Prevalence of Diagnosed Obstructive Sleep Apnea in the United States 2013-2016: Insured Patients Actively Seeking Care
Abstract
Background: The prevalence of obstructive sleep apnea (OSA) has not been assessed within the United States (US) in over adecade.
Objectives:From 2013 to 2016, we calculated annual 2-year limited duration prevalence of diagnosed OSA in a large (~66million), geographically diverse insured population. We evaluated trends by age and sex; and assessed positive airway pressure (PAP) use and excessive sleepiness (hypersomnia diagnosis, or prescriptions for stimulant or wake-promoting agent [WPA]).
Methods:Overall and age/sex specific prevalence per 100 insured persons was calculated on an annual basis. The cohort was defined to include those with medical and pharmacy claims activity. To mitigate rule-out diagnoses,cases had to have ≥2 medical claims for OSA within a 6-month period. Overall annual prevalences were directly standardized to the US population using 2016 US age and sex Census weights.
Results: Annualage/sex adjusted prevalence of OSA increased from 2.4% in 2013 to 3.4% in 2016. OSA patients had a mean age of 58 years and there was a ≈2:1 male:female prevalence ratio. OSA patients with PAP claims increased from 42.2% to 44.1% over the study period. Excessive sleepiness (hypersomnia or stimulant/WPA prescriptions) for patients with or without PAP use both declined by ≈ 4% -5%.
Conclusions:Diagnosed OSA prevalence and PAP use among insured members with claims activity increased during 2013-2016 while clinical markers of excessive sleepiness declined. Males had a much higher prevalence of OSA than females.
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References
1. Pang KP, Terris DJ. Screening for obstructive sleep apnea: an evidence-based analysis. Am J Otolaryngol. 2006;27(2):112-8.
2. Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest. 2006;130(3):780-6.
3. Section on Pediatric Pulmonology SboOSASAAoP. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109(4):704-12.
4. Kapoor M, Greenough G. Home Sleep Tests for Obstructive Sleep Apnea (OSA). J Am 296 Board Fam Med. 2015;28(4):504-9.
5. Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarez-Sala R, et al. Prevalence of symptoms and risk of sleep apnea in primary care. Chest. 2003;124(4):1406-14.
6. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-47.
7. Cepeda-Valery B, Acharjee S, Romero-Corral A, Pressman GS, Gami AS. Obstructive sleep apnea and acute coronary syndromes: etiology, risk, and management. Curr Cardiol Rep. 2014;16(10):535.
8. Sidhu K, Tang A. Modifiable Risk Factors in Atrial Fibrillation: The Role of Alcohol, Obesity, and Sleep Apnea. Can J Cardiol. 2017;33(7):947-9.
9. Mohsenin V. Obstructive sleep apnea and hypertension: a critical review. Curr Hypertens 307 Rep. 2014;16(10):482.
10. Lin CC, Hu CC, Ho JD, Chiu HW, Lin HC. Obstructive sleep apnea and increased risk of glaucoma: a population-based matched-cohort study. Ophthalmology. 2013;120(8):1559-64.
11. Zhao Y, Yu BY, Liu Y. Meta-Analysis of the Effect of Obstructive Sleep Apnea on Cardiovascular Events After Percutaneous Coronary Intervention. Am J Cardiol. 2017;120(6):1026-30.
12. Rosen CL, Debaun MR, Strunk RC, Redline S, Seicean S, Craven DI, et al. Obstructive sleep apnea and sickle cell anemia. Pediatrics. 2014;134(2):273-81.
13. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-43.
14. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14.
15. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-8.
16. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81.
17. Grosse SD, Boulet SL, Grant AM, Hulihan MM, Faughnan ME. The use of US health insurance data for surveillance of rare disorders: hereditary hemorrhagic telangiectasia. Genet Med. 2014;16(1):33-9.
18. Fukuda H, Ikeda S, Shiroiwa T, Fukuda T. The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan. Pharmacoeconomics. 2016;34(10):1005-14.
19. Tanihara S, Okamoto E, Une H. A statistical analysis of 'rule-out' diagnoses in outpatient health insurance claims in Japan. J Eval Clin Pract. 2011;17(6):1070-4.
20. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17(8):857-72.
21. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-5.
22. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea?: The Rational Clinical Examination systematic review. JAMA. 2013;310(7):731-41.
23. Baratta F, Pastori D, Bucci T, Fabiani M, Fabiani V, Brunori M, et al. Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome. Sleep Med. 2018;43:66-70.
24. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J. 2008;15(7):365-9.
