Gamaldo Alyssa A, Beydoun May A, Beydoun Hind A, Liang Hailun, Salas Rachel E, Zonderman Alan B, Gamaldo Charlene E, Eid Shaker M
School of Aging Studies, University of South FloridaTampa, FL, USA; Behavioral Epidemiology Section, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRPBaltimore, MD, USA; Human Development and Family Studies, Penn State UniversityState College, PA, USA.
Behavioral Epidemiology Section, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP Baltimore, MD, USA.
Front Aging Neurosci. 2016 Nov 15;8:266. doi: 10.3389/fnagi.2016.00266. eCollection 2016.
We examined the rates, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of sleep disturbances in older hospitalized patients. Using the U.S. Nationwide Inpatient Sample database (2002-2012), older patients (≥60 years) were selected and rates of insomnia, obstructive sleep apnea (OSA) and other sleep disturbances (OSD) were estimated using ICD-9CM. TC, adjusted for inflation, was of primary interest, while MR and LOS were secondary outcomes. Multivariable regression analyses were conducted. Of 35,258,031 older adults, 263,865 (0.75%) had insomnia, 750,851 (2.13%) OSA and 21,814 (0.06%) OSD. Insomnia rates increased significantly (0.27% in 2002 to 1.29 in 2012, -trend < 0.001), with a similar trend observed for OSA (1.47 in 2006 to 5.01 in 2012, -trend < 0.001). TC (2012 $) for insomnia-related hospital admission increased over time from $22,250 in 2002 to $31,527 in 2012, and increased similarly for OSA and OSD; while LOS and MR both decreased. Women with any sleep disturbance had lower MR and TC than men, while Whites had consistently higher odds of insomnia, OSA, and OSD than older Blacks and Hispanics. Co-morbidities such as depression, cardiovascular risk factors, and neurological disorders steadily increased over time in patients with sleep disturbances. TC increased over time in patients with sleep disturbances while LOS and MR decreased. Further, research should focus on identifying the mechanisms that explain the association between increasing sleep disturbance rates and expenditures within hospital settings and the potential hospital expenditures of unrecognized sleep disturbances in the elderly.
我们研究了老年住院患者睡眠障碍的发生率、预测因素及结局（死亡风险、住院时间和总费用）。利用美国全国住院样本数据库（2002 - 2012年），选取老年患者（≥60岁），并使用国际疾病分类第九版临床修订本（ICD - 9CM）估算失眠、阻塞性睡眠呼吸暂停（OSA）及其他睡眠障碍（OSD）的发生率。经通胀调整后的总费用是主要研究对象，而死亡风险和住院时间则是次要结局。进行了多变量回归分析。在35258031名老年人中，263865人（0.75%）患有失眠，750851人（2.13%）患有阻塞性睡眠呼吸暂停，21814人（0.06%）患有其他睡眠障碍。失眠发生率显著上升（从2002年的0.27%升至2012年的1.29%，P趋势<0.001），阻塞性睡眠呼吸暂停也呈现类似趋势（从2006年的1.47升至2012年的5.01，P趋势<0.001）。与失眠相关的住院总费用（2012年美元）随时间推移从2002年的22250美元增至2012年的31527美元，阻塞性睡眠呼吸暂停和其他睡眠障碍的费用也有类似增长；而住院时间和死亡风险均有所下降。患有任何睡眠障碍的女性的死亡风险和总费用均低于男性，而白人患失眠、阻塞性睡眠呼吸暂停和其他睡眠障碍的几率始终高于老年黑人和西班牙裔。睡眠障碍患者中，诸如抑郁症、心血管危险因素和神经疾病等合并症随时间稳步增加。睡眠障碍患者的总费用随时间增加，而住院时间和死亡风险下降。此外，研究应聚焦于确定解释医院环境中睡眠障碍发生率上升与费用之间关联的机制，以及老年人未被识别的睡眠障碍的潜在医院费用。
