Association of sleep study outcomes and health care utilization in children with sickle cell disease: a multicenter study.

Sickle cell disease (SCD) is associated with increased health care utilization. Sleep disorders have been linked to increased SCD complications. We aimed to study the association between sleep study outcomes and health care utilization in children with SCD. This is a multicenter retrospective cohort study of children with SCD who underwent polysomnography (PSG) in 3 centers in the United States. We reviewed health care utilization (emergency department [ED] visits, hospital admissions, and total encounters) related to SCD 2 years before and after the PSG. A total of 210 children with SCD from the 3 centers with PSG were included in the analysis. Univariate analysis showed that nocturnal hypoxemia (lower mean oxygen saturation percent [SpO2] and a higher percentage of total sleep time spent with SpO2 <90% [TST90]) and increased periodic leg movement index correlated with increased health care utilization; however, obstructive sleep apnea and arousal index did not. Older age, sickle cell anemia genotypes, hemoglobin level, and hydroxyurea use also correlated with increased health care utilization. After including age, genotype, and hemoglobin in a multivariate linear regression analysis, only percent TST90 maintained a significant association with health care utilization. In conclusion, our study showed that nocturnal hypoxemia (indicated by higher percent TST90) is associated with increased health care utilization (more than doubled) in children with SCD. Our multicenter study determined targetable interventions that could reduce ED visits and hospital admissions in children with SCD. Further studies are needed to confirm these results and study the effect of interventions to treat sleep disorders on health care utilization in SCD.