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STUDY OBJECTIVES: To examine the impact of adherence to continuous positive airway pressure (CPAP) therapy on health care utilization among a nationally representative and sample of older adults with multiple morbidities and pre-existing cardiovascular disease and subsequently diagnosed with obstructive sleep apnea in the United States. METHODS: Our data source was a random 5% sample of Medicare administrative claims data. All participants (n = 1,921) were of age ≥ 65 years, diagnosed with cardiovascular disease and obstructive sleep apnea, and subsequently began treatment with CPAP between 2009–2013. Based on the number of CPAP machine charges, individuals were categorized as low, partial, or high adherers (ie, < 4, 4–12, and > 12 CPAP charges, respectively). The impact of CPAP adherence status on health care utilization was assessed across multiple points of service, including outpatient encounters, inpatient stays, emergency department visits, and prescription fills over 24 months following CPAP initiation. RESULTS: Significant differences in demographic and comorbid disease characteristics were observed between low adherers (n = 377), partial adherers (n = 236), and high adherers (n = 1,308). After adjusting for covariates and relative to low adherers, high adherers demonstrated reduced inpatient visits (hazard ratio 0.75; 95% confidence interval 0.57, 0.97). CONCLUSIONS: In this nationally representative sample of older Medicare beneficiaries with multiple morbidities and relative to low adherers, high adherers demonstrated reduced inpatient utilization. CITATION: Wickwire EM, Bailey MD, Somers VK, et al. CPAP adherence is associated with reduced inpatient utilization among older adult Medicare beneficiaries with pre-existing cardiovascular disease. J Clin Sleep Med. 2022;18(1):39–45.

STUDY OBJECTIVES: To examine the impact of adherence to continuous positive airway pressure (CPAP) therapy on risk of stroke among a nationally representative sample of older adults with obstructive sleep apnea. METHODS: We performed a retrospective cohort study among Medicare beneficiaries aged ≥ 65 years who were newly diagnosed with obstructive sleep apnea and had initiated CPAP (2009–2013). Monthly indicators of CPAP adherence included charges for machines, masks, or supplies and were summed over a 25-month follow-up to create a CPAP adherence variable. Stroke was modeled as a function of CPAP adherence using generalized estimating equations. RESULTS: We found that 5,757 beneficiaries met the inclusion criteria and were included in the final sample. Of these, 407 (7%) experienced stroke. After adjusting for demographic and clinical characteristics, CPAP adherence was associated with a reduced risk of stroke (hazard ratio, 0.98; 95% confidence interval, 0.96–0.99) over 25 months, indicating a 2% reduction in risk of stroke for each month of CPAP adherence. When sensitivity analyses were performed to stratify results by time since the first CPAP charge, the protective effect remained significant for the 12- and 6-month but not the 3-month outcome models. CONCLUSIONS: In this national analysis of older adult Medicare beneficiaries with obstructive sleep apnea, CPAP adherence was associated with significantly reduced risk of stroke. CITATION: Wickwire EM, Bailey MD, Somers VK, et al. CPAP adherence is associated with reduced risk for stroke among older adult Medicare beneficiaries with obstructive sleep apnea. J Clin Sleep Med. 2021;17(6):1249–1255.

