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Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: FR-PO281

Trends of Obstructive Sleep Apnea (OSA) Among US Veterans with and Without CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Shieu, Monica, University of Michigan, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States
  • Zivin, Kara, University of Michigan and Department of Veterans Affairs, Ann Arbor, Michigan, United States
  • Tuot, Delphine S., University of California, San Francisco, San Francisco, California, United States
  • Powe, Neil R., Priscilla Chan and Mark Zuckerberg San Francisco Gen Hosp & UCSF, San Francisco, California, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

Increasing attention has been paid to sleep problems among patients with CKD. OSA is one of the most common sleep-breathing disorders but is often under-recognized, particularly among persons with CKD. We examined trends in OSA by CKD status over the past ten years.

Methods

The study population were outpatients and inpatients in the Veterans Health Administration from FY2009-18, who were alive at the end of each fiscal year and aged >18 at the start of that year. Crude 1-year period prevalence (PP) of OSA was computed as the number of OSA cases identified from medical records in that year, divided by the number of persons in the study population that year. CKD was defined by at least one of 3 criteria: 1) a diagnostic ICD-9/10-CM code for CKD, 2) estimated glomerular filtration rate <60 ml/min/1.73m2, or 3) albumin-to-creatinine ratio >30 mg/g. Two definitions of OSA were used: one based on a single ICD-9-CM or ICD-10-CM code (327.23 or G47.33); and one based on multiple ICD-9/10-CM codes, including CPAP treatment and organic sleep apnea.

Results

Throughout the study period, the 1-year PP of OSA was higher in CKD than non-CKD patients. Using either OSA definition, the PP in both groups increased gradually from FY2009 to FY2015, rose more sharply to FY2016, then increased gradually again to FY2018. The use of multiple ICD codes increased the PP by approximately15% throughout the decade. By FY2018, in patients with CKD, the PP rose to 26.5% using a single ICD code and to 36.8% using multiple codes

Conclusion

The gradual increase in the crude PP of diagnosed OSA in VA patients both with and without CKD may be attributable to the increasing incidence of OSA due to changes in OSA risk factors such as obesity and comorbidities, and likely to the increased detection of OSA due to greater awareness of the condition. The sudden increase in OSA PP in FY2015-16 probably resulted from the switch from ICD-9-CM to ICD-10-CM coding. Further studies are needed to document and explain OSA prevalence trends in veterans and other populations.

Funding

  • Other U.S. Government Support