Sleep Disorders and Sleep Deprivation An Unmet Public Health Problem (2006) / Chapter Skim
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4 Functional and Economic Impact of Sleep Loss and Sleep-Related Disorders
4 Functional and Economic Impact of Sleep Loss and Sleep-Related Disorders
Pages 137-172
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From page 137... ...
Hundreds of billions of dollars a year are spent on direct medical costs associ ated with doctor visits, hospital services, prescriptions, and over the-counter drugs. Compared to healthy individuals, individuals suffering from sleep loss, sleep disorders, or both are less produc tive, have an increased health care utilization, and an increased likelihood of accidents.
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From page 138... ...
The deficits include attention, vigilance, and other measures of cognition, including memory and complex decision making. This section addresses sleep loss and then turns to sleep-disordered breathing and other sleep disorders.
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From page 139... ...
The intervention schedule not only enhanced interns' sleep duration and lowered their rate of attentional failures, but also reduced the rate of serious medical errors, according to two articles published in 2004 in the New England Journal of Medicine. In the first article, the investigators used a within-subjects design (n = 20 interns)
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From page 140... ...
140 SLEEP DISORDERS AND SLEEP DEPRIVATION BOX 4-1 continued Incidence of Serious Medical Errors (rate/1,000 patient days) Traditional Intervention Variable Schedule Schedule P Value Serious medical errors made by interns Serious medical errors 176 (136.0)
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From page 141... ...
. Attention and reaction time are altered by experimental sleep loss, which leads to cumulative, dose-dependent deterioration of attention and reaction time (Figure 4-1)
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From page 142... ...
. Sleep Loss in Adolescents and Academic Performance Sleep loss in adolescence is common and grows progressively worse over the course of adolescence, according to studies from numerous countries (Wolfson and Carskadon, 2003; Howell et al., 2004)
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From page 143... ...
IMPACT OF SLEEP LOSS AND SLEEP-RELATED DISORDERS 143 40 30 sample of 20 10 Percentage 0 < 5 5 to 6 6 to 7 7 to 8 8 to 9 > 9 Reported school night total sleep time (hours) 60 50 sample 40 of 30 20 Percentage 10 0 before 5:00 5:00 to 6:00 6:00 to 7:00 after 7:00 Reported school day rise time 40 30 sample of 20 10 Percentage 0 before 8:00 9:00 10:00 11:00 12:00 after 8:00 pm to to to to to 1:00 am 9:00 10:00 11:00 12:00 1:00 Reported school night bedtime FIGURE 4-2 Sample distribution of sleep patterns.
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From page 144... ...
, but the question of causality has not been resolved by longitudinal studies. A 3year study of 2,200 middle school students did not find that sleep loss resulted in lower academic performance.
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From page 145... ...
Obstructive Sleep Apnea Is Associated with Development, Cognition, and Behavior in Children Children with obstructive sleep apnea (OSA) often have problems in development, cognition, behavior, and academic performance, according to detailed reviews of the evidence (Schechter, 2002; Bass et al., 2004)
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From page 146... ...
Sleep-Disordered Breathing and Cognitive Impairment in Adults Several cross-sectional studies indicate that sleep-disordered breathing in adults is associated with impaired cognitive function (Greenberg et al., 1987; Bedard et al., 1991; Naegele et al., 1995; Redline et al., 1997; Kim et al., 1997)
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From page 147... ...
. Driver sleepiness is most frequently a manifestation of sleep loss, as discussed below, but other sleep disorders, which have lower prevalence, contribute to the problem, including sleepdisordered breathing, restless legs syndrome, and narcolepsy.
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From page 148... ...
. After a night of total sleep deprivation, impairments in lane-keeping ability were similar to those found with blood alcohol content of 0.07 percent (Fairclough and Graham, 1999)
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From page 149... ...
During the year they collected information about sleep patterns and other potential risk factors for work-related injuries. The 108 employees who reported being injured during the next year could be assessed for risk factors without recall bias affecting the results.
