LAUSR

Insomnia and OSA, comorbidly known as COMISA, are the two most common sleep disorders. There is limited real world evidence comparing these patient groups and understanding their burden on the US healthcare system. This study compares real world data from patients with COMISA to those with OSA or insomnia alone from a US national sample. This retrospective study used insurance claims data (commercial, Medicare Advantage, Medicaid) from patients with insomnia and patients with OSA. COMISA patients were identified from the OSA patients that had evidence of insomnia (ICD-9/10 diagnosis code or insomnia prescription fill) in the year prior to and year post OSA diagnosis. The index date for patients with insomnia was the first evidence of insomnia. The index date for patients with OSA and COMISA was the sleep test with an OSA diagnosis. Demographics, comorbid conditions, and healthcare costs were described for each patient group. Overall, 14.5% of patients with insomnia also had a diagnosis of OSA, and 23.0% of patients with OSA also had a diagnosis of insomnia. After applying inclusion/exclusion criteria, the study had 1,075,339 patients with insomnia only, 1,272,333 patients with OSA only, and 157,894 with COMISA. Patients with insomnia were more commonly female (64%), OSA more commonly male (59%), and COMISA more evenly split (53% female/47% male). Patients with COMISA had a higher number of conditions (aside from OSA and insomnia) than patients with OSA or insomnia alone (mean number of conditions: 3.3 vs OSA: 2.6, insomnia: 2.1). Patients with OSA or COMISA had a markedly higher prevalence of cardiac conditions, respiratory conditions, and hyperlipidemia. Those with insomnia or COMISA had a markedly higher prevalence of depression and anxiety. COMISA patients were the most expensive to the healthcare system with total annual costs averaging $12,492 per patient (insomnia: $9,672, OSA: $9,589), stemming from increased costs in outpatient hospitalizations, office visits, and prescription medications. Patients with COMISA have more conditions and cost the healthcare system more than patients with OSA or insomnia alone. Further research and treatment innovation is needed to support sustainable treatment options to mitigate this cost burden. ResMed