Skip to main content
SpringerLink
Log in

Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to examine the incremental economic burden of sleep apnea syndrome (SAS) among individuals with concomitant asthma, chronic obstructive pulmonary disease (COPD), or both (i.e., asthma/COPD).

Methods

Maryland Medicaid claims data were used to identify beneficiaries with asthma (n = 3,072), COPD (n = 3,455), or both (n = 2,604). We compared patient’s baseline characteristics by SAS and stratified the analyses by disease cohort to examine the effect of SAS on medical utilization and cost.

Results

SAS was more prevalent among beneficiaries with asthma/COPD (6.72%) than beneficiaries with COPD alone (2.87%) or asthma alone (2.15%). Asthma/COPD and COPD beneficiaries with SAS had more medical service claims (p < 0.001) and higher medical cost than beneficiaries without SAS: $5,773 and $4,155 in excess costs among asthma/COPD (p = 0.037) and COPD patients (p = 0.035), respectively. Medical utilization and cost did not differ by SAS in asthma patients (p = 0.567).

Conclusions

SAS may add additional economic burden on beneficiaries who already have COPD or asthma/COPD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Erman MK (2006) Selected sleep disorders: restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy. Psychiatr Clin North Am 4:947–967. doi:10.1016/j.psc.2006.09.007 abstract viii–ix

    Article  Google Scholar 

  2. National Heart Lung and Blood Institute Diseases and conditions index, sleep disorders, sleep apnea. Available via http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html. Accessed 20 October 2008

  3. Boehlecke BA (2000) Epidemiology and pathogenesis of sleep-disordered breathing. Curr Opin Pulm Med 6:471–478. doi:10.1097/00063198-200011000-00002

    Article  CAS  PubMed  Google Scholar 

  4. Parati G, Lombardi C, Narkiewicz K (2007) Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk. Am J Physiol Regul Integr Comp Physiol 4:R1671–R1683. doi:10.1152/ajpregu.00400.2007

    Google Scholar 

  5. Tarasiuk A, Greenberg-Dotan S, Simon-Tuval T et al (2007) Elevated morbidity and health care use in children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1:55–61

    Google Scholar 

  6. Reuveni H, Greenberg-Dotan S, Simon-Tuval T et al (2008) Elevated healthcare utilisation in young adult males with obstructive sleep apnoea. Eur Respir J 2:273–279. doi:10.1183/09031936.00097907

    Article  Google Scholar 

  7. Tarasiuk A, Greenberg-Dotan S, Simon-Tuval T et al (2008) The effect of obstructive sleep apnea on morbidity and health care utilization of middle-aged and older adults. J Am Geriatr Soc 2:247–254. doi:10.1111/j.1532-5415.2007.01544.x

    Article  Google Scholar 

  8. Kapur V, Blough DK, Sandblom RE et al (1999) The medical cost of undiagnosed sleep apnea. Sleep 6:749–755

    Google Scholar 

  9. Alkhalil M, Schulman ES, Getsy J (2008) Obstructive sleep apnea syndrome and asthma: the role of continuous positive airway pressure treatment. Ann Allergy Asthma Immunol 4:350–357

    Article  Google Scholar 

  10. Krachman S, Minai OA, Scharf SM (2008) Sleep abnormalities and treatment in emphysema. Proc Am Thorac Soc 4:536–542. doi:10.1513/pats.200708-134ET

    Article  Google Scholar 

  11. ten Brinke A, Sterk PJ, Masclee AA et al (2005) Risk factors of frequent exacerbations in difficult-to-treat asthma. Eur Respir J 5:812–818. doi:10.1183/09031936.05.00037905

    Article  Google Scholar 

  12. Karachaliou F, Kostikas K, Pastaka C et al (2007) Prevalence of sleep-related symptoms in a primary care population—their relation to asthma and copd. Prim Care Respir J 4:222–228

    Article  Google Scholar 

  13. Shaya FT, Dongyi D, Akazawa MO et al (2008) Burden of concomitant asthma and copd in a medicaid population. Chest 1:14–19. doi:10.1378/chest.07-2317

    Article  Google Scholar 

  14. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 5:373–383. doi:10.1016/0021-9681(87) 90171-8

