School of Nursing, University of Pittsburgh, 3500 Victoria St, 415 Victoria Building, Pittsburgh, PA, 15241, USA.
VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Respir Res. 2023 Mar 25;24(1):93. doi: 10.1186/s12931-023-02401-w.
Insomnia has been linked to adverse chronic obstructive pulmonary disease (COPD) outcomes including exacerbations, yet its impact on COPD-related healthcare utilization and costs is unknown. In this study, we investigated the associations between insomnia and healthcare utilization and costs in patients with COPD. A retrospective cohort of veterans with COPD were identified from national Veterans Affairs administration data for fiscal years 2012-2017. Insomnia was operationalized as having an insomnia diagnosis based on International Classification of Disease codes or having a prescription of > 30 doses of a sedative-hypnotic medication in a given fiscal year. The index date for insomnia was the first date when dual criteria for COPD and insomnia was met. The index date for those without insomnia was set as the COPD index date. Our primary outcomes were 1-year healthcare utilization and costs related to outpatient visits and hospitalizations after index date. COPD-related healthcare utilization variables included number of prescription fills of corticosteroids and/or antibiotics and outpatient visits and hospitalizations with a primary diagnosis of COPD. Out of 1,011,646 patients (96% men, mean age 68.4 years) diagnosed with COPD, 407,363 (38.8%) had insomnia. After adjustment for confounders, insomnia was associated with higher rates of outpatient visits, hospitalizations, and fills for corticosteroids and/or antibiotics, longer hospital length of stay, and $10,344 higher hospitalization costs in the 12 months after index date. These findings highlight the importance of insomnia as a potentially modifiable target for reducing the burden of COPD on patients and healthcare systems.
失眠与慢性阻塞性肺疾病（COPD）的不良结局相关，包括加重，但它对 COPD 相关医疗保健利用和成本的影响尚不清楚。在这项研究中，我们调查了失眠与 COPD 患者医疗保健利用和成本之间的关系。从 2012 年至 2017 年的国家退伍军人事务部数据中确定了一个患有 COPD 的退伍军人回顾性队列。失眠通过国际疾病分类代码确定有失眠诊断或在给定财政年度开处>30 剂镇静催眠药物的处方来操作。失眠的索引日期是同时满足 COPD 和失眠双重标准的第一天。没有失眠的患者的索引日期设定为 COPD 的索引日期。我们的主要结果是在索引日期后 1 年内与门诊就诊和住院相关的医疗保健利用和成本。COPD 相关医疗保健利用变量包括皮质类固醇和/或抗生素的处方数量以及以 COPD 为主要诊断的门诊就诊和住院。在 1011646 名（96%为男性，平均年龄 68.4 岁）诊断为 COPD 的患者中，有 407363 名（38.8%）患有失眠。在调整混杂因素后，失眠与更高的门诊就诊、住院、皮质类固醇和/或抗生素的处方次数、更长的住院时间以及索引日期后 12 个月住院费用增加 10344 美元相关。这些发现强调了失眠作为减轻 COPD 患者和医疗保健系统负担的潜在可改变目标的重要性。
