Investigating the Link Between Insomnia and COPD-Related Healthcare Costs

Faith Luyster, PhD

Research suggests insomnia could be a mediator in reducing the burden of Chronic Obstructive Pulmonary Disease (COPD) on patients and healthcare systems. According to the study treating insomnia may have a significant impact on decreasing healthcare utilization and conserving costs related to the disease.

As a condition that affects millions of people worldwide, and a leading cause of morbidity and mortality, COPD is a prominent public health concern. In recent years, the association between insomnia and adverse COPD outcomes has been increasingly recognized, with evidence suggesting that insomnia is associated with exacerbations of COPD.

However, not much is known about the impact of insomnia on COPD-related healthcare utilization and costs, as stated by the study. This investigation aimed to examine the associations between these costs and insomnia in patients with COPD.

Faith Luyster, School of Nursing, University of Pittsburgh, and a team of investigators gathered data from the National Veterans Affairs (VA) administration database for fiscal years 2012-2017 to identify a retrospective cohort of veterans with COPD.

Burden of Insomnia on Healthcare and Patients

The study included more than 1 million individuals, most of which were men (96%, mean age 68.4 years) who were diagnosed with COPD. Within this population, 407,363 (38.8%) had insomnia.

After adjusting for confounders, investigators found that insomnia was associated with higher rates of outpatient visits, hospitalizations, and fills for medications like corticosteroids and antibiotics, as well as a longer hospital length of stay. Additionally, an increase of $10,344 higher was observed in hospitalization costs within the year following the index date.

For this evaluation, insomnia was defined as having an insomnia diagnosis based on International Classification of Disease codes or having a prescription of 30 doses or less 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 were met.

COPD and Insomnia: Evaluating the Relationship

Study initiation for those without insomnia had an index date set by that of the COPD index date. The primary outcomes were 1-year healthcare utilization and costs related to outpatient visits and hospitalizations after that date.

COPD-related healthcare utilization variables included the number of prescription fills (corticosteroids, antibiotics) and outpatient visits and hospitalizations, with a primary diagnosis of COPD.

Investigators noted that additional studies are needed to investigate the mechanisms underlying the association between insomnia and adverse COPD outcomes and to explore the potential benefits of insomnia treatment in patients with COPD.

"Insomnia was associated with increased COPD-related healthcare utilization and costs," they wrote. "Patients with insomnia had hospital stays that were 38% longer than patients without insomnia, which likely contributed to greater hospitalization-related costs among patients with insomnia."

References:

1. Luyster FS, Boudreaux-Kelly MY, Bon JM. Insomnia in chronic obstructive pulmonary disease and associations with healthcare utilization and costs. Respir Res. 2023;24(1):93. Published 2023 Mar 25. doi:10.1186/s12931-023-02401-w