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From page 150... ...
Until recently, most of the studies addressing this question were not large enough to yield an answer. In 2005, a large, prospective study of 34,000 nursing home residents across the state of Michigan ruled out use of hypnotic medications as a risk factor for falls (Avidan et al., 2005)
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From page 151... ...
The strongest evidence for the public health benefits of treatment comes from clinical trials and retrospective studies of the impact of CPAP therapy for sleep apnea. These studies also dispel any doubt of the causal relationship between sleep disorders and accidents.
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From page 152... ...
. Using health-related measures of quality of life, the functional impact of sleep loss was assessed by a large and nationally representative survey, the United States Behavioral Risk Factor Surveillance System (Strine and Chapman, 2005)
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From page 153... ...
. However, very few studies have assessed the association between sleep loss and sleep disorders and health-related quality of life in children.
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Sleep loss is indeed reported more frequently by parents after the birth of a child than during pregnancy (Gay et al., 2004)
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. ECONOMIC IMPACT OF SLEEP LOSS AND SLEEP DISORDERS Although problems falling asleep or daytime sleepiness affect 35 to 40 percent of the population (Hossain and Shapiro, 2002)
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. Obstructive Sleep Apnea Individuals with OSA also place a significant burden on the health care system.
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From page 157... ...
Direct Costs of Sleep Loss and Sleep Disorders Billions of dollars are spent each year in the United States on the direct costs of sleep loss and sleep disorders. These medical costs include expenses associated with doctor visits, hospital services, prescriptions and over-thecounter medications.
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From page 158... ...
. As is the case with direct costs, for each of these categories further analysis is required to determine the complete indirect costs of sleep loss and sleep disorders.
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From page 159... ...
Substances used for insomnia Prescription medications 809.92 Nonprescription medications 325.80 Alcohol 780.39 Melatonin 50.00 Total Cost of Substances 1,966.11 Health care services for insomnia Outpatient physician visits 660.00 Psychologist visits 122.40 Social working visits 75.30 Sleep specialist visits 18.20 Mental health organizations 153.00 In-patient hospital care 30.80 Nursing home care 10,900.00 Total 11,960.70 Total direct costs 13,926.11 SOURCE: Walsh and Engelhardt (1999)
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From page 160... ...
; therefore, as the United States population continues to age it is expected that the cost associated with falls caused by insomnia will also continue to rise. Economic Impact of Obstructive Sleep Apnea Direct Cost Similar to other sleep disorders, there is very limited data on the direct costs associated with obstructive sleep apnea.
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From page 161... ...
. Relationship Between Socioeconomic Status, Race, and Obstructive Sleep Apnea The relationship between socioeconomic status, race, and obstructive sleep apnea is not well understood.
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From page 162... ...
Summary Although the data are limited, the effect of sleep disorders, chronic sleep loss, and sleepiness on accident rates, performance deficits, and health care utilization on the American economy is significant. The high estimated costs to society of leaving the most prevalent sleep disorders untreated are far more than the costs that would be incurred by delivering adequate treatment.
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From page 163... ...
A report from the restless legs syndrome diagnosis and epidemiology workshop at the Na tional Institutes of Health. Sleep Medicine 4(2)
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From page 164... ...
American Journal of Respira tory and Critical Care Medicine 170(5)
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2003. Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome.
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American Journal of Respiratory and Critical Care Medicine 170(4)
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From page 167... ...
American Journal of Respiratory and Critical Care Medicine 170(9)
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From page 168... ...
American Journal of Respiratory and Critical Care Medicine 164(11)
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1998. Comparison of the severity of sleep-disordered breathing in Asian and Caucasian patients seen at a sleep disorders center.
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From page 170... ...
American Journal of Respiratory and Critical Care Medicine 157(3 Pt 1)
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From page 171... ...
1996. Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea.
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From page 172... ...
2005. Cognition and performance in patients with obstructive sleep apnea.
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