Children with Sleep Disorders Have Double the Odds of Increased Health Care Usage

Pranshu Adavadkar, MD

Credit: University of Illinois, College of Medicine

Among children with a chronic medical condition those with specific sleep disorders had nearly double the odds of having increased health care utilization, a new study reported.¹

“The results were impressive, suggesting a clear role of sleep disorders in health care utilization in children with chronic medical conditions,” said lead investigator Pranshu Adavadkar, MD, associate professor in the department of pediatrics at the University of Illinois Chicago, in an American Academy of Sleep Medicine press release.²

The odds were only increased for the sleeping disorders of sleep-disordered breathing, insomnia, and circadian rhythm sleep disorder.¹

Children with chronic medical conditions, such as asthma and diabetes, face health burdens and have increased utilization—and thus cost—of health care. Sleep disorders only exacerbate these health challenges.

Adavadkar and colleagues conducted a study to assess the risk of increased health care utilization associated with sleep disorders in children with chronic medical conditions. They leveraged Medicaid data from a cohort of children enrolled in the Coordinated Healthcare for Complex Kids project. The study included 3052 participants aged 0 to 18 years with ≥ 1 chronic medical condition.

Most participants (77%) had multiple chronic medical conditions. The chronic medical conditions in the study included asthma/respiratory disorders, developmental disorders, ADHD, diabetes/metabolic disorders, overweight/obesity, prematurity, neurologic disorders, and mood disorders. Investigators also evaluated the link between health care utilization for children with either 1 or multiple chronic medical conditions.

The team divided participants based on their prior hospitalizations and emergency department visits in the 12 months before the enrollment: low (no hospitalization or emergency department visit; n = 7486), medium (1 -2 hospitalizations or 1 – 2 ED visits; n = 8063), and high (≥ 3 hospitalizations or ≥ 4 emergency department visits; n = 776). Children with sickle cell disease were excluded from the study because they would be automatically placed in the “high” group.

Children aged 0 – 2 years were the most prevalent age group in the high health care utilization group (32.1%). The 6 – 10-year age group was the most prevalent in the low (32.1%) and medium (26.7%) health care utilization groups.

Although health care utilization did not vary significantly by sex, it did for race and ethnicity. Black and Hispanic children were more prevalent in the low health care utilization group 38.2% and 22.5%, respectively) than the High health care utilization group (29% and 18.3%, respectively).

The team observed children with ≥ 2 chronic medical conditions were most likely to have high health care utilization (87%) and were the least likely to be in the low health care utilization group (71.9%). In contrast, children with only 1 chronic medical condition were more likely to use less health care (28.1%) than more health care (13%).

Investigators analyzed each sleep disorder with the covariates of age group, race, and chronic medical conditions with the multivariable cumulative logistic regression analysis. Overall, investigators observed children with both chronic medical conditions and a sleep disorder had nearly twice the odds of having increased health care utilization compared with children without a sleep disorder (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.67 – 2.01). However, only specific sleep disorders increased the odds, which were sleep-disordered breathing (OR, 1.51; 95% CI, 1.17 – 1.95), insomnia (OR, 1.46; 95% CI, 1.06 – 2.02), and circadian rhythm sleep disorder (OR, 2.45; 95% CI, 1.07 – 6.64).

Black and Hispanic children were linked to nearly a 50% lower risk of increased health care utilization compared with White children (OR, 0.58; 95% CI, 0.45 – 0.73). The risk of health care utilization reduced with age (OR, 0.94; 95% CI, 0.94 – 0.95).

After adjusting for other chronic medical conditions, sleep disorders, and demographic factors, the team observed increased risks for health care utilization risks for asthma/respiratory disorders (OR, 1.53; 95% CI, 1.40 – 1.67), prematurity (OR, 2.31; 95% CI, 1.94 – 2.76), neurologic disorders (OR, 2.28; 95% CI, 1.87 – 2.78) and mood disorders (OR, 1.75; 95% CI, 1.57 – 1.95). Developmental disorders were linked to a decreased risk of health care utilization (OR, 0.49; 95% CI, 0.40 – 0.60), and obesity and diabetes/metabolic were not associated with increased health care utilization risk.

“Understanding the specific sleep disorders that significantly increase health care utilization risk can inform targeted interventions and screenings for better management of these high-risk children,” Adavadkar said.²

^References

1. ^{Adavadkar PA, Brooks L, Pappalardo AA, Schwartz A, Rasinski K, Martin MA. Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. J Clin Sleep Med. 2024;20(4):595-601. doi:10.5664/jcsm.10936}
2. ^{Health Care Utilization Is Increased in High-Risk Children Who Have A Sleep Disorder. American Academy of Sleep Medicine. April 1, 2024. https://aasm.org/health-care-utilization-is-increased-in-high-risk-children-who-have-a-sleep-disorder/. Accessed April 15, 2024.}