scholarly journals 0538 What Happens After Prescription of Insomnia Medication Among Older Adults?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A206-A206
Author(s):  
S L Jobe ◽  
J S Albrecht ◽  
S M Scharf ◽  
A M Johnson ◽  
E M Wickwire
Keyword(s):  
Older Adults ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Sleep Disturbances ◽  
International Classification Of Diseases ◽  
Prior History ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Sleep Complaints ◽  
Obstructive Sleep

Abstract Introduction Despite consensus recommendations regarding need for caution and careful management, sedative hypnotic insomnia therapies remain commonly prescribed among older adults. Further, sleep medications are often prescribed in the absence of a thorough sleep history or evaluation. However, little is known about delivery of sleep-related care following prescription of insomnia medications. Thus, the purpose of this study was to characterize the course of sleep-related care following a prescription fill for insomnia medication among older adults. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Insomnia medications were identified by searching the Part D prescription drug claims and included FDA-approved insomnia-related medication classes and drugs. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of insomnia medication users who received sleep disorder diagnoses. Results A total of 33,252 Medicare beneficiaries without prior history of sleep disorders received at least one FDA-approved insomnia medication fill between 2006-2013. Of these, 43.2% (n=14,354) eventually received a sleep disorder diagnosis. Among those receiving a sleep diagnosis after being prescribed insomnia medication, insomnia was the most common disorder (71.0%; n=10,198). Further, 15.0% (n=2,149) of individuals who were prescribed insomnia medication received an obstructive sleep apnea diagnosis, 6.6% (n=947) were diagnosed with sleep disturbances, and 5.9% (n=845) were diagnosed with restless legs syndrome. Of those who received a sleep disorder diagnosis, 95.1% (n=13,649) were diagnosed with one sleep disorder, 4.5% (n=639) were diagnosed with two sleep disorders, and 0.4% (n=66) were diagnosed with three or more sleep disorders. Conclusion Fewer than half of Medicare beneficiaries prescribed FDA-approved sedative hypnotic insomnia medications ever received a formal sleep-related diagnosis. These results suggest that clinicians prescribe sedative hypnotics without thoroughly evaluating sleep complaints. Support This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

scholarly journals 1183 Board-certified Sleep Medicine Physicians See A Greater Proportion Of Complex Sleep Patients Than Non-specialist Providers

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A452-A452
Author(s):  
S L Jobe ◽  
J S Albrecht ◽  
S M Scharf ◽  
A M Johnson ◽  
S Parthasarathy ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Sleep Medicine ◽  
Board Certification ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Sleep Complaints ◽  
Obstructive Sleep ◽  
The Impact

Abstract Introduction Despite a growing literature regarding the impact of board-certification in sleep medicine, little is known about the complexity of patients seen by board-certified sleep medicine physicians (BCSMPs) relative to non-specialists. To address this gap, the purpose of the current study was to evaluate the differences in sleep complaints among Medicare beneficiaries seen by BCSMPs relative to individuals seen by non-specialists. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of sleep disorder diagnoses patients received by provider status. BCSMPs were identified using a cross-matching procedure based on National Provider Identifier (NPI). Results A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013. Of these, only 2.2% were seen by BCSMPs. Relative to beneficiaries seen by non-specialists, those seen by BCSMPs were more likely to be diagnosed with more than one sleep disorder (p<0.001). Specifically, 91.0% of individuals seen by non-specialists received only one sleep disorder diagnosis, whereas 75.9% of individuals seen by BCSMPs received only one sleep disorder diagnosis. Among beneficiaries seen by non-specialists, the most common sleep disorders were insomnia (48.2%; n=26,967), obstructive sleep apnea (OSA; 31.4%; n=17,554), and restless legs syndrome (8.7%; n=4,871). Among those seen by BCSMPs, the most common sleep disorders were OSA, (70.4%; n=901), sleep apnea with hypersomnia (16.5%; n=211), and insomnia (11.7%; n=150). Conclusion BCSMPs see more complex sleep patients than do non-specialists. These results suggest the possibility that more complex patients are referred for sleep specialty care. Further, these results demonstrate the value of board certification in sleep medicine in caring for complex sleep patients. Support This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

scholarly journals 1178 Predictors Of Being Seen By A Board-certified Sleep Medicine Provider

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A450-A450
Author(s):  
J M Levri ◽  
S Jobe ◽  
J Albrecht ◽  
S Scharf ◽  
A Johnson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disorder ◽  
Demographic Data ◽  
International Classification Of Diseases ◽  
Sleep Medicine ◽  
Multivariate Logistic Regression Model ◽  
Administrative Claims ◽  
Obstructive Sleep ◽  
The Impact