STUDY OBJECTIVES: The aim of this study was to characterize older adult Medicare beneficiaries seen by board-certified sleep medicine providers (BCSMPs) and identify predictors of being seen by a BCSMP. METHODS: Our data source was a random 5% sample of Medicare administrative claims data (2006–2013). BCSMPs were identified using a cross-matching procedure based on national provider identifiers available within the Medicare database and assigned based on the first sleep disorder diagnosis received. Sleep disorders (insomnia, sleep-related breathing disorders, hypersomnias, circadian rhythm sleep-wake disorders, parasomnias, and restless legs syndrome) were operationalized as International Classification of Disease, Ninth Revision, Clinical Modification diagnostic codes. The number of sleep disorders per beneficiary was computed and compared between BCSMPs and nonspecialists. Logistic regression was used to identify medical and demographic predictors of being seen by a BCSMP. RESULTS: A total of 57,209 beneficiaries received one or more sleep disorder diagnoses during the study period. Of these, 1,279 (2.2%) were initially diagnosed by a BCSMP. Relative to individuals seen by nonspecialists, beneficiaries treated by a BCSMP were more likely to have two or more sleep disorders (9.0% vs 24.1%, P < .001). The most common diagnosis assigned by BCSMPs was obstructive sleep apnea (70.4% of patients seen by BCSMPs were diagnosed with obstructive sleep apnea). The most common diagnosis assigned by nonspecialists was insomnia (48.2% of patients seen by nonspecialists were diagnosed with insomnia). In a fully adjusted regression model, male sex (odds ratio [OR] 1.53; 95% confidence interval [CI] 1.36, 1.72), asthma (OR 1.50; 95% CI 1.30, 1.73), and heart failure (OR 1.24; 95% CI 1.10, 1.41) were positively associated with being treated by a BCSMP. Conversely, depression (OR 0.85, 95% CI 0.73, 1.00), anxiety (OR 0.69, 95% CI .59, .82), Alzheimer and related dementias (OR 0.80, 95% CI .65, .99), and anemia (OR .88, 95% CI .78, .99) were associated with a reduced likelihood of being seen by a BCSMP. CONCLUSIONS: Relative to older adults seen by nonspecialists, those seen by BCSMPs are more medically but less psychiatrically complex and are diagnosed with a greater number of sleep disorders. These results suggest the possibility that medically complex patients are referred for specialty care, whereas psychiatrically complex patients might be seen at the nonspecialist level. Further, these results demonstrate the value of board certification in sleep medicine in caring for complex sleep patients. CITATION: Wickwire EM, Jobe SL, Parthasarathy S, et al. Which older adults receive sleep medicine specialty care? Predictors of being seen by a board-certified sleep medicine provider. J Clin Sleep Med. 2020;16(11):1909–1915.

To examine (1) the impact of adherence to continuous positive airway pressure (CPAP) therapy on risk for cardiovascular (CVD) events among a nationally representative sample of older adults with obstructive sleep apnea (OSA), and (2) the heterogeneity of this effect across subgroups defined by race, sex, and socioeconomic status. We conducted a retrospective cohort study among Medicare beneficiaries aged ≥ 65 years with OSA (2009–2013). Monthly indicators of CPAP adherence (charges for machines, masks, or supplies) were summed over 25 months to create a CPAP adherence variable. New CVD events (ischemic heart disease, cardiac and peripheral procedures) were modeled as a function of CPAP adherence using generalized estimating equations. Heterogeneity of the effect of CPAP on new CVD events was evaluated based on race, sex, and socioeconomic status. Among 5024 beneficiaries diagnosed with OSA who initiated CPAP, 1678 (33%) demonstrated new CVD events. Following adjustment for demographic and clinical characteristics, CPAP adherence was associated with reduced risk of new CVD events (hazard ratio 0.95; 95% confidence interval 0.94, 0.96) over 25 months. When analyses were stratified by time since the first CPAP charge, the protective effect remained significant for the 12- and 6-month, but not 3-month, outcome models. No significant differences were observed in the protective effect of CPAP based on race, sex, or socioeconomic status. In this national study of older adult Medicare beneficiaries with OSA, CPAP adherence was associated with greatly reduced risk for CVD events. This risk reduction was consistent across race, sex, and socioeconomic subgroups.

STUDY OBJECTIVES: To examine the proportion of Medicare beneficiaries with sleep disorders who were evaluated by board-certified sleep medicine providers (BCSMPs). METHODS: Using a random 5% sample of Medicare administrative claims data (2007–2011), BCSMPs were identified by employing a novel cross-matching approach based on National Provider Identifiers available within the Medicare database. Sleep disorders were included based partially on the International Classification of Sleep Disorders, Third Edition (insomnia, sleep-related breathing disorders, hypersomnias, circadian rhythm sleep-wake disorders, parasomnias, and restless legs syndrome), and operationalized as International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. The proportion of beneficiaries with each disorder who were seen by BCSMPs and nonspecialists was computed. RESULTS: Among older adult Medicare beneficiaries with sleep disorders, the most common sleep disorder was insomnia (n = 65,033), and the least common sleep disorder was narcolepsy (n = 784). Individuals with central sleep apnea (n = 1,561) were most likely to be treated by a BCSMP (63.9% of beneficiaries with central sleep apnea), and individuals diagnosed with insomnia were least likely to be treated by a BCSMP (16.4% of beneficiaries with insomnia). Most BCSMPs treated beneficiaries with obstructive sleep apnea (84.9% of BCSMPs) and insomnia (75.8% of BCSMPs). CONCLUSIONS: BCSMPs are involved in the care of a substantial proportion of Medicare beneficiaries with sleep disorders. CITATION: Wickwire EM, Albrecht JS, Dorsch JJ, et al. Practice patterns of board-certified sleep medicine providers: a national analysis among older adult Medicare beneficiaries. J Clin Sleep Med. 2020;16(5):689–694.