    Article  Google Scholar 

  15. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with icd-9-cm administrative databases. J Clin Epidemiol 6:613–619. doi:10.1016/0895-4356(92) 90133-8

    Article  Google Scholar 

  16. See CQ, Mensah E, Olopade CO (2006) Obesity, ethnicity, and sleep-disordered breathing: medical and health policy implications. Clin Chest Med 3:521–533. doi:10.1016/j.ccm.2006.04.008 viii

    Article  Google Scholar 

  17. Manning WG, Basu A, Mullahy J (2005) Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ 3:465–488. doi:10.1016/j.jhealeco.2004.09.011

    Article  Google Scholar 

  18. Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2:136–143. doi:10.1513/pats.200709-155MG

    Article  Google Scholar 

  19. Rosen CL (2004) Obstructive sleep apnea syndrome in children: controversies in diagnosis and treatment. Pediatr Clin North Am 1:153–167. doi:10.1016/S0031-3955(03)00183-4 vii

    Article  Google Scholar 

  20. Ramagopal M, Scharf SM, Roberts DW et al (2008) Obstructive sleep apnea and history of asthma in snoring children. Sleep Breath 4:381–392. doi:10.1007/s11325-008-0174-x

    Article  Google Scholar 

  21. Kutty K (2004) Sleep and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2:104–112. doi:10.1097/00063198-200403000-00004

    Article  Google Scholar 

  22. Weitzenblum E, Chaouat A, Kessler R et al (2008) Overlap syndrome: obstructive sleep apnea in patients with chronic obstructive pulmonary disease. Proc Am Thorac Soc 2:237–241. doi:10.1513/pats.200706-077MG

    Article  Google Scholar 

  23. Blanchette CM, Gutierrez B, Ory C et al (2008) Economic burden in direct costs of concomitant chronic obstructive pulmonary disease and asthma in a medicare advantage population. J Manag Care Pharm 2:176–185

    Google Scholar 

  24. Welch KC, Scharf SM (2007) Construct validity for the health utilities index in a sleep center. Sleep Breath 4:295–303. doi:10.1007/s11325-007-0111-4

    Article  Google Scholar 

  25. Fanfulla F, Cascone L, Taurino AE (2004) Sleep disordered breathing in patients with chronic obstructive pulmonary disease. Minerva Med 4:307–321

    Google Scholar 

  26. Somers VK, White DP, Amin R et al (2008) Sleep apnea and cardiovascular disease: an American heart association/American college of cardiology foundation scientific statement from the American heart association council for high blood pressure research professional education committee, council on clinical cardiology, stroke council, and council on cardiovascular nursing. J Am Coll Cardiol 8:686–717. doi:10.1016/j.jacc.2008.05.002

    Article  Google Scholar 

  27. Foster E (2008) Wake up! Uncovering sleep apnea misconceptions. Nurse Pract 6:22–28

    Google Scholar 

  28. Gurubhagavatula I, Nkwuo JE, Maislin G et al (2008) Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea. Accid Anal Prev 1:104–115. doi:10.1016/j.aap. 2007.04.011

    Article  Google Scholar 

  29. Deutsch PA, Simmons MS, Wallace JM (2006) Cost-effectiveness of split-night polysomnography and home studies in the evaluation of obstructive sleep apnea syndrome. J Clin Sleep Med 2:145–153

    PubMed  Google Scholar 

  30. Mapel DW, Frost FJ, Hurley JS et al (2006) An algorithm for the identification of undiagnosed copd cases using administrative claims data. J Manag Care Pharm 6:457–465

    Google Scholar 

Download references

Conflicts of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA

    Fadia T. Shaya, Pei-Jung Lin & Mohammad H. Aljawadi

  2. Division of Pulmonary and Critical Care Medicine, University of Maryland Sleep Disorders Center, Baltimore, MD, USA

    Steven M. Scharf

Authors
  1. Fadia T. Shaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pei-Jung Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad H. Aljawadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven M. Scharf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fadia T. Shaya.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shaya, F.T., Lin, PJ., Aljawadi, M.H. et al. Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome. Sleep Breath 13, 317–323 (2009). https://doi.org/10.1007/s11325-009-0266-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-009-0266-2

Keywords

Search

Navigation