Abstract Introduction Although several studies have evaluated the impact of board-certification in sleep medicine regarding obstructive sleep apnea treatment outcomes, no studies to date have identified predictive factors to determine which patients are evaluated by board-certified sleep medicine providers (BCSMP) in the clinical practice. Thus, the purpose of this study was to identify predictors of being seen by a BCSMP, relative to non-sleep specialist providers. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorder diagnoses such as insomnia, obstructive sleep apnea, restless legs syndrome, hypersomnias, and parasomnias, as well as medical comorbidities including cardiovascular, cerebrovascular, mood, pulmonary, and neurological disorders, were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographic data were obtained from the claims. BCSMP were identified using a novel cross-matching approach based on National Provider Identifier (NPI). Results A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013, but only 1,279 (2.2%) of these individuals were ever seen by a BCSMP. Within a multivariate logistic regression model, male gender, asthma, and heart failure were significantly associated with being seen by a BCSMP. Additionally, BCSMP were more likely to evaluate patients with two or more sleep diagnoses. Conclusion Complexity of sleep disorders and cardiovascular and lung comorbidities were predictive of being seen by a BCSMP. These results demonstrate the importance of BCSMPs in caring for complex sleep medicine patients. Support This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

616 Restless sleep and other comorbidities in children with attention deficit hyperactivity disorder

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A242-A242
Author(s):  
Vidhi Kapoor ◽  
Raffaele Ferri ◽  
Mark Stein ◽  
Chris Ruth ◽  
Jennifer Reed ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Sleep Disturbances ◽  
Psychiatric Comorbidities ◽  
Children With Adhd ◽  
Hyperactivity Disorder ◽  
Obstructive Sleep ◽  
Pediatric Sleep Medicine

Abstract Introduction The etiology of restless sleep has recently been identified as secondary to various medical and sleep conditions. Parents of children with ADHD complain of restless sleep and sleep disturbances in their children. We aimed to assess restless sleep causes in our patient population with ADHD and establish the prevalence of restless sleep disorder (RSD), as recently defined. Methods A retrospective study of children with ADHD who underwent polysomnography was carried out. Diagnostic and descriptive information collected for each patient included age, sex, polysomnographic parameters, sleep disorders, psychiatric comorbidities, and medications. Results Sixty-six PSGs were reviewed. The mean age of children was 11.6 (±3.6 SD) years; 17 were female and 49 were male. Parents of 54 (81.1%) children had concerns of restlessness during sleep; 47 (71.2%) children had obstructive sleep apnea, 17 (25.8%) had PLMS ≥5/hour, 13 (19.7%) had RLS, 6 (9.1%) had RSD, 27 (41%) had depression or anxiety, 5 (7.6%) had insomnia. Conclusion In a pediatric sleep medicine referred group of patients with ADHD, who are known to have significant sleep and psychiatric comorbidities, obstructive sleep apnea, RLS, and RSD were found to be the most prevalent sleep disorders, whereas depression and anxiety were the most common psychiatric disorders. Complaint of secondary restless sleep seems to be common, while primary restless sleep disorder was seen in approximately 9% of children. The results of this study aid pediatricians and child psychiatrists in screening children with ADHD for associated sleep disorders. Support (if any):

scholarly journals Sleep in Older Adults and Its Possible Relations With COVID-19

2021 ◽  
Vol 13 ◽  
Author(s):  
Gabriel Natan Pires ◽  
Isabela Antunes Ishikura ◽  
Sandra Doria Xavier ◽  
Caetano Petrella ◽  
Ronaldo Delmonte Piovezan ◽  
...  
Keyword(s):  
Older Adults ◽  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Slow Wave Sleep ◽  
Sleep Onset ◽  
Community Dwelling ◽  
Sleep Onset Latency ◽  
Wake Time ◽  
Obstructive Sleep

Since the beginning of the COVID-19 pandemic, older adults have been found to be a highly vulnerable group, with a higher prevalence of severe cases and negative outcomes. Research has focused on the reasons why older adults are at greater risk; Sleep-related factors have been suggested as one possible explanation for this. An individual’s sleep pattern undergoes significant changes over the course of their life. In older adults a specific sleep profile can be observed, one characterized by advanced sleep timing, a morningness preference, longer sleep-onset latency, shorter overall sleep duration, increased sleep fragmentation, reduced slow-wave sleep and, increased wake time after sleep onset. Additionally, an increased prevalence of sleep disorders can be observed, such as obstructive sleep apnea and insomnia. Previous research has already linked sleep disorders (especially sleep apnea) with COVID-19, but few studies have focused specifically on the older population. We believe that the intrinsic sleep patterns of older adults, and the prevalence of sleep disorders in this population, may be important factors that could explain why they are at a greater risk of negative COVID-19 outcomes. In this review, we discuss the relationship between sleep and COVID-19 among older adults, focusing on three different aspects: (1) Sleep-related issues that might increase the likelihood of getting infected by SARS-COV-2; (2) Sleep disturbances that might increase the predisposition to worse COVID-19 prognosis and outcomes; and (3) COVID-19-related aspects affecting community-dwelling older adults, such as social isolation, quarantine, and home confinement, among others, that might impact sleep.

scholarly journals Seizures, Stimulators, and Sleep, Oh My!

