Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome

Shaya, Fadia T.; Lin, Pei‐Jung; Aljawadi, Mohammad; Scharf, Steven M.

doi:10.1007/s11325-009-0266-2

Cited by 48 publications

(50 citation statements)

References 27 publications

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“…This ratio was 3.5 times in our study. In addition, in previous studies, hypertension, cor pulmonale, chronic renal failure, peptic ulcer, liver disease, and apnea were shown to increase the total cost of COPD 6,7,33–35…”

Section: Discussionmentioning

confidence: 94%

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Deniz

Şengül

Aydemir³

et al. 2016

COPD

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PurposeWe aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship between comorbidities and clinical variables.Patients and methodsAll patients hospitalized with a diagnosis of COPD exacerbation between January 1, 2014, and December 31, 2014, at all state hospitals of Aydın province, a city located in the western part of Turkey, were included in this study. The costs examined in the study pertained to medications, laboratory tests, hospital stays, and other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees.ResultsA total of 3,095 patients with 5,237 exacerbations (mean age, 71.9±10.5 years; 2,434 males and 661 females) were evaluated. For 880 of the patients (28.9%), or 3,852 of the exacerbations (73.1%), at least one comorbid disease was recorded. The mean cost of each exacerbation was $808.5±1,586, including $325.1±879.9 (40.7%) for hospital stays, $223.1±1,300.9 (27.6%) for medications, $46.3±49.6 (0.9%) for laboratory expenditures, and $214±1,068 (26.5%) for other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. The cost of each exacerbation was $1,014.9 in patients with at least one comorbidity, whereas it was $233.6 in patients without comorbidity (P<0.001). Age >65 years, female gender, hospitalization in an intensive care unit, invasive or noninvasive mechanical ventilation, and a long duration of hospitalization were all found to be significant factors in increasing total costs during the exacerbations requiring hospitalization (P<0.05 for all).ConclusionComorbidities have an important role in the total costs of acute exacerbations of COPD. Strategies for the prevention, diagnosis, and effective management of comorbidities would decrease the overall financial burden associated with acute exacerbations of COPD.

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Section: Discussionmentioning

confidence: 94%

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Deniz

Şengül

Aydemir³

et al. 2016

COPD

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“…Our findings based on the SHHS, which is a community-based cohort study not enriched by sampling for people with lung disease, confirm that impairments in lung function that do not fall in the range associated with clinical diagnoses are nevertheless associated with a higher risk for all-cause mortality. Previous studies have shown that patients with "overlap syndrome" (COPD and SDB) have a high predisposition for adverse sequelae including COPD exacerbations and poor patient-reported outcomes (10,21). Based on such evidence, it was hypothesized that SDB and lung function (i.e., lower FEV 1 ) would synergistically augment risk for mortality.…”

Section: Discussionmentioning

confidence: 99%

Influence of Lung Function and Sleep-disordered Breathing on All-Cause Mortality. A Community-based Study

Putcha

Crainiceanu

Norato

et al. 2016

Am J Respir Crit Care Med

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Rationale: Whether sleep-disordered breathing (SDB) severity and diminished lung function act synergistically to heighten the risk of adverse health outcomes remains a topic of significant debate.Objectives: The current study sought to determine whether the association between lower lung function and mortality would be stronger in those with increasing severity of SDB in a communitybased cohort of middle-aged and older adults.Methods: Full montage home sleep testing and spirometry data were analyzed on 6,173 participants of the Sleep Heart Health Study. Proportional hazards models were used to calculate risk for all-cause mortality, with FEV 1 and apnea-hypopnea index (AHI) as the primary exposure indicators along with several potential confounders.Measurements and Main Results: All-cause mortality rate was 26.9 per 1,000 person-years in those with SDB (AHI >5 events/h) and 18.2 per 1,000 person-years in those without (AHI ,5 events/h). For every 200-ml decrease in FEV 1 , all-cause mortality increased by 11.0% in those without SDB (hazard ratio, 1.11; 95% confidence interval, 1.08-1.13). In contrast, for every 200-ml decrease in FEV 1 , all-cause mortality increased by only 6.0% in participants with SDB (hazard ratio, 1.06; 95% confidence interval, 1.04-1.09). Additionally, the incremental influence of lung function on all-cause mortality was less with increasing severity of SDB (P value for interaction between AHI and FEV 1 , 0.004).Conclusions: Lung function was associated with risk for all-cause mortality. The incremental contribution of lung function to mortality diminishes with increasing severity of SDB.

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“…The nocturnal desaturations are more severe in the overlap syndrome, thus predisposing to polycythemia, pulmonary hypertension and cor pulmonale [7,10]. In addition, these patients are shown to have an elevated economic burden compared with patients with COPD alone [16].…”

Section: Discussionmentioning

confidence: 99%

LABA in patients with stage I COPD and mild sleep apnea syndrome: a pilot study

et al. 2010

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AbstractPatients suffering from both sleep apnea-hypopnea syndrome (SAHS) and chronic obstructive pulmonary disease (COPD) have a more severe form of sleep apnea. Knowing all pathophysiological aspects that mutually interact in sleep disorders and COPD, we aimed to investigate if the introduction of long-acting β2 agonists (LABA) during the night could improve overnight oxygenation and the ability to perform daily activities in stage I COPD patients with mild SAHS. We conducted a prospective study of 22 patients with stage I COPD and SAHS confirmed by overnight polygraph screening, without nocturnal CPAP treatment. During twelve weeks, all patients used LABA (salmeterol 50 mcg) with a metered dose inhaler before bedtime. The levels of apnea hypopnea index, oxygen saturation, heart rate, and Epworth daytime sleepiness scale (ESS) were recorded before and after the treatment. There was a significant improvement of lowest and average overnight oxygenation compared to baseline (mean difference 2.1±0.42, p<0.0001; 1.7±0.3, p<0.0001, respectively). In addition, patients reported reduction in daytime sleepiness according to ESS (mean difference 1.23±0.51; p=0.03). Fewer patients exhibited tachycardia when on salmeterol (68 vs. 41%; p=0.01). Use of inhaled salmeterol improves overnight oxygenation in patients with stage I COPD and SAHS. Future prospective studies are warranted to confirm this potentially beneficial effect of long-acting β2 agonists.

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Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome

Abstract: SAS may add additional economic burden on beneficiaries who already have COPD or asthma/COPD.

Cited by 48 publications

References 27 publications

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Clinical factors and comorbidities affecting the cost of hospital-treated COPD

Influence of Lung Function and Sleep-disordered Breathing on All-Cause Mortality. A Community-based Study

LABA in patients with stage I COPD and mild sleep apnea syndrome: a pilot study

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