Table 1.
Untreated OSAS puts patients at increased risk for the following health conditions.
| Condition | Quantified risk | Quantified costs | Reference |
|---|---|---|---|
| Hypertension | Sleep apnea is an independent risk factor for hypertension. 89% of patients with resistant hypertension have moderate sleep apnea. About 50% of essential hypertension patients have sleep apnea; about 50% of apnea patients have hypertension. | In 2010 high blood pressure cost the US $93.5 billion in health care services (Centers for Disease Control). In 2008 the cost of treating hypertension in the US was $50.6 billion (American Heart Association (AHA)). Patients with OSAS are 2–3 times more likely to be taking antihypertensive medications than controls (more prescriptions, more doses, greater cost). | Pepperd 20003 Nieto 20004 Otake 200244 Young 20092 Lurie 201135 Pedrosa 201136 Roger 201284 Phillips 20135 Lloberes 201498 Schein 201423 |
| Heart failure | Male patients with OSAS are 6 times or more likely to be treated for congestive heart failure compared to controls. OSAS patients have reduced left ventricular ejection fraction. | It has been estimated by the AHA that the cost of treating heart failure in the USA in 2015 will be $44.6 billion. | Shahar 200112 Smith 200271 Roger 201284 Sun 201337 |
| Arrhythmias | Atrial fibrillation is very common in sleep apnea. Untreated sleep apnea independently predicts atrial fibrillation recurrence in patients undergoing ablation therapy. Patients with severe OSAS are less likely to respond to antiarrhythmic drug therapy. OSAS patients who had a stroke had higher rates of atrial fibrillation. | The annual direct cost of treating a single patient with atrial fibrillation is $8705. The annual cost to the USA is $26 billion. | Gami 200838 Albuquerque 201239 Bitter 201240 Monahan 201242 Mansukhani 201241 Roger 201284 Goyal 201499 Vizzardi 201417 |
| Coronary artery disease | Men with sleep apnea are more likely to have coronary heart disease, and are more likely to have fatal and nonfatal cardiovascular events if untreated. Women with sleep apnea also have increased risk of coronary heart disease, and their risk is attenuated by use of CPAP. | The cost of coronary heart disease in the US is about $190 billion per year. The average cost for treating acute myocardial infarction in 2006 was about $14,000 per patient. | Selim 201015 Marin 201214 Roger 201284 Loo 201413 Campos-Rodriguez 20148 |
| Stroke | There is a strong association between sleep apnea and the subsequent development of ischemic stroke, which can be attenuated with CPAP use. | The cost of treating stroke in the US in 2008 was $34.3 billion (AHA). The lifetime cost of treating a single patient with stroke is likely between $100,000 and $300,000. | Taylor 199685 Yaggi 200511 Redline 201010 Roger 201284 Cho 201343 Campos-Rodriguez 20148 |
| Metabolic syndrome | Sleep apnea is associated with the metabolic syndrome in women and men. | The age-adjusted prevalence for metabolic syndrome is 35.1% for men and 32.6% for women. Each component of the syndrome is associated with increased costs for hypertension ($550), obesity ($366), low high-density lipoprotein ($363), and high triglycerides ($317) (P < 0.001 for all). | Nichols 201159 Hall 201258 Roger 201284 Schmitt 201360 Lin 201457 |
| Type II diabetes | In adults without known diabetes, increasing OSAS severity is independently associated with impaired glucose metabolism, higher HbA1c values, increasing them to higher risks of diabetes. Sleep apnea is associated with impairments in insulin sensitivity, glucose effectiveness, and pancreatic beta-cell function. | In 2007, the direct ($116 billion) and indirect ($58 billion) cost attributable to diabetes was $174 billion. | Reichmuth 20056 Punjabi 20097 CDC 201145 Priou 201247 Guest 2014100 |
| Depression | Depression is more than two times more common in females with sleep apnea than the general population. Depressive symptoms may improve with apnea treatment. | The cost of depression was $ 83.1 billion dollars in 2000: $ 26.1 billion (31%) were direct medical costs, $5.4 billion (7%) were suicide-related mortality costs, and $51.5 billion (62%) were workplace costs. | Smith 200271 Greenberg 200346 El-Sherbini 201170 Gagnadoux 2014101 |
| Adverse perioperative event | Untreated sleep apnea patients are much more likely to develop serious perioperative events including cardiac arrest and respiratory failure that require ICU stays. | Mean intensive care unit cost and length of stay were $31,574 and 14.4 days for patients requiring mechanical ventilation and $12,931 and 8.5 days for those not requiring mechanical ventilation. | Dasta 200549 Vasu 201248 Gaddam 2013102 Memtsoudis 201464 Stundner 201463 Mutter 201450 |
| Cancer | Cancer rate is increased particularly in patients with hypoxemia and with sleep apnea. Cancer-related mortality increases with hypoxemia and severity of sleep apnea in younger patients. | Unknown | Rich 201119 Nieto 201261 Martinez-Garcia 2014103 Chen 2014104 Marshall 2014105 |
| Death | Death rate is increased, particularly in patients less than 50 years of age. | Not applicable | Young 200818 Rich 201119 Marshall 2014105 |