Has the Prevalence of Sleep Disorders Grown in Recent Years?

The prevalence of sleep disorders such as narcolepsy and obstructive sleep apnea (OSA) increased appreciably from 2013 to 2016, according to study findings published in the Journal of Clinical Sleep Medicine.

The evolution of sleep issues from being characterized as symptoms to disorders has increased awareness of the debilitating effect they can have alone or as comorbid conditions. When assessing for potential sleep disorders, there are 3 main complaints that have contributed to tentative diagnoses: insomnia, daytime somnolence, and sleep-associated motor phenomena. A recent review recommended that when taking a patient history, specific questions are needed to ensure proper diagnosis and enable strategic treatments.

For a sleep disorder such as narcolepsy, which is diagnosed via multiple sleep latency tests, a rise in prevalence was observed along with idiopathic hypersomnia (IH) in a prior study.

So, is this increase in prevalence due to greater awareness or increased incidence?

The researchers sought to further assess these trends in narcolepsy prevalence by examining the data of a large insured population with claims activity (Symphony Health) from 2013 to 2016. Along with this primary objective, secondary objectives were to assess the prevalence of other sleep disorders and the frequency of diagnostic sleep testing.

Claims data were analyzed to estimate the annual prevalence per 100,000 patients with narcolepsy and other sleep disorders, including OSA, IH, rapid eye movement sleep behavior disorder, and periodic limb movement disorder. Prevalence was adjusted to the age/sex distribution of the 2016 US census estimates, noted the researchers.

In their analysis, the researchers found that the prevalence of narcolepsy per 100,000 persons increased 14%, from 38.9 in 2013 to 44.3 in 2016. This increased prevalence was additionally observed in other examined sleep disorders:

• OSA prevalence increased 41% over the study period from 2429 to 3420 per 100,000
• IH prevalence increased 32%
• Periodic limb movement disorder increased 30%
• Rapid eye movement sleep behavior disorder increased 64%

“For each sleep disorder, prevalence was higher for those with commercial insurance versus Medicare/Medicaid, and markedly lower prevalence was observed for the Northeast compared with the Midwest, South, and Western US regions,” expanded the study authors.

For the secondary objective of assessing for the frequency of diagnostic sleep testing, multiple sleep latency and maintenance of wakefulness testing declined by 20% and polysomnography by 15%. However, home sleep apnea testing exhibited a significant 177% increase.

Although prevalence trends appear on the rise, researchers highlight that it is still unknown whether this is due to increased incidence or increased awareness, warranting further analyses.

Reference

Acquavella J, Mehra R, Bron M, et al. Prevalence of narcolepsy, other sleep disorders, and diagnostic tests from 2013–2016: insured patients actively seeking care. J Clin Sleep Med. Published online August 15, 2020. doi:10.5664/jcsm.8482