The Japanese Gastric Cancer Association provided updated criteria for endoscopic local excision of early-stage gastric cancer in 2018. The purpose of this study was to evaluate utilization patterns for endoscopic local excision in the United States for resectable gastric adenocarcinoma.Patients with resectable gastric adenocarcinoma were identified from the National Cancer Database between 2010 and 2017. Patients were classified into strict appropriate criteria, expanded criteria, and inappropriate based on the Japanese Gastric Cancer Association guidelines. Factors associated with endoscopic local excision were identified using univariate and logistic multivariate regression.Within the National Cancer Database, 46,334 patients were stratified into strict appropriate criteria (n = 1,405), expanded criteria (n = 727), and inappropriate (n = 43,675). Annual cases of local excision increased by 76.9% over the study period, from 273 in 2010 to 483 in 2017. Among patients who underwent local excision, 10.1% were classified as strict appropriate criteria, 1.6% were classified as expanded criteria, and 84.5% were classified as inappropriate. Among inappropriate patients, factors associated with endoscopic local excision were: more recent year of diagnosis, increasing age, female sex, tumor located in the cardia, smaller size, low-grade, absence of lymphovascular invasion, and treatment at an academic facility.The use of endoscopic local excision for gastric cancer has nearly doubled since 2010. However, most patients do not satisfy consensus criteria for endoscopic therapy.

Study Objectives To describe initial insomnia-related encounters among a national sample of Medicare beneficiaries, and to identify older adults at risk for potentially inappropriate prescription insomnia medication usage. Methods Our data source was a random 5% sample of Medicare administrative claims data (2006–2013). Insomnia was operationalized as International Classification of Disease, Ninth Revision, Clinical Modification diagnostic codes. Insomnia medications included FDA-approved insomnia-related medication classes and drugs. Logistic regression was employed to identify predictors of being “prescribed only” (i.e., being prescribed an insomnia medication without a corresponding insomnia diagnosis). Results A total of N = 60 362 beneficiaries received either an insomnia diagnosis or a prescription for an insomnia medication as their first sleep-related encounter during the study period. Of these, 55.1% (n = 33 245) were prescribed only, whereas 44.9% (n = 27 117) received a concurrent insomnia diagnosis. In a fully adjusted regression model, younger age (odds ratio (OR) 0.98; 95% confidence interval (CI) 0.98, 0.99), male sex (OR 1.15; 95% CI 1.11, 1.20), and several comorbid conditions (i.e., dementia [OR 1.21; 95% CI 1.15, 1.27] and anemia [OR 1.17; 95% CI 1.13, 1.22]) were positively associated with being prescribed only. Conversely, black individuals (OR 0.83; 95% CI 0.78, 0.89) and those of “other” race (OR 0.89; 95% CI 0.84, 0.94) were less likely to be prescribed only. Individuals who received care from a board-certified sleep medicine provider (BCSMP) were less likely to be prescribed only (OR 0.27; 95% CI 0.16, 0.46). Conclusions Fewer than half of Medicare beneficiaries prescribed insomnia medications ever received a formal sleep-related diagnosis.

To examine (1) the impact of adherence to continuous positive airway pressure (CPAP) therapy on risk for cardiovascular (CVD) events among a nationally representative sample of older adults with obstructive sleep apnea (OSA), and (2) the heterogeneity of this effect across subgroups defined by race, sex, and socioeconomic status.We conducted a retrospective cohort study among Medicare beneficiaries aged ≥ 65 years with OSA (2009-2013). Monthly indicators of CPAP adherence (charges for machines, masks, or supplies) were summed over 25 months to create a CPAP adherence variable. New CVD events (ischemic heart disease, cardiac and peripheral procedures) were modeled as a function of CPAP adherence using generalized estimating equations. Heterogeneity of the effect of CPAP on new CVD events was evaluated based on race, sex, and socioeconomic status.Among 5024 beneficiaries diagnosed with OSA who initiated CPAP, 1678 (33%) demonstrated new CVD events. Following adjustment for demographic and clinical characteristics, CPAP adherence was associated with reduced risk of new CVD events (hazard ratio 0.95; 95% confidence interval 0.94, 0.96) over 25 months. When analyses were stratified by time since the first CPAP charge, the protective effect remained significant for the 12- and 6-month, but not 3-month, outcome models. No significant differences were observed in the protective effect of CPAP based on race, sex, or socioeconomic status.In this national study of older adult Medicare beneficiaries with OSA, CPAP adherence was associated with greatly reduced risk for CVD events. This risk reduction was consistent across race, sex, and socioeconomic subgroups.

