Long-term welfare consequences of sleep apnea in 20-64-year-olds - influence of gender: A nationwide cohort study.

Study objectives: Obstructive sleep apnea (OSA) is associated with a significant welfare burden. Little information is available about long-term welfare consequences for women and men. Here we evaluated the long-term gender-associated welfare of patients with OSA.

Methods: Using data from the Danish National Patient Registry and other public databases, all patients aged 20-64 years with a diagnosis of OSA were included. They were compared with citizens matched by age, sex, marital status, and community location, in a ratio of 1:4. All health and social costs were included from public registries.

Results: A total of 55,783 men and 19,241 women with OSA were compared with 223,783 and 76,961 controls, respectively. As a group, people with OSA had significantly higher morbidity, mortality, health costs, transfer incomes, sickness benefits, whereas their educational level, and professional affiliation were lower, and patients retired earlier than their corresponding controls. These patterns could be identified as much as 15 years before diagnosis, with changes becoming more pronounced after diagnosis and management. There was a significant gender difference, whereby women had higher morbidity and mortality rates and social welfare social costs than men in all domains, before and after diagnosis. The total case patient net costs for men/women were 4217/8259 €/year before diagnosis and 8749/13730 €/year after diagnosis.

Conclusions: OSA is associated with a significant welfare burden (morbidity, mortality, healthcare cost, social impact). These effects are present years before diagnosis and increase thereafter. There are significant gender differences, whereby women tend to experience a significantly higher health and welfare burden than men before and after diagnosis. The study highlights a need to pay closer attention to OSA, particularly in women, in whom the disease is probably underdiagnosed.