Sleep Disorders Linked to Increased Healthcare Utilization in Chronically Ill Children

The propensity for heightened healthcare engagement in children with chronic medical ailments escalates significantly when compounded with sleep disorders, as per a recent investigation into Medicaid claims data.

The research indicates that among children afflicted with chronic medical conditions, those concurrently diagnosed with a sleep disorder exhibit nearly double the likelihood of heightened healthcare utilization (odds ratio = 1.83) compared to those without such disorders. Predominantly, sleep-disordered breathing emerged as the most prevalent diagnosis, affecting 1,796 children. Individuals grappling with sleep-disordered breathing manifest a 1.5-fold increase in healthcare utilization (OR=1.51). The analysts meticulously adjusted the analyses to account for potential confounding factors such as age, race, and other chronic medical afflictions.

“The results were impressive, suggesting a clear role of sleep disorders in health care utilization in children with chronic medical conditions.”- Dr. Pranshu Adavadkar, principal investigator and lead author, associate professor in the department of pediatrics at the University of Illinois Chicago and director of pediatric sleep medicine at the UI Health Sleep Sciences Center

The findings of the study grace the pages of the April 1 edition of the Journal of Clinical Sleep Medicine, the esteemed publication of the American Academy of Sleep Medicine.

Drawing from Illinois Medicaid claims data encompassing 16,325 children spanning up to 18 years of age, the researchers embarked on their inquiry. The study cohort predominantly comprised denizens of urban locales, with a significant representation from ethnic minority cohorts grappling with diminished socioeconomic statuses. Each participant bore the burden of at least one chronic medical affliction, such as asthma, obesity, diabetes, or attention-deficit/hyperactivity disorder, with a staggering 77% navigating the complexities of multiple chronic maladies. Categorization into three tiers of healthcare engagement, contingent upon hospitalizations and emergency department visits within the preceding 12 months, delineated the participants: low (devoid of hospitalizations or ED visits), medium (one to two hospitalizations or one to three ED visits), and high (three or more hospitalizations or four or more ED visits).

Chronic medical conditions and sleep disturbances were discerned utilizing codes from the International Classification of Diseases, 9th Revision and ICD-10. Sleep-disordered breathing, encompassing diagnoses of apnea solely, snoring exclusively, or the combination thereof, manifested in 14.2% of children with medium healthcare utilization and 20.6% of those with heightened utilization.

Adavadkar underscored the disproportionate healthcare utilization and financial burdens borne by children grappling with chronic medical conditions, particularly among families ensconced in lower socioeconomic echelons, including beneficiaries of the Medicaid insurance program. Consequently, one avenue to mitigate these financial strains entails addressing concurrent sleep disturbances.

“Acquiring insights into the specific sleep disorders that accentuate the risk of heightened healthcare utilization can pave the way for tailored interventions and screening mechanisms, fostering enhanced management of these vulnerable children,” posited Adavadkar.

The authors further underscored the propensity for underdiagnosis of sleep disorders in pediatric cohorts, suggesting that the nexus between sleep disorders and healthcare utilization might be even more pronounced than the findings of this investigation imply.

For more information: Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis, Journal of Clinical Sleep Medicine, https://doi.org/10.5664/jcsm.10936