(079) Medication Use Patterns Among Older Adults With Obstructive Sleep Apnea With and Without Comorbid Insomnia

Background: Obstructive sleep apnea (OSA) commonly co-occurs with insomnia, a condition known as co-morbid insomnia and sleep apnea (COMISA). Insomnia may impact the health of patients with OSA as it can render managing the condition challenging. It is crucial to understand how COMISA patients use medications to identify potential safety issues and improve treatment strategies for better health outcomes in this vulnerable group.

Objectives: To characterize differences in medication use patterns between participants with COMISA and OSA alone.

Methods: This cross-sectional study analyzed the 2018 Health and Retirement Study (HRS), a nationally representative cohort study of 20,000 U.S. adults aged 50+ years. Participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder, and reported on insomnia symptoms experienced (“difficulty falling asleep,” “waking during the night,” “waking too early,” and “feeling rested in the morning”). We identified patients reporting a diagnosis of sleep apnea alone as well as COMISA (sleep apnea with at least one insomnia symptom). Participants also self-reported whether they regularly take medications for a series of health conditions; we focused on those for “cholesterol,” “pain,“ “breathing problems,” “stomach problems,” “sleep,” “anxiety and depression” and whether they took “aspirin or blood thinners.” We also summed the number of medication types used to identify those using multiple medications (i.e., >1 medication). We used logistic regression models to identify differences in medication use between those with COMISA and OSA alone, adjusting for age, sex, race, marital status, education, region, number of health conditions, body mass index, and smoking.

Results: Of 1,776 HRS participants with OSA (mean age=65.1 years [SE=0.28], 39.2% female, 94.2% non-Hispanic White), approximately half (46.8%) had COMISA. Compared to those with OSA alone, COMISA patients were more likely to use sleep medications (adjusted odds ratio [AOR]=3.03, 95% confidence interval [CI]=2.05, 4.47), opioids (AOR=1.46, 95% CI=1.02, 2.09), and medications for stomach problems (AOR=1.42, 95% CI=1.04, 1.92), after adjusting for confounders.

Conclusions: We found individuals with COMISA are more likely to use sleep medications, opioids, and gastroenterology medications than those with OSA alone. As these medications may themselves worsen OSA symptoms, implementing treatment strategies that, for example, include de-prescribing practices, may help optimize patient care and outcomes in persons with COMISA.