25. Sin DD, Mayers I, Man GC, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest. 2002;121(2):430-5.
26. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5(2):173-8.
27. Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2014(1):CD007736.
28. Association ASA. Awake. Sleep Apnea.; 2018.
29. Broström A, Nilsen P, Johansson P, Ulander M, Strömberg A, Svanborg E, et al. Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: a qualitative content analysis. Sleep Med. 2010;11(2):126-30.
30. Olsen S, Smith S, Oei T, Douglas J. Health belief model predicts adherence to CPAP before experience with CPAP. Eur Respir J. 2008;32(3):710-7.
31. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15(6):343-56.
32. Won CHJ, Qin L, Selim B, Yaggi HK. Varying Hypopnea Definitions Affect Obstructive Sleep Apnea Severity Classification and Association With Cardiovascular Disease. J Clin Sleep 363 Med. 2018;14(12):1987-94.
33. Malhotra RK, Kirsch DB, Kristo DA, Olson EJ, Aurora RN, Carden KA, et al. Polysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med. 2018;14(7):1245-7.
34. Ruehland WR, Rochford PD, O'Donoghue FJ, Pierce RJ, Singh P, Thornton AT. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep.2009;32(2):150-7.
35. Mansukhani MP, Kolla BP, Wang Z, Morgenthaler TI. Effect of Varying Definitions of Hypopnea on the Diagnosis and Clinical Outcomes of Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis. J Clin Sleep Med. 2019;15(5):687-96.
36. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291(16):2013-6.
37. Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10(7):753-8.
38. Devaraj U, Rajagopala S, Kumar A, Ramachandran P, Devereaux PJ, D'Souza GA. Undiagnosed Obstructive Sleep Apnea and Postoperative Outcomes: A Prospective Observational 380 Study. Respiration. 2017;94(1):18-25.
39. Lang CJ, Appleton SL, Vakulin A, McEvoy RD, Vincent AD, Wittert GA, et al. Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study. J Clin Sleep Med. 2017;13(4):575-82.
40. Hamilton GS, Joosten SA. Obstructive sleep apnoea and obesity. Aust Fam Physician. 2017;46(7):460-3.
41. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-9.
42. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-21.
43. Santamaria J, Iranzo A, Ma Montserrat J, de Pablo J. Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. Sleep Med Rev. 2007;11(3):195-207.
44. Castiglioni P, Lombardi C, Cortelli P, Parati G. Why excessive sleepiness may persist in OSA patients receiving adequate CPAP treatment. Eur Respir J. 2012;39(1):226-7; author reply 7- 394 8.
45. Thorpe KE, Florence CS, Howard DH, Joski P. The rising prevalence of treated disease: effects on private health insurance spending. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5-317-W5-25.
46. Thomas RJ, Guilleminault C, Ayappa I, Rapoport DM. Scoring respiratory events in sleep medicine: who is the driver--biology or medical insurance? J Clin Sleep Med. 2014;10(11):1245- 7.
2. Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest. 2006;130(3):780-6.
3. Section on Pediatric Pulmonology SboOSASAAoP. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109(4):704-12.
4. Kapoor M, Greenough G. Home Sleep Tests for Obstructive Sleep Apnea (OSA). J Am 296 Board Fam Med. 2015;28(4):504-9.
5. Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarez-Sala R, et al. Prevalence of symptoms and risk of sleep apnea in primary care. Chest. 2003;124(4):1406-14.
6. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-47.
7. Cepeda-Valery B, Acharjee S, Romero-Corral A, Pressman GS, Gami AS. Obstructive sleep apnea and acute coronary syndromes: etiology, risk, and management. Curr Cardiol Rep. 2014;16(10):535.
8. Sidhu K, Tang A. Modifiable Risk Factors in Atrial Fibrillation: The Role of Alcohol, Obesity, and Sleep Apnea. Can J Cardiol. 2017;33(7):947-9.
9. Mohsenin V. Obstructive sleep apnea and hypertension: a critical review. Curr Hypertens 307 Rep. 2014;16(10):482.
10. Lin CC, Hu CC, Ho JD, Chiu HW, Lin HC. Obstructive sleep apnea and increased risk of glaucoma: a population-based matched-cohort study. Ophthalmology. 2013;120(8):1559-64.
11. Zhao Y, Yu BY, Liu Y. Meta-Analysis of the Effect of Obstructive Sleep Apnea on Cardiovascular Events After Percutaneous Coronary Intervention. Am J Cardiol. 2017;120(6):1026-30.
