Obstructive sleep apnea (OSA) is a prevalent, yet often underdiagnosed condition characterized by repetitive episodes of partial or complete upper airway obstruction during sleep, leading to disrupted breathing, snoring, and daytime fatigue. Left untreated, OSA imposes significant health and economic burdens, including increased healthcare utilization, costly comorbidities, and reduced workplace productivity. Effective treatment, particularly with positive airway pressure (PAP) therapy, has been shown to reduce acute care and emergency service utilization, lower overall healthcare costs, and improve health and wellness outcomes. Proactive screening for OSA can further amplify these benefits by identifying and treating patients early, preventing costly complications. This article explores these cost-saving benefits, the importance of proactive screening, and includes a graphic to illustrate the impact of treatment, supported by evidence from recent studies.
Proactive screening for OSA is critical to reducing its health and economic toll. Despite affecting an estimated 17% of adults, with prevalence rising to 31% in older populations, OSA remains underdiagnosed, with only 12% of patients initially raising concerns with their physicians and just 30% being warned about the condition by primary care providers. This diagnostic gap contributes to untreated OSA’s estimated $149.6 billion annual cost in the United States, including $30 billion in increased healthcare utilization due to comorbidities like hypertension, heart disease, diabetes, and depression. Proactive screening, using tools like the STOP-Bang questionnaire or home sleep apnea testing, can identify at-risk patients early, particularly those with risk factors such as obesity, advanced age, or a history of snoring.
Early identification through screening allows for timely intervention, preventing the progression of OSA-related complications. For instance, untreated OSA is associated with a 2–3 times higher risk of cardiovascular events, including myocardial infarction and stroke, which drive significant healthcare costs. A study of Medicare beneficiaries found that patients diagnosed and treated for OSA within 12 months had 29% lower healthcare costs compared to untreated patients, highlighting the cost-saving potential of early intervention. Screening also reduces indirect costs, such as workplace productivity losses ($86.9 billion annually) and motor vehicle accidents ($26.2 billion annually), by addressing symptoms like daytime sleepiness that impair performance and safety. By integrating OSA screening into routine primary care, physicians can mitigate these risks, improve patient outcomes, and achieve substantial cost savings.
Clinical trials have demonstrated the efficacy of GLP-1 agonists for weight loss. The STEP 1 trial reported that patients treated with semaglutide 2.4 mg weekly achieved a mean weight loss of 14.9% over 68 weeks, compared to 2.4% with placebo.1 Similarly, liraglutide 3.0 mg daily resulted in a mean weight loss of 8.4% in the SCALE trial.2 These reductions are clinically meaningful, as a 5-10% weight loss is associated with improvements in cardiometabolic risk factors.
Treating OSA, particularly with PAP therapy, significantly reduces the need for acute care and emergency services. A retrospective cohort study involving 1,098 patients with moderate to severe OSA found that every additional hour of PAP usage per night was associated with an 8% decrease in inpatient visits (rate ratio 0.92) and a 4% decrease in overall acute care visits (rate ratio 0.96). Adherent patients, defined as those using PAP for more than four hours per night on at least 70% of nights, experienced significantly fewer emergency department visits and inpatient stays compared to non-adherent patients. Among those with emergency department costs, PAP adherence was linked to 27% lower costs. These findings suggest that consistent PAP use can prevent acute health events, reducing the strain on emergency services and hospitals.
Another study analyzing Medicare claims data from 2016–2018 reported that patients with OSA who received treatment for over 12 months had 29% lower healthcare costs, while those treated for less than 12 months saw a 27% reduction compared to untreated patients. Even patients with comorbidities showed cost reductions of 18–16%, underscoring the broad applicability of these savings. By mitigating the severity of OSA-related complications, such as cardiovascular events or respiratory distress, treatment reduces the frequency and intensity of acute care needs, leading to substantial savings for healthcare systems.
