The effect of obstructive sleep apnea on morbidity and health care utilization of middle-aged and older adults

J Am Geriatr Soc. 2008 Feb;56(2):247-54. doi: 10.1111/j.1532-5415.2007.01544.x.


Objectives: To determine whether elderly subjects with obstructive sleep apnea (OSA) had different morbidity and health care utilization than elderly subjects without OSA and middle-aged patients with OSA 2 years before diagnosis.

Design: Case-control study between January 2001 and April 2003.

Setting: Two sleep-wake disorders centers.

Participants: One hundred fifty-eight elderly and 1,166 middle-aged (aged 67-89 and 40-64, respectively) patients with OSA were matched 1:1 with healthy controls according to age, sex, geographic area, and primary physician.

Measurements: Polysomnography, medical diagnoses, and healthcare utilization.

Results: Healthcare costs 2 years before diagnosis were more than 1.8 times as high for elderly and middle-aged patients with OSA as for controls (P<.001). Expenditures of elderly patients with OSA were 1.9 times as high as for middle-aged patients with OSA (P<.001). Multiple logistic regression analysis (adjusting for age, body mass index, and apnea hypopnea index) revealed that cardiovascular disease (CVD) (odds ratio (OR)=4.1, 95% confidence interval (CI)=1.8-9.3) and use of psychoactive drugs (OR=3.8, 95% CI=1.5-10.1) are independent determinants for the top-third most-costly elderly patients with OSA.

Conclusion: Elderly patients with OSA have high healthcare utilization because of CVD morbidity and use of psychoactive medications. Therefore, OSA has clinical significance in elderly people.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Chi-Square Distribution
  • Comorbidity
  • Female
  • Health Expenditures / statistics & numerical data
  • Health Services for the Aged / statistics & numerical data*
  • Humans
  • Israel / epidemiology
  • Logistic Models
  • Male
  • Middle Aged
  • Polysomnography
  • Prevalence
  • Prospective Studies
  • Sleep Apnea, Obstructive / economics*
  • Sleep Apnea, Obstructive / epidemiology*
  • Surveys and Questionnaires