12. Rosen CL, Debaun MR, Strunk RC, Redline S, Seicean S, Craven DI, et al. Obstructive sleep apnea and sickle cell anemia. Pediatrics. 2014;134(2):273-81.
13. Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-43.
14. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14.
15. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-8.
16. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81.
17. Grosse SD, Boulet SL, Grant AM, Hulihan MM, Faughnan ME. The use of US health insurance data for surveillance of rare disorders: hereditary hemorrhagic telangiectasia. Genet Med. 2014;16(1):33-9.
18. Fukuda H, Ikeda S, Shiroiwa T, Fukuda T. The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan. Pharmacoeconomics. 2016;34(10):1005-14.
19. Tanihara S, Okamoto E, Une H. A statistical analysis of 'rule-out' diagnoses in outpatient health insurance claims in Japan. J Eval Clin Pract. 2011;17(6):1070-4.
20. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17(8):857-72.
21. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-5.
22. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea?: The Rational Clinical Examination systematic review. JAMA. 2013;310(7):731-41.
23. Baratta F, Pastori D, Bucci T, Fabiani M, Fabiani V, Brunori M, et al. Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome. Sleep Med. 2018;43:66-70.
24. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J. 2008;15(7):365-9.
25. Sin DD, Mayers I, Man GC, Pawluk L. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest. 2002;121(2):430-5.
26. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5(2):173-8.
27. Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2014(1):CD007736.
28. Association ASA. Awake. Sleep Apnea.; 2018.
29. Broström A, Nilsen P, Johansson P, Ulander M, Strömberg A, Svanborg E, et al. Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: a qualitative content analysis. Sleep Med. 2010;11(2):126-30.
30. Olsen S, Smith S, Oei T, Douglas J. Health belief model predicts adherence to CPAP before experience with CPAP. Eur Respir J. 2008;32(3):710-7.
31. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15(6):343-56.
32. Won CHJ, Qin L, Selim B, Yaggi HK. Varying Hypopnea Definitions Affect Obstructive Sleep Apnea Severity Classification and Association With Cardiovascular Disease. J Clin Sleep 363 Med. 2018;14(12):1987-94.
33. Malhotra RK, Kirsch DB, Kristo DA, Olson EJ, Aurora RN, Carden KA, et al. Polysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med. 2018;14(7):1245-7.
34. Ruehland WR, Rochford PD, O'Donoghue FJ, Pierce RJ, Singh P, Thornton AT. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep.2009;32(2):150-7.
35. Mansukhani MP, Kolla BP, Wang Z, Morgenthaler TI. Effect of Varying Definitions of Hypopnea on the Diagnosis and Clinical Outcomes of Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis. J Clin Sleep Med. 2019;15(5):687-96.
36. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291(16):2013-6.
37. Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009;10(7):753-8.
38. Devaraj U, Rajagopala S, Kumar A, Ramachandran P, Devereaux PJ, D'Souza GA. Undiagnosed Obstructive Sleep Apnea and Postoperative Outcomes: A Prospective Observational 380 Study. Respiration. 2017;94(1):18-25.
39. Lang CJ, Appleton SL, Vakulin A, McEvoy RD, Vincent AD, Wittert GA, et al. Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study. J Clin Sleep Med. 2017;13(4):575-82.
40. Hamilton GS, Joosten SA. Obstructive sleep apnoea and obesity. Aust Fam Physician. 2017;46(7):460-3.
41. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-9.
42. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-21.
43. Santamaria J, Iranzo A, Ma Montserrat J, de Pablo J. Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. Sleep Med Rev. 2007;11(3):195-207.
44. Castiglioni P, Lombardi C, Cortelli P, Parati G. Why excessive sleepiness may persist in OSA patients receiving adequate CPAP treatment. Eur Respir J. 2012;39(1):226-7; author reply 7- 394 8.
45. Thorpe KE, Florence CS, Howard DH, Joski P. The rising prevalence of treated disease: effects on private health insurance spending. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5-317-W5-25.
46. Thomas RJ, Guilleminault C, Ayappa I, Rapoport DM. Scoring respiratory events in sleep medicine: who is the driver--biology or medical insurance? J Clin Sleep Med. 2014;10(11):1245- 7.
Authors
Suomi, J., Hess, G., Won, C., Bron, M., & Acquavella, J. (2020). Prevalence of Diagnosed Obstructive Sleep Apnea in the United States 2013-2016: Insured Patients Actively Seeking Care. Journal of Current Medical Research and Opinion, 3(06), 478–486. https://doi.org/10.15520/jcmro.v3i06.301
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