Chest
Volume 121, Issue 1, January 2002, Pages 164-172
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Clinical Investigations
Sleep and Breathing
What Are Obstructive Sleep Apnea Patients Being Treated for Prior to This Diagnosis?

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Background

Patients with obstructive sleep apnea syndrome (OSAS) use health-care resources at higher rates than control subjects for years prior to diagnosis. Although obesity and certain cardiovascular disorders are more common in OSAS patients, the precise cause of increased health-care utilization is unclear.

Objectives

To examine the causes of increased utilization, and what patients with OSAS were being treated for prior to this diagnosis.

Methods

We compared the records of 773 patients with OSAS to those of age-, gender-, geographic-, and physician-matched control subjects from the general population.

Results

We found that sleep apnea patients used 23 to 50% more resources (defined by physician fees, physician visits, and hospital nights) in the 5 years prior to diagnosis than did control subjects. We examined the diagnoses made and found that apnea patients are at higher risk for hypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.0 to 3.3), congestive heart failure (OR, 3.9; 95% CI, 1.7 to 8.9), cardiac arrhythmias (OR, 2.2; 95% CI, 1.2 to 4.0), cardiovascular disease (OR, 2.6; 95% CI, 2.0 to 3.3), chronic obstructive airways disease (OR, 1.6; 95% CI, 1.2 to 2.0), and depression (OR, 1.4; 95% CI, 1.0 to 1.9). To control for the confounding effects of obesity and to determine the independent effects of body mass index (BMI), gender, age, degree of hypoxemia, apnea-hypopnea index, and sleepiness in the 773 patients, we performed a logistic regression analysis with the dependent variable being diagnosis, and a linear regression analysis with the dependent variable being measures of health-care utilization. Age and BMI were significant independent predictors of most cardiovascular diagnoses and arthropathy. Male gender predicted ischemic heart disease (OR, 2.98; 95% CI, 1.36 to 6.54), and female gender was predictive of chronic obstructive airways disease (OR, 2.63; 95% CI, 1.85 to 3.72) and depression (OR, 2.24; 95% CI, 1.45 to 3.44). The best model predicting health-care utilization measures was comprised of age, gender, and BMI, and explained 9%, 14%, and 8% of the variability in physician fees, number of physician claims, and number of physician visits, respectively.

Conclusion

Of all comorbid diagnoses, significantly increased utilization was found for cardiovascular disease and especially hypertension in the OSAS patients.

Section snippets

Materials and Methods

This study was undertaken in the Canadian province of Manitoba. All residents have access to government-funded health-care services, including physician visits and hospitalizations. Each physician visit generates a standardized claim form submitted to a central government agency (Manitoba Health), which then renders payment. Manitoba Health maintains a detailed computer database, the Manitoba Health database (MHdb), tracking all visits to physicians, hospitalizations, and outpatient surgeries

Results

Table 1 shows the characteristics of the OSAS patients. They were, on average, obese and had symptomatic OSAS. There were more men than women, reflecting the gender distribution of this disorder.3 The female OSAS patients were significantly older (p < 0.001) and more obese (p < 0.001) than the male patients; however, the male patients had higher apnea indexes (p < 0.001) and Epworth Sleepiness Scale (ESS) scores (p = 0.013) than the female patients.

Discussion

We found that prior to diagnosis of OSAS (and not necessarily prior to disease onset), sleep apnea patients more frequently received diagnoses of a variety of other conditions compared to the control subjects. These include hypertension, congestive heart failure, cardiac arrhythmias, cardiovascular disease, obstructive airways disease, and depression. This indicates that apnea patients are more ill than control subjects, and also suggests that some may have incorrect diagnoses and may be

Conclusion

We found that in the years leading up to diagnosis of OSAS, patients with sleep apnea are more likely than control subjects to be treated for cardiovascular diseases, chronic obstructive airways disease, and depression. Depression appears to be treated differently in sleep apnea patients (with higher usage of antidepressant medications) than in the general population. Age and BMI are significant predictors of many of the cardiovascular diagnoses in OSAS patients, while other variables such as

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Supported in part by National Institutes of Health grant No. R01 HL63342–01A1.

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