Chest
Volume 120, Issue 2, August 2001, Pages 377-383
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Clinical Investigations
Obesity And Hypoventilation
The Use of Health-Care Resources in Obesity-Hypoventilation Syndrome

https://doi.org/10.1378/chest.120.2.377Get rights and content

Objective

To document health-care utilization (ie, physician claims and hospitalizations) in patients with obesity-hypoventilation syndrome (OHS), for 5 years prior to the diagnosis and for 2 years after the diagnosis and initiation of treatment.

Design

Retrospective observational cohort study.

Setting

University-based sleep disorders center in Manitoba, Canada.

Patients and control subjects

Twenty OHS patients (mean [± SD] age, 52.7 ± 9.5 years; body mass index [BMI], 47.3 ± 11.0 kg/m2; Paco2, 59.7 ± 13.8 mm Hg; Pao2, 51.6 ± 12.4 mm Hg) were matched to two sets of control subjects. First, each case was matched to 15 general population control subjects (GPCs) by age, gender, and geographic location, and, second, each case was matched to a single obese control subject (OBC) who was matched using the same criteria as for the GPCs, plus the measurement of BMI.

Measurements and results

In the 5 years before diagnosis, the 20 OHS patients had (mean ± SE) 11.2 ± 1.8 physician visits per patient per year vs 5.7 ± 0.8 (p < 0.01) visits for OBCs and 4.5 ± 0.4 (p < 0.001) visits for GPCs. OHS patients generated higher fees, $623 ± 96 per patient per year for the 5 years prior to diagnosis compared to $252 ± 34 (p < 0.001) for OBCs and $236 ± 25 (p < 0.001) for GPCs. OHS patients were much more likely to be hospitalized than were subjects in either control group in the 5 years prior to diagnosis (odds ratio [OR] vs GPCs, 8.6) (95% confidence interval [CI], 5.9 to 12.7); OR vs OBCs, 4.9 (95% CI, 2.3 to 10.1). In the 2 years after diagnosis and the initiation of treatment (usually continuous positive airway pressure or bilevel positive airway pressure), there was a significant linear reduction in physician fees. In the 2 years after the initiation of treatment, there was a 68.4% decrease in days hospitalized per year (5 years before treatment, 7.9 days per patient per year; after 2 years of treatment, 2.5 days per patient per year[p = 0.01]).

Conclusions

OHS patients are heavy users of health care for several years prior to evaluation and treatment of their sleep breathing disorder; there is a substantial reduction in days hospitalized once the diagnosis is made and treatment is instituted.

Section snippets

Materials and Methods

This study was conducted in the Province of Manitoba (1997 population, 1,147,90016) where all residents have equal access to government-funded health care. Standardized data, based on every physician and hospital contact, are submitted to Manitoba Health, the provincial agency responsible for funding. This information (including patient identification, physician claims, diagnoses, costs, hospitalization, and institutionalization data) is maintained and controlled in the Manitoba Health Database

Results

The group of 20 OHS patients was made up of 8 men and 12 women. The mean (± SD) patient age was 52.7 ± 9.5 years, and the average BMI was 47.3 ± 11.0 kg/m2 (range, 33.9 to 69.0 kg/m2). The mean FEV1 was 64.4 ± 17.3% predicted, and the mean FEV1/FVC ratio was 77.0 ± 12.7%. The patients were significantly hypercapnic and hypoxemic (Paco2, 59.7 ± 13.8 mm Hg; Pao2, 51.6 ± 12.4 mm Hg).

Polysomnography revealed an average AHI of 20.7 ± 23.9 and marked hypoxemia during sleep, with patients spending

Discussion

An individual is overweight with a BMI of > 25 kg/m2, and obesity can be defined as a weight that is > 20% above ideal body weight or a BMI if > 30 kg/m2.1 Obesity is becoming a worldwide problem.1234 Morbid obesity, BMI (> 40 kg/m2), results in serious sequelae that place a burden on the health-care system. It has been estimated that the direct cost of obesity in Canada is about $2 billion per annum, or 2.4% of the total health-care budget.5 This is a result of long-term detrimental health

Conclusions

OHS patients are heavy users of health-care resources for several years prior to the evaluation and treatment of their sleep breathing disorder, and there is a substantial reduction in days hospitalized once treatment is instituted.

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    Supported in part by National Institutes of Health grant R01 HL63342–01A1.

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