2019 ◽  
pp. 629-641
Author(s):  
Thapanee Somboon ◽  
Nancy Foldvary-Schaefer
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Vagus Nerve Stimulation ◽  
Sleep Complaints ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
The Impact

This chapter discusses the relationships between epilepsy and sleep disorders, and the impact of vagus nerve stimulation (VNS) on breathing in sleep. The prevalence of sleep disorders in people with epilepsy is twofold to threefold greater than estimates in the general population. Obstructive sleep apnea (OSA) is the most common sleep disorder investigated in epilepsy populations. Treatment of OSA has been shown to reduce seizures in some patients. In contrast, VNS therapy for epilepsy is associated with stimulation-induced respiratory changes in sleep, and in some cases it produces a clinical OSA syndrome. Given the high prevalence of sleep complaints among people with epilepsy, further research is warranted to confirm the role of sleep disorder therapies in epilepsy.

scholarly journals Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽  
2021 ◽  
Author(s):  
G L Dunietz ◽  
R D Chervin ◽  
J F Burke ◽  
A S Conceicao ◽  
T J Braley
Keyword(s):  
Older Adults ◽  
Statistical Significance ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Lower Odds ◽  
Logistic Regression Models ◽  
Not Otherwise Specified ◽  
Dementia Risk ◽  
Obstructive Sleep ◽  
Study Participants

Abstract Study Objectives To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults. Methods This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses. Results In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76). Conclusions PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.

Integrative Sleep Medicine

2021 ◽  
Keyword(s):  
Circadian Rhythm ◽  
Sleep Disorders ◽  
Health Care Providers ◽  
Sleep Disturbances ◽  
Well Being ◽  
Sleep Medicine ◽  
Whole Body ◽  
Care Providers ◽  
Obstructive Sleep ◽  
The Many

Sleep is one of the key underpinnings of human health, yet sleep disturbances and impaired sleep are rampant in modern life. Healthy sleep is a whole-body process impacted by circadian rhythm, daily activities, and emotional well-being, among others. When properly aligned, these work in concert to produce restorative and refreshing sleep. When not in balance, however, sleep disorders result. Yet too often, the approach to treatment of sleep disorders is compartmentalized, failing to recognize all of the complex interactions that are involved. This text offers a comprehensive approach to sleep and sleep disorders by delineating the many factors that interplay into healthy sleep. Health care providers can learn how to better manage their patients with sleep disorders by integrating complementary and conventional approaches. Using an evidence-based approach throughout, this book describes the basics of normal sleep then delves into the foundations of integrative sleep medicine, including the circadian rhythm, mind/body-sleep connection, light, dreaming, the gastrointestinal system, and botanicals/supplements. Specific sleep issues and disorders are then addressed from an integrative perspective, including insomnia, obstructive sleep apnea, sleep related movement disorders, and parasomnias.

scholarly journals The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Jeff A. Dennis ◽  
Ahmad Alazzeh ◽  
Ann Marie Kumfer ◽  
Rebecca McDonald-Thomas ◽  
Alan N. Peiris
Keyword(s):  
Sleep Apnea ◽  
Sleep Disturbance ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Inflammatory Markers ◽  
Sleep Disturbances ◽  
Laboratory Data ◽  
Poor Sleep ◽  
Distribution Width ◽  
Inflammatory Status

Background/Objective. Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. Methods. Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. Results. Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. Conclusion. Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.

scholarly journals Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. 31-40
Keyword(s):  
Older Adults ◽  
Claims Data ◽  
The United States ◽  
Prescription Opioid ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

scholarly journals Sleep disorders in migraine

2021 ◽  
pp. 111-120
Author(s):  
N. V. Vashchenko ◽  
A. I. Kozhev ◽  
Ju. E. Azimovа
Keyword(s):  
Combination Therapy ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Mutual Influence ◽  
Integrated Approach ◽  
Epidemiological Studies ◽  
Exact Nature ◽  
Obstructive Sleep ◽  
Underlying Mechanisms

Migraine and sleep disorders are common in the general population, may be associated with each other and often significantly reduce patients’ quality of life. Clinicians and epidemiological studies have long acknowledged a link between these conditions. However, the exact nature of this relationship, its underlying mechanisms and patterns are complex and not fully understood. This publication brings together the latest data on the relationship between migraine and sleep disorders: the biochemical and functional-anatomical background, the mutual influence of these conditions on each other and the typical sleep disturbances in migraine patients (such as insomnia, obstructive sleep apnea, parasomnia, snoring, excessive daytime sleepiness). The paper discusses the hypotheses of pathogenetic relationships based on the studies of the central nervous system’s anatomical and physiological features in people with migraine and sleep disorders. The available data should encourage physicians to evaluate sleep quality in migraineurs and use combination therapy systematically. The therapy of insomnia is reviewed: both nonpharmacological and pharmacological therapies are discussed; the advantages of an integrated approach are discussed, and a brief overview of each group of medications is offered.Lastly, a case study of a patient with chronic migraine and insomnia treated with Doxylamine in combination therapy is presented. Treatment with Doxylamine significantly reduced the incidence of insomnia, probably thereby positively influencing the course of migraine as well.

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