass index; the Centers for Medicare & Medicaid Services approved home sleep apnea testing during the period being studied; and that the authors are unable to assess HCU and costs from the patient, employer or societal perspectives.1 Another unmentioned limitation was lack of data on socioeconomic status and patient-centered measures such as household income and self-perceived health status. Previous research showed higher proportion of OSA cases in those with lower socioeconomic status.18 Access to health care for older adults with OSA may also be influenced by socioeconomic status.Furthermore, consistent findings of increased HCU among individuals with untreated OSA prompt several important questions regarding contributing factors. This work confirms that patients with OSA are heavy users of health care 5 to 10 years before diagnosis of OSA.9 Why does OSA often go undiagnosed and untreated? Previously described factors in the literature to explain the causes of undiagnosed and untreated OSA included little or no sleep disorders training among clinicians,9 lack of availability and access to sleep labs and sleep specialists,19 and a commonly held belief that OSA may not pose a serious health risk.20 Because early diagnosis and treatment of OSA would improve quality of life and functional ability in older adults and should reduce HCU,9 policymakers and health care leaders should consider ways to improve OSA screening and treatment measures as well as education of clinicians in detection of OSA.Finally, this study provides an opportunity to examine the role of sex in OSA research. Research has shown multiple differences between men and women with OSA, with apnea severity and self-perceived health status being lower, and HCU, age and body mass index higher in women than men.21,22 OSA is more common in men than women and is often underdiagnosed in adult women.22 Wickwire et al acknowledge sex differences in the number of OSA older adults in the study and accounted for sex differences by adding an interaction term in each model. No significant modification effect by sex was found. It is hoped that the study findings will stimulate further research on the role of sex between OSA and HCU in older adults, as well as understanding mechanisms underlying sex disparities in OSA, if significant disparities exist.We commend the authors for the rigorous and comprehensive way in which they tackled the dearth of research on the economic impact of OSA in older adults. Their study design and analytic approach serves as a reminder of the significant population-level economic burden associated with older men and women with OSA. We need to do a better job in early diagnosis and treatment of OSA, which may decrease morbidity and reduce HCU and cost in older adults.DISCLOSURE STATEMENTAll authors have seen and approved this manuscript. The authors report no conflicts of interest.REFERENCES1. Wickwire EM, Tom SE, Vadlamani A, et al.. Older adult US Medicare beneficiaries with untreated obstructive sleep apnea are heavier users of health care than matched control patients. J Clin Sleep Med. 2020;16(1):81–89. https://doi.org/10.5664/jcsm.8128 LinkGoogle Scholar2. Konecny T, Kuniyoshi FH, Orban M, et al.. Under-diagnosis of sleep apnea in patients after acute myocardial infarction. J Am Coll Cardiol. 2010;56(9):742–743. https://doi.org/10.1016/j.jacc.2010.04.032 CrossrefGoogle Scholar3. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–1384. https://doi.org/10.1056/NEJM200005113421901 CrossrefGoogle Scholar4. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521–530. https://doi.org/10.1093/aje/kwh261 CrossrefGoogle Scholar5. Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK. Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med. 2009;122(12):1122–1127. https://doi.org/10.1016/j.amjmed.2009.04.026 CrossrefGoogle Scholar6. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–2041. https://doi.org/10.1056/NEJMoa043104 CrossrefGoogle Scholar7. Peppard PE, Szklo-Coxe M, Hla KM, Young T. Longitudinal association of sleep-related breathing disorder and depression. Arch Intern Med. 2006;166(16):1709–1715. https://doi.org/10.1001/archinte.166.16.1709 CrossrefGoogle Scholar8. Wang H, Parker JD, Newton GE, et al.. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol. 2007;49(15):1625–1631. https://doi.org/10.1016/j.jacc.2006.12.046 CrossrefGoogle Scholar9. Ronald J, Delaive K, Roos L, Manfreda J, Bahammam A, Kryger MH. Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients. Sleep. 