Kate Johnson

June 23, 2011

June 23, 2011 (Minneapolis, Minnesota) — Sleep complaints, while underreported to healthcare providers, are linked to increased healthcare utilization, hospitalization, and work absenteeism, according to an analysis of the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2006.

"We recommend that healthcare providers routinely assess for the presence and etiology of sleep complaints and disorders," said Jon-Erik Holty, MD, from the Pulmonary, Critical Care, and Sleep Section of the Palo Alto Veterans Affairs Medical Center and the Center for Primary Care and Outcomes Research at Stanford University in California.

Presenting the findings here at SLEEP 2011: Associated Professional Sleep Societies 25th Annual Meeting, Dr. Holty said the data represent the first sleep and healthcare utilization assessments from NHANES.

NHANES is a nationally representative, cross-sectional survey of health and nutrition conducted annually and including approximately 5000 English- and Spanish-speaking adults and children.

The primary purpose of NHANES is to estimate the prevalence and risk factors of major disease within the United States, he explained. Beginning in 2005, 25 questions related to sleep habits, complaints, and disorders and 10 questions on healthcare utilization were added.

The researchers analyzed responses from 2183 noninstitutionalized adult respondents (mean age, 46 years; 51% female) with a mean body mass index of 28. Most reported their health as "excellent," "very good," or "good."

Almost everyone (99%) reported at least 1 sleep complaint, with a mean of 4.2 complaints per respondent. Specifically, 56% reported feeling unrested despite adequate hours of sleep, 54% reported not getting enough sleep, 45% reported snoring, 45% reported excessive daytime sleepiness, 37% reported trouble falling asleep, and 12% reported nocturnal gasping or witnessed apnea.

Although 1% had clinically diagnosed insomnia, 37% had possible insomnia, which was estimated using adapted Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria, Dr. Holty reported. Similarly, although 4.6% had clinically diagnosed sleep apnea, 33% had possible sleep apnea, which was estimated using an adaptation of the Berlin questionnaire.

Only 24% of respondents had reported their sleep complaints to their physician or healthcare provider, yet these sleep complaints were directly linked to an increased rate of healthcare visits in the last year.

Compared with good sleepers, people who have trouble sleeping were more likely to have had a healthcare visit within the past year (85% vs 59%), more likely to have been hospitalized (16% vs 8%), more likely to have had one or more mental healthcare visits (20% vs 5%), and more likely to have missed 6 or more days of work (14% vs 7%), Dr. Holty announced.

After adjusting for known risk factors for sleep problems, multivariate analysis showed that people who have trouble with sleep had an odds ratios (OR) of 3.1 for having more than 1 annual healthcare visit, an OR of 2.8 for hospitalization, an OR of 4.9 for a mental health visit, and an OR of 2.4 for missing 6 or more days of work.

The mean number of hours of sleep reported by respondents was 6.9 per night, with 5% reporting less than 5 hours per night. In addition, 15% reported the use of sleeping pills 2 or more times per month.

Respondents with less than 5 or more than 9 hours of sleep per night had the highest rates of healthcare utilization.

It is a generally accepted fact that sleep complaints are underreported by patients and are underdiagnosed by physicians, said Dr. Holty.

Possible barriers to and biases in diagnosis are important to consider, he added. For example, the presence or absence of healthcare insurance is 1 potential barrier.

When comparing respondents with a clinical diagnosis of insomnia with those with "possible insomnia," those with a clinical diagnosis were more likely to have health insurance. And when comparing respondents with a clinical diagnosis of sleep apnea with those with possible sleep apnea, those with a clinical diagnosis tended to be older, male, and white and were more likely to have health insurance.

Those reporting trouble sleeping were also more likely to have cancer, cardiovascular disease, chronic obstructive pulmonary disease, depression, diabetes, or hypertension, he added, suggesting that for physicians, simply asking about sleep may prove to be an efficient screening tool to assess the need for further evaluation.

Dr. Holty has disclosed no relevant financial relationships.

SLEEP 2011: Associated Professional Sleep Societies 25th Annual Meeting: Abstract 0975. Presented June 15, 2011.


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