Do Your Patients Have Poor Sleep Health?

An analysis of the 2010 Behavioral Risk Factor Surveillance System (BRFSS) database [CDC BRFSS] showed the following relationship between body-mass index and self reported measures of poor sleep health. More disturbed sleep is reported in both underweight (BMI < 18.5) and obese (BMI > 30) patient populations, which could create an opportunity for risk-based stratification for further diagnostic testing.

Utilization of Diagnostics for Sleep Apnea

State-by-state variations in sleep health are undoubtedly due to a large number of factors. Using publically available data sources from the Center for Medicare and Medicaid Services, it's possible to look at individual state's utilization (Medicare Part B) of diagnostic testing for sleep apnea, as a function of the state's Medicare population.

In the graph below, it is interesting to observe that Kentucky and West Virginia have relatively low utilization rates for polysomnography, despite having a higher proportion of overweight and obese individuals (red lines) who have self reported getting poor sleep (graph in previous section).

It is our hope that these insights will increase awareness in the provider and payer (both health and auto insurance) communities and improve the sleep health of countless individuals.

Creating a Learning Healthcare System

The analyses presented here are initial insights gleaned from large, publicly available datasets. The digital health information technology infrastructure being deployed throughout the United States today has the power to revolutionize the quality of our healthcare system. For example, patient specific information from electronic health records should trigger care providers with recommendations for diagnostic testing based on a personal risk assessment. By monitoring billing transactions, and ultimately, diagnosis codes we can assess the efficacy and effectiveness of these clinical decision support triggers, and in a closed loop fashion, adapt the algorithms to improve continuously from the newly created knowledge.