1999;22(2):225–229. https://doi.org/10.1093/sleep/22.2.225 CrossrefGoogle Scholar10. Diaz K, Faverio P, Hospenthal A, Restrepo MI, Amuan ME, Pugh MJ. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients. Ann Thorac Med. 2014;9(2):92–98. https://doi.org/10.4103/1817-1737.128854 CrossrefGoogle Scholar11. Kao LT, Lee HC, Lin HC, Tsai MC, Chung SD. Healthcare service utilization by patients with obstructive sleep apnea: a population-based study. PLoS One. 2015;10(9):e0137459. https://doi.org/10.1371/journal.pone.0137459 CrossrefGoogle Scholar12. Banno K, Ramsey C, Walld R, Kryger MH. Expenditure on health care in obese women with and without sleep apnea. Sleep. 2009;32(2):247–252. https://doi.org/10.1093/sleep/32.2.247 CrossrefGoogle Scholar13. Tarasiuk A, Greenberg-Dotan S, Simon-Tuval T, Oksenberg A, Reuveni H. The effect of obstructive sleep apnea on morbidity and health care utilization of middle-aged and older adults. J Am Geriatr Soc. 2008;56(2):247–254. https://doi.org/10.1111/j.1532-5415.2007.01544.x CrossrefGoogle Scholar14. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14(6):486–495. https://doi.org/10.1093/sleep/14.6.486 CrossrefGoogle Scholar15. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med. 1998;157(1):144–148. https://doi.org/10.1164/ajrccm.157.1.9706079 CrossrefGoogle Scholar16. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–1239. https://doi.org/10.1164/rccm.2109080 CrossrefGoogle Scholar17. Lee W, Nagubadi S, Kryger MH, Mokhlesi B. Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Rev Respir Med. 2008;2(3):349–364. https://doi.org/10.1586/17476348.2.3.349 CrossrefGoogle Scholar18. Guglielmi O, Lanteri P, Garbarino S. Association between socioeconomic status, belonging to an ethnic minority and obstructive sleep apnea: a systematic review of the literature. Sleep Med. 2019;57100–106. https://doi.org/10.1016/j.sleep.2019.01.042 CrossrefGoogle Scholar19. Leger D, Bayon V, Laaban JP, Philip P. Impact of sleep apnea on economics. Sleep Med Rev. 2012;16(5):455–462. https://doi.org/10.1016/j.smrv.2011.10.001 CrossrefGoogle Scholar20. Tarasiuk A, Greenberg-Dotan S, Brin YS, Simon T, Tal A, Reuveni H. Determinants affecting health-care utilization in obstructive sleep apnea syndrome patients. Chest. 2005;128(3):1310–1314. https://doi.org/10.1378/chest.128.3.1310 CrossrefGoogle Scholar21. Otake K, Delaive K, Walld R, Manfreda J, Kryger MH. Cardiovascular medication use in patients with undiagnosed obstructive sleep apnoea. Thorax. 2002;57(5):417–422. https://doi.org/10.1136/thorax.57.5.417 CrossrefGoogle Scholar22. Greenberg-Dotan S, Reuveni H, Simon-Tuval T, Oksenberg A, Tarasiuk A. Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients. Sleep. 2007;30(9):1173–1180. https://doi.org/10.1093/sleep/30.9.1173 CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in AdultsD’Rozario A, Galgut Y, Crawford M and Bartlett D Sleep Medicine Clinics, 10.1016/j.jsmc.2020.10.006, , Online publication date: 1-Jan-2021. Thanaviratananich S The economic impact of sleep deprivation Reference Module in Neuroscience and Biobehavioral Psychology, 10.1016/B978-0-12-822963-7.00069-4, . A review of therapies for the overlap syndrome of obstructive sleep apnea and chronic obstructive pulmonary diseaseSuri T and Suri J FASEB BioAdvances, 10.1096/fba.2021-00024, Vol. 3, No. 9, (683-693), Online publication date: 1-Sep-2021. Volume 16 • Issue 1 • January 15, 2020ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationNovember 14, 2019Submitted in final revised formNovember 14, 2019Accepted for publicationNovember 14, 2019Published onlineJanuary 15, 2020 Information© 2020 American Academy of Sleep Medicine" @default.
• W2995607353 created "2019-12-26" @default.
• W2995607353 creator A5010271477 @default.
• W2995607353 creator A5078975113 @default.
• W2995607353 date "2020-01-15" @default.
• W2995607353 modified "2023-10-02" @default.
• W2995607353 title "Greater health care utilization and cost associated with untreated sleep apnea" @default.
• W2995607353 cites W1211885493 @default.
• W2995607353 cites W130795321 @default.
• W2995607353 cites W1516787272 @default.
• W2995607353 cites W1524116808 @default.
• W2995607353 cites W1994066150 @default.
• W2995607353 cites W2009890892 @default.
• W2995607353 cites W2028025368 @default.
• W2995607353 cites W2068328326 @default.
• W2995607353 cites W2090299097 @default.
• W2995607353 cites W2103939721 @default.
• W2995607353 cites W2105727933 @default.
• W2995607353 cites W2107216158 @default.
