A substantial percentage of Medicare beneficiaries with sleep disorders undergo evaluations by board-certified sleep medicine providers, with the majority of clinicians treating patients with insomnia and obstructive sleep apnea, according to study results published in the Journal of Clinical Sleep Medicine.

Previous research has demonstrated that consultation with a board-certified sleep medicine provider may be associated with positive patient outcomes, including improved adherence to recommended treatment regimens. However, there has been conflicting data, and therefore the investigators conducted the study to assess the national patterns of sleep medicine care delivery by board-certified sleep medicine providers.­

In this study, US-based sleep medicine researchers assessed a random 5% sample of Medicare administrative claims data from 2007 to 2011 to identify board-certified sleep medicine providers who evaluated Medicare beneficiaries with sleep disorders.

A novel cross-matching strategy based on national provider identifiers in the Medicare database was used to identify these providers. Only patients who had sleep disorders partially based on The International Classification of Sleep Disorders, Third Edition and International Classification of Disease, Ninth Edition, clinical modification diagnostic codes. To evaluate the relationship between board-certified sleep specialist and quantity of sleep medicine care, the researchers calculated the percentage of beneficiaries in each sleep disorder category who were treated by a specialist at any time during the 24-month continuous coverage.


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A total of 4462 specialists were identified and contributed to the final dataset. The range of unique visits to board-certified sleep medicine providers in Medicare beneficiaries with a diagnosed sleep disorder was 0 to 4. In older adult Medicare beneficiaries with a diagnosed sleep ­d­isorder, insomnia was the most common sleep disorder (n=65,033). And the least common was narcolepsy (n=784).

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Beneficiaries with insomnia were less likely to be evaluated and treated by a board-certified sleep medicine provider (16.4%), whereas beneficiaries with central sleep apnea were more likely to be treated by a board-certified sleep medicine provider (63.9%). Approximately 84.9% and 75.8% of board-certified sleep medicine providers treated Medicare beneficiaries with obstructive sleep apnea and insomnia, respectively.

Study limitations included the reliance on claims data to identify sleep disorders and the lack of objective sleep parameters for further assessment.

The investigators suggested that additional research “should evaluate the impact of board-certified sleep medicine provider status on quality of care as well as health and economic outcomes.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Wickwire EM, Albrecht JS, Dorsch JJ, et al. Practice patterns of board-certified sleep medicine providers: a national analysis among older adult Medicare beneficiaries [published online February 6, 2020]. J Clin Sleep Med. doi:10.5664/jcsm.8326

This article originally appeared on Neurology Advisor