Health, social and economical consequences of sleep-disordered breathing: a controlled national study
Health, social and economical consequences of sleep-disordered breathing: a controlled national study
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DOI：
10.1136/thx.2010.143958
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发表时间：
2011-07-01
期刊：
影响因子：
10
通讯作者：
Kjellberg, Jakob
中科院分区：
文献类型：
--
作者：
Jennum, Poul;Kjellberg, Jakob
睡眠呼吸障碍（打鼾、睡眠呼吸暂停（SA）和肥胖低通气综合征（OHS））的客观直接和间接代价及其治疗尚不完整。方法利用1998-2006年丹麦国家患者登记处的资料，分别选取12045例、19438例和755例诊断为打鼾、SA和OHS的患者。对于每名患者，从丹麦民事登记系统统计中随机选择4名年龄、性别和社会经济相匹配的公民（分别为48 180、77 752和3020）。直接成本提取自丹麦卫生部、丹麦药品管理局和国家卫生安全局，间接成本基于相关社会统计数据。结果打鼾，尤其是SA和OHS，与健康相关的接触率、药物使用率、失业率显著升高有关，并增加了社会经济成本（尤其是间接成本）。这些影响随着SA的严重程度而增加，OHS患者的就业率最低。工作的SA和OHS患者的收入水平低于工作的对照组。打鼾、SA和OHS患者的年度超额直接和间接总费用分别为（sic）705、（sic）3860和（sic）11 320。打鼾、SA和OHS患者的年平均超额社会转移收入分别为（sic）147、（sic）879和（sic）3263。这些社会经济后果在SA和OHS患者首次诊断前8年就存在，并随着疾病进展进一步增加。在2年的观察期内，持续气道正压通气（CPAP）治疗降低了SA患者的死亡率，但没有降低OHS患者的死亡率。结论睡眠呼吸障碍对患者个人和社会都有重大的社会经济后果。尽管CPAP治疗降低了死亡率，但早期发现疾病可能对疾病并发症产生更大的影响。
Background The objective direct and indirect costs of sleep-disordered breathing (snoring, sleep apnoea (SA) and obesity hypoventilation syndrome (OHS)) and the treatment are incompletely described.Methods Using data from the Danish National Patient Registry (1998-2006), 12 045, 19 438 and 755 patients were identified with a diagnosis of snoring, SA and OHS, respectively. For every patient, four age-, sex- and socioeconomic-matched citizens were randomly selected (48 180, 77 752 and 3020, respectively) from the Danish Civil Registration System Statistics Direct costs were extracted from the Danish Ministry of Health, Danish Medicines Agency and National Health Security and indirect costs were based on data derived from the Coherent Social Statistics.Results Snoring, and especially SA and OHS, were associated with significantly higher rates of health-related contact, medication use, unemployment and accounted for increased socioeconomic costs (especially indirect costs). These effects increased with the severity of SA and patients with OHS had the lowest employment rates. The income level of patients with SA and OHS who were employed was lower than that of employed control subjects. The annual excess total direct and indirect costs for patients with snoring, SA and OHS were (sic)705, (sic)3860 and (sic)11 320, respectively. Patients with snoring, SA and OHS received an annual mean excess social transfer income of (sic)147, (sic)879 and (sic)3263, respectively. These socioeconomic consequences were present up to 8 years prior to the first diagnosis in patients with SA and OHS, and further increased with disease advancement. Treatment with continuous positive airway pressure (CPAP) reduced mortality in patients with SA but not in those with OHS within an observation period of 2 years.Conclusion Sleep-disordered breathing has major socioeconomic consequences for the individual patient and for society. Although CPAP treatment reduces mortality, earlier disease detection could have a greater impact on disease complications.