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The Use of Health-Care Resources in Obesity-Hypoventilation Syndrome^*

^* From the Sleep Disorders Centre (Drs. Berg and Kryger and Mr. Delaive), Section of Respiratory Diseases and Department of Medicine, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba; and the Department of Community Health Sciences (Dr. Manfreda), Centre for Health Policy and Evaluation, University of Manitoba (Mr. Walld), Winnipeg, Manitoba. Supported in part by National Institutes of Health grant R01 HL63342–01A1.

Correspondence to: Meir H. Kryger, MD, FCCP, Director, Sleep Disorder Centre, St. Boniface General Hospital, Room R2034, 351 Taché Ave, Winnipeg, Manitoba R2H 2A6; e-mail: kryger{at}sleep.umanitoba.ca

Objective: To document health-care utilization (ie, physician claims and hospitalizations) in patients with obesity-hypoventilation syndrome (OHS), for 5 years prior to the diagnosis and for 2 years after the diagnosis and initiation of treatment.

Design: Retrospective observational cohort study.

Setting: University-based sleep disorders center in Manitoba, Canada.

Patients and control subjects: Twenty OHS patients (mean [± SD] age, 52.7 ± 9.5 years; body mass index [BMI], 47.3 ± 11.0 kg/m²; PaCO₂, 59.7 ± 13.8 mm Hg; PaO₂, 51.6 ± 12.4 mm Hg) were matched to two sets of control subjects. First, each case was matched to 15 general population control subjects (GPCs) by age, gender, and geographic location, and, second, each case was matched to a single obese control subject (OBC) who was matched using the same criteria as for the GPCs, plus the measurement of BMI.

Measurements and results: In the 5 years before diagnosis, the 20 OHS patients had (mean ± SE) 11.2 ± 1.8 physician visits per patient per year vs 5.7 ± 0.8 (p < 0.01) visits for OBCs and 4.5 ± 0.4 (p < 0.001) visits for GPCs. OHS patients generated higher fees, $623 ± 96 per patient per year for the 5 years prior to diagnosis compared to $252 ± 34 (p < 0.001) for OBCs and $236 ± 25 (p < 0.001) for GPCs. OHS patients were much more likely to be hospitalized than were subjects in either control group in the 5 years prior to diagnosis (odds ratio [OR] vs GPCs, 8.6) (95% confidence interval [CI], 5.9 to 12.7); OR vs OBCs, 4.9 (95% CI, 2.3 to 10.1). In the 2 years after diagnosis and the initiation of treatment (usually continuous positive airway pressure or bilevel positive airway pressure), there was a significant linear reduction in physician fees. In the 2 years after the initiation of treatment, there was a 68.4% decrease in days hospitalized per year (5 years before treatment, 7.9 days per patient per year; after 2 years of treatment, 2.5 days per patient per year [p = 0.01]).

Conclusions: OHS patients are heavy users of health care for several years prior to evaluation and treatment of their sleep breathing disorder; there is a substantial reduction in days hospitalized once the diagnosis is made and treatment is instituted.

Key Words: apnea • hypoventilation • obesity • sleep • utilization

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