0895 Greater Sleep Reactivity and Poorer Sleep Efficiency Are Associated with Increased Medical Expenditures

Abstract Introduction Insufficient sleep costs the U.S. economy over $411 billion per year in lost productivity. However, most studies investigating the economic costs of sleep rely on flawed retrospective measures of sleep (e.g., typical sleep patterns in the past month). These measures are prone to recall bias and do not accurately capture daily variability in sleep patterns. To address these gaps, we examined how sleep metrics captured from prospective sleep diaries were associated with medical claims approximately one year later. Methods Participants were 452 World Trade Center 9/11 responders enrolled in the World Trade Center Health Program in 2017 (mean age = 52.22 years, SD = 8.73, 10.6% female). At baseline, participants completed 14 days of self-reported sleep and stress measures each morning. Mean sleep efficiency, variability in sleep efficiency, as well as a novel measure of sleep reactivity (i.e., how much people’s sleep efficiency changes in response to previous-day stressors) were used to predict total yearly medical claims, physical health claims, and mental health claims approximately one year later , covarying for participant age and sex. Results Greater sleep reactivity to stress was associated with more total medical claims (b = $7,742.63, p < .001), more physical health claims (b = $1,421.87, p < .001), and more mental health claims (b = $2,682.81, p < .001). Lower mean sleep efficiency was associated with more total medical claims (b = -$7,669.63, p = .018), more physical health claims (b = -$2,103.42, p = .026), and more mental health claims (b = -$2,494.76, p = .011). Greater variability in sleep efficiency was associated with more total medical claims (b = $14,020.82, p = .010) and more mental health claims (b = $7,035.91, p < .001). Conclusion Individuals with greater sleep disturbances engage in more healthcare utilization. Given the steep costs of insufficient sleep, it may be important to proactively address sleep problems to prevent downstream social and economic consequences. Support (if any) NIOSH U01OH011321 (PI: Kotov)