Economic Implications of the Diagnosis of Obstructive Sleep Apnea

• Sleep apnea syndromes
• Cost-benefit analysis
• Polysomnography
• Positive-pressure respiration
• Quality-adjusted life years

The past decade has witnessed considerable accumulation of evidence indicating just how common the obstructive sleep apnea syndrome is. The most definitive study to date, the Wisconsin Sleep Cohort Study, estimates that 4% of middle-aged adult men and 2% of middle-aged adult women have symptomatic sleep apnea (1). Prevalence rates in persons older than 65 years are even higher (2). Moreover, evidence of morbidity associated with this condition is growing. Obstructive sleep apnea causes excessive daytime sleepiness (3, 4), and, in prospective studies, an increased risk for vehicular crashes has been demonstrated in men (5). Sleep apnea is a risk factor for cardiovascular conditions, although data supporting this assertion have been received with some skepticism (6). Recently, however, the large, multicenter Sleep Heart Study demonstrated in initial cross-sectional analyses an increased risk for hypertension in persons with sleep apnea, particularly those younger than 60 years of age, even after controlling for common confounders (such as obesity) (Samet J. Personal communication; 1998).

Sleep apnea is a chronic condition, and an estimated 80% to 90% …