ObjectiveTo compare differences in health care resource utilization (HcRU) over time between Medicare beneficiaries with and without Parkinson disease (PD).MethodsThis retrospective observational study used the Chronic Conditions Data Warehouse (5% Medicare sample) between 2005 and 2015. In a propensity score–matched (age, sex, race, and comorbidity adjusted) sample of beneficiaries with and without PD, we examined all-cause HcRU due to inpatient admissions, emergency department (ED) admissions, skilled nursing facility (SNF) admissions, health care provider encounters, neurologist visits, rehabilitation service visits, and non-PD medication fills. Relative to beneficiaries without PD, we reported adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for beneficiaries with PD using generalized linear models with log link and negative binomial variance functions.ResultsA total of 467,064 Medicare enrollees (unmatched sample) met the inclusion criteria. Of these, 3.3% had PD. In the matched sample and relative to beneficiaries without PD, beneficiaries with PD displayed higher rates of inpatient admissions (IRR 1.29, 95% CI 1.24–1.34), ED admissions (IRR 1.31, 95% CI 1.27–1.34), SNF admissions (IRR 2.00, 95% CI 1.92–2.09), health care provider encounters (IRR 1.18, 95% CI 1.16–1.20), neurologist visits (IRR 5.57, 95% CI 5.35–5.78), rehabilitation service visits (IRR 1.47, 95% CI 1.41–1.53), and non-PD medication fills (IRR 1.10, 95% CI 1.08–1.11) over time.ConclusionThese results reflect patterns of medical care among Medicare beneficiaries with PD. The findings can help clinicians, payers, and policy makers make evidence-based decisions for the allocation of scarce health care resources for PD management.Classification of EvidenceThis study provides Class II evidence that Medicare beneficiaries with PD use more health care resources than matched controls without PD.

To examine the effect of untreated obstructive sleep apnea (OSA) on health care utilization (HCU) and costs among a nationally representative sample of Medicare beneficiaries.Our data source was a random 5% sample of Medicare administrative claims data for years 2006-2013. OSA was operationalized as (1) receipt of one or more International Classification of Disease, Version 9, Clinical Modification diagnostic codes for OSA in combination with (2) initiation of OSA treatment with either continuous positive airway pressure or oral appliance (OA) therapy. First, HCU and costs were assessed during the 12 months prior to treatment initiation. Next, these HCU and costs were compared between beneficiaries with OSA and matched control patients without sleep-disordered breathing using generalized linear models.The final sample (n = 287,191) included 10,317 beneficiaries with OSA and 276,874 control patients. In fully adjusted models, during the year prior to OSA diagnosis and relative to matched control patients, beneficiaries with OSA demonstrated increased HCU and higher mean total annual costs ($19,566, 95% confidence interval [CI] $13,239, $25,894) as well as higher mean annual costs across all individual points of service. Inpatient care was associated with the highest incremental costs (ie, greater than control patients; $15,482, 95% CI $8,521, $22,443) and prescriptions were associated with the lowest incremental costs (ie, greater than control patients; $431, 95% CI $339, $522).In this randomly selected and nationally representative sample of Medicare beneficiaries and relative to matched control patients, individuals with untreated OSA demonstrated increased HCU and costs across all points of service.

Study Objectives To examine rates of adherence to continuous positive airway pressure (CPAP) therapy among a representative sample of older adult Medicare beneficiaries with obstructive sleep apnea (OSA), and to identify demographic and health-related factors associated with CPAP adherence. Methods Using a 5% sample of Medicare claims data, we utilized Medicare policy and CPAP machine charges as a proxy for CPAP adherence. A cumulative logit model was used to identify demographic, medical, and psychiatric predictors of CPAP adherence status. Results Of beneficiaries who initiated CPAP (n = 3,229), 74.9% (n = 2,417) met the so-called “90-day Medicare adherence criteria,” but only 58.8% of these individuals (n = 1,420) continued to use CPAP throughout the entire 13-month rent-to-own period. Anxiety, anemia, fibromyalgia, traumatic brain injury, and lower socioeconomic status (SES) were all associated with reduced CPAP adherence. Conclusions These results provide the first national estimates of CPAP adherence among older adult Medicare beneficiaries in the United States. In addition, findings highlight the salience of medical and psychiatric comorbidity, as well as SES, as important markers of CPAP adherence among older adults in the United States. Future studies should seek to evaluate interventions to improve CPAP adherence among older adults of lower SES.

Study Objectives To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries. Methods Using a random 5% sample of Medicare administrative data (