Lowered Costs of Care
The economic burden of untreated OSA is significant, with undiagnosed cases costing the United States approximately $149.6 billion annually. Treating OSA, particularly with PAP therapy, has been shown to be cost-effective by reducing these associated costs. A large-scale study of 179,542 patients newly diagnosed with OSA found that PAP adherence was associated with significantly lower total healthcare costs, with adherent patients incurring mean annual costs of $5,874 compared to $6,523 for intermediately adherent and $6,355 for non-adherent patients. These savings stem from reduced emergency room visits and hospitalizations, as well as lower medication costs for managing comorbidities.
In specific industries, such as transportation, targeted OSA treatment programs have demonstrated significant cost savings. For example, a study of commercial drivers treated with continuous positive airway pressure (CPAP) found an average savings of $550 per driver per month, with hospital admissions reduced by nearly 25% and overall healthcare expenditures cut in half. Similarly, the Union Pacific Railroad Employees Health System reported savings of approximately $200 per member per month through their "Complete Sleep" program, which utilized CPAP to manage OSA. These findings highlight that investing in OSA diagnosis and treatment can yield immediate and long-term financial benefits for both healthcare payers and employers.
From a societal perspective, a cost-of-illness analysis in Italy estimated the total economic burden of OSA at €13.8–41.3 billion annually, with significant portions attributed to indirect costs like lost productivity and motor vehicle accidents. Treating OSA not only reduces direct medical costs but also mitigates these indirect costs, further amplifying savings.
Beyond cost savings, treating OSA significantly enhances patient health and wellness, contributing to both individual quality of life and societal benefits. A survey of 506 patients treated for OSA, commissioned by the American Academy of Sleep Medicine (AASM), reported improved sleep quality, longer nightly sleep duration, and a 40% decline in workplace absences. Health benefits included a 56% improvement in heart disease risk and a 41% reduction in hypertension among treated patients. Additionally, positive behavioral changes, such as a reduction in weekly cigarette consumption from 22.3 to 8.5, were observed, further improving health outcomes.
OSA treatment also enhances health-related quality of life (HrQoL), as measured by quality-adjusted life years (QALYs). A study in Italy estimated that untreated OSA results in a QALY loss valued at €2.8–9.0 billion annually, which can be mitigated through treatment. Therapies like CPAP and oral appliances (OA) improve HrQoL by alleviating symptoms such as daytime sleepiness and fatigue, enabling patients to engage more fully in work and leisure activities. Moreover, treatment reduces the risk of serious comorbidities, including cardiovascular disease, diabetes, and depression, which not only improves patient well-being but also reduces long-term healthcare costs associated with these conditions.
Despite the clear benefits, challenges remain in ensuring widespread OSA diagnosis and treatment adherence. Adherence to PAP therapy, while effective, can be challenging, with studies showing that 60% of patients achieve adherence (using PAP >4 hours per night on ≥70% of nights). Improving patient education, providing ongoing support, and exploring alternative treatments like oral appliances or surgical options for non-adherent patients could further enhance outcomes and cost savings.
Future research should focus on reducing biases, such as the healthy adherer effect, and addressing confounding factors to better quantify the cost-saving potential of OSA treatment. Additionally, integrating sleep medicine training into medical education and raising awareness among stakeholders—patients, providers, payers, and employers—can help close diagnosis gaps and promote proactive management of OSA.
Treating sleep apnea, particularly with PAP therapy, offers significant cost savings by reducing acute care and emergency service utilization, lowering overall healthcare costs, and improving health and wellness outcomes. Proactive screening is essential to identify at-risk patients early, preventing costly complications and maximizing these benefits. Studies consistently demonstrate that adherent patients experience fewer hospital visits, lower medical expenditures, and enhanced quality of life, with benefits extending to reduced workplace absences and accident risks. For healthcare systems, employers, and society, investing in OSA diagnosis, screening, and treatment is a cost-effective strategy that aligns with the triple aim of better care, better health, and lower costs. By addressing barriers to diagnosis and adherence, physicians can lead the way in improving both economic and health outcomes for millions affected by OSA.
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