The Price Is High, and the Outcome is Poor

Abstract

Introduction: Healthcare costs are a major concern for individuals especially in the United States. The healthcare delivery system in the US is challenged with pressures to reduce costs while not diminishing access to high quality care. Study objective: To determine impact of delayed diagnosis of OSA, on different co- morbidities, patient outcome and healthcare costs. Methods: A retrospective review of 7150 patients' health records from four metropolitan, non-academic sleep centers. Non OSA cases were excluded, 1644 (23%), with the diagnosis of insomnia. Of the remaining 5506 cases, 3854 (70 %) were males and 1652 (30 %) were females. The cases were broken down by AHI severity. More than half (55%) of the patients had moderate to severe sleep disordered breathing (SDB). We then further analyzed each group according to their co-morbidity, 65 % with freq. of nocturnal micturition, 60 % hypertension, 40 % depression, 27 %headache, 24 % hypertension, heart failure and diabetes, 15 % chronic fatigue, and 12 % decreased sex drive.( the total percentage is above 100%, since patient may have multiple co morbidity) We then divided cases based on referral, 43% were self referred, 28 %by ENT, 15 % by internal medicine, 5 % by cardiology, 9 % by bariatric surgery, 6.5 % by neurology and 5 % by psychiatry. Results: Our review revealed that delayed diagnosis and failure to screen results in high healthcare costs and poor patient outcome. Conclusion: It is evident that SDB is a prevalent condition. It plays a major role in some of the most predominant and costly illnesses effecting the middle aged and elderly population, an example of that is Heart Disease. We are not diagnosing these patients early enough and are missing opportunities to save signiicant healthcare costs and result in better patient outcomes.