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Obstructive sleep apnea in diabetic patients is associated with higher healthcare utilization

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

Obstructive sleep apnea (OSA) is a frequent comorbid condition in patients with type 2 diabetic (T2DM). Concomitant OSA is associated with a detrimental impact on metabolic control. Both OSA and T2DM independently lead to increased cardiovascular disease and mortality. The impact of OSA on the acceleration of organ dysfunction leading to increased healthcare utilization is unknown.

Methods

This is a retrospective case–control cohort study, a secondary analysis utilizing a nationwide dataset. Patients who underwent elective surgical procedures from 2009 to 2014 were identified. Among these patients, we compared patients with obstructive sleep apnea and those without obstructive sleep apnea. Exact 1:1 matching was performed based on similar characteristics such as age, sex, geographic location, surgical facility environment, performing surgeon, and severity of illness during hospitalization. The subgroup of patients with T2DM with or without OSA was analyzed for post-discharge hospital admissions, intensive care unit (ICU) admissions, emergency room (ER) visits, and outpatient visits.

Results

Among 47,719 matched patients of the initial study, this subgroup included 4,567 patients with diabetes and OSA and 3,842 patients with diabetes but no OSA. In the presence of comorbid OSA, patients with T2DM had higher odds of increased healthcare utilization among all the outcomes: inpatient visits increased with an odds ratio of 2.50 (confidence interval (CI) 2.28–2.74) and ICU admissions 1.96 (CI 1.73–2.25) ER 1.93 **(CI 1.75–2.12) and outpatient visits 2.18 (CI 2.00–2.38). Future healthcare utilization per 100 patient-years was also increased significantly among all outcomes (p < 0.0001).

Conclusions

In patients with diabetes undergoing elective surgery, the presence of OSA was associated with higher future healthcare utilization.

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Acknowledgements

We thank Eve Shaffer for her contributions.

Funding

This material is the result of work supported with resources and the use of facilities at the Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX. The deidentified data was provided by the Advisory Board Company. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.

u.s. department of veterans affairs

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Authors and Affiliations

  1. Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Ritwick Agrawal, Venkata D. Bandi, Max Hirshkowitz & Amir Sharafkhaneh

  2. Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA

    Ritwick Agrawal, Venkata D. Bandi, Max Hirshkowitz & Amir Sharafkhaneh

  3. Eula AI, Sydney, Australia, At the Time of This Study, the author was affiliated with the Advisory Board Company, Washington, DC, USA

    Andrew M. Spiegelman

Authors
  1. Ritwick Agrawal
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  2. Andrew M. Spiegelman
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  3. Venkata D. Bandi
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  4. Max Hirshkowitz
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  5. Amir Sharafkhaneh
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Corresponding author

Correspondence to Ritwick Agrawal.

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Ethics approval

This research was approved by the Institutional Review Board of Baylor College of Medicine and the Research and Development Committee of Michael E. DeBakey Veteran Affairs Medical Center. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This type of study does not require informed consent.

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The authors declare no competing interests.

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Agrawal, R., Spiegelman, A.M., Bandi, V.D. et al. Obstructive sleep apnea in diabetic patients is associated with higher healthcare utilization. Sleep Breath 26, 1817–1820 (2022). https://doi.org/10.1007/s11325-021-02552-4

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  • DOI: https://doi.org/10.1007/s11325-021-02552-4

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