Abstract
Abstract
Introduction:
Sleep disorders are associated with hypertension and cardiovascular diseases (CVD), and treatment of sleep disorders may improve outcomes. To examine burden of sleep disorders, treatment rates, and racial/ethnic differences among patients with hypertension/CVD, we examined the national burden of sleep disorders, compared with rates of sleep disorder treatments, and evaluated whether racial/ethnic disparities exist among patients with hypertension/CVD.
Methods:
We analyzed data from a nationally representative US sample of 417,950 adult ambulatory visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), 2005–2012. We identified visits by adults with hypertension or CVD (coronary artery disease, congestive heart failure, or stroke) in which a diagnosis of sleep disorders or complaints were recorded. Primary measures were provision of a sleep study, medication, or behavioral therapy to improve diet, weight loss, or exercise). We conducted multivariate logistic regression analyses to examine sleep disorder treatment by demographic and clinical risk factors.
Results:
Sleep apnea was identified in 11.1-per-1,000 visits and insomnia in 10.5-per-1,000 visits, while any sleep disorder was identified in 22.5-per-1,000 visits. Overall, patients with hypertension and a sleep disorder were referred for a sleep study in 7.6% of visits, prescribed sleep medication in 29.7% of visits, and offered behavioral therapy in 31.0% of visits. In adjusted analyses, behavioral therapy was more likely to be provided to patients who were obese compared with those who were normal/overweight (OR=2.89; 95%CI[2.00–4.17];p<0.001), but less likely to be provided to smokers than nonsmokers (OR=0.61; 95%CI[0.38–0.99];p<0.05). Non-hispanic blacks were less likely to receive medications than were non-Hispanic whites (OR=0.44; 95%CI[0.21–0.92];p<0.05). There were no differences in sleep study by race/ethnicity, but patients with insomnia were less likely to be referred for a sleep study compared with patients with sleep apnea (OR=0.07; 95%CI[0.03–0.18];p<.001).
Conclusion:
Although sleep disorders were observed in a small proportion of patients with hypertension/CVD, the prevalence rates were relatively lower than those reported for the general population. Behavioral therapy was provided in a small number of visits, and non-Hispanic Blacks were less likely to receive medications than non-Hispanic Whites.
Support (If Any):
NHLBI (R25HL116378).