• W2995607353 cites W2111071590 @default.
• W2995607353 cites W2115476973 @default.
• W2995607353 cites W2124052130 @default.
• W2995607353 cites W2136619654 @default.
• W2995607353 cites W2148345618 @default.
• W2995607353 cites W2151108490 @default.
• W2995607353 cites W2335449614 @default.
• W2995607353 cites W24002251 @default.
• W2995607353 cites W2913317889 @default.
• W2995607353 cites W2992057888 @default.
• W2995607353 doi "https://doi.org/10.5664/jcsm.8152" @default.
• W2995607353 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7053011" @default.
• W2995607353 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/31957652" @default.
• W2995607353 hasPublicationYear "2020" @default.
• W2995607353 type Work @default.
• W2995607353 sameAs 2995607353 @default.
• W2995607353 citedByCount "10" @default.
• W2995607353 countsByYear W29956073532021 @default.
• W2995607353 countsByYear W29956073532022 @default.
• W2995607353 countsByYear W29956073532023 @default.
• W2995607353 crossrefType "journal-article" @default.
• W2995607353 hasAuthorship W2995607353A5010271477 @default.
• W2995607353 hasAuthorship W2995607353A5078975113 @default.
• W2995607353 hasBestOaLocation W29956073531 @default.
• W2995607353 hasConcept C111919701 @default.
• W2995607353 hasConcept C126322002 @default.
• W2995607353 hasConcept C160735492 @default.
• W2995607353 hasConcept C162324750 @default.
• W2995607353 hasConcept C177713679 @default.
• W2995607353 hasConcept C187212893 @default.
• W2995607353 hasConcept C194828623 @default.
• W2995607353 hasConcept C2775841894 @default.
• W2995607353 hasConcept C2776006263 @default.
• W2995607353 hasConcept C2777935920 @default.
• W2995607353 hasConcept C2778205975 @default.
• W2995607353 hasConcept C2781326671 @default.
• W2995607353 hasConcept C2911073662 @default.
• W2995607353 hasConcept C41008148 @default.
• W2995607353 hasConcept C50522688 @default.
• W2995607353 hasConcept C71924100 @default.
• W2995607353 hasConceptScore W2995607353C111919701 @default.
• W2995607353 hasConceptScore W2995607353C126322002 @default.
• W2995607353 hasConceptScore W2995607353C160735492 @default.
• W2995607353 hasConceptScore W2995607353C162324750 @default.
• W2995607353 hasConceptScore W2995607353C177713679 @default.
• W2995607353 hasConceptScore W2995607353C187212893 @default.
• W2995607353 hasConceptScore W2995607353C194828623 @default.
• W2995607353 hasConceptScore W2995607353C2775841894 @default.
• W2995607353 hasConceptScore W2995607353C2776006263 @default.
• W2995607353 hasConceptScore W2995607353C2777935920 @default.
• W2995607353 hasConceptScore W2995607353C2778205975 @default.
• W2995607353 hasConceptScore W2995607353C2781326671 @default.
• W2995607353 hasConceptScore W2995607353C2911073662 @default.
• W2995607353 hasConceptScore W2995607353C41008148 @default.
• W2995607353 hasConceptScore W2995607353C50522688 @default.
• W2995607353 hasConceptScore W2995607353C71924100 @default.
• W2995607353 hasIssue "1" @default.
• W2995607353 hasLocation W29956073531 @default.
• W2995607353 hasLocation W29956073532 @default.
• W2995607353 hasLocation W29956073533 @default.
• W2995607353 hasLocation W29956073534 @default.
• W2995607353 hasOpenAccess W2995607353 @default.
• W2995607353 hasPrimaryLocation W29956073531 @default.
• W2995607353 hasRelatedWork W1969950653 @default.
• W2995607353 hasRelatedWork W2001192257 @default.
• W2995607353 hasRelatedWork W2016370421 @default.
• W2995607353 hasRelatedWork W2113982368 @default.
• W2995607353 hasRelatedWork W2141150043 @default.
• W2995607353 hasRelatedWork W2167944550 @default.
• W2995607353 hasRelatedWork W2319103027 @default.
• W2995607353 hasRelatedWork W3092127899 @default.
• W2995607353 hasRelatedWork W4214927823 @default.
• W2995607353 hasRelatedWork W4290169068 @default.
• W2995607353 hasVolume "16" @default.
• W2995607353 isParatext "false" @default.
• W2995607353 isRetracted "false" @default.
• W2995607353 magId "2995607353" @default.
• W2995607353 workType "article" @default.