Key Points
Our multicenter study correlated the sleep study outcomes and health care utilization (emergency visits and admissions) in children with SCD
We showed that nocturnal hypoxemia and periodic leg movements are associated with increased healthcare utilization.
Sickle cell disease (SCD) is associated with increased healthcare utilization. Sleep disorders have been linked to increased SCD complications. We aimed to study the association between sleep study outcomes and healthcare utilization in children with SCD. This is a multicenter retrospective cohort study of children with SCD who underwent polysomnography (PSG) in 3 centers in the United States. We reviewed healthcare utilization (emergency department (ED) visits, hospital admissions, and total encounters) related to SCD 2 years before and after the PSG. A total of 210 children with SCD from the 3 centers with a PSG were included in the analysis. Univariate analysis showed that nocturnal hypoxemia (lower mean oxygen saturation and higher percent of total sleep time spent with SpO2 below 90% (%TST90)) and increased periodic leg movement index correlated with increased healthcare utilization; however, obstructive sleep apnea and arousal index did not. Older age, sickle cell anemia genotypes, hemoglobin level, and hydroxyurea use also correlated with increased healthcare utilization. After including the age, genotype, and hemoglobin in a multivariate linear regression analysis, only %TST90 maintained a significant association with healthcare utilization. In conclusion, our study showed that nocturnal hypoxemia (indicated by higher %TST90) is associated with increased healthcare utilization (more than doubled) in children with SCD. Our multicenter study determined targetable interventions that could reduce ED visits and hospital admissions in children with SCD. Further studies are needed to confirm these results and study the effect of interventions to treat sleep disorders on healthcare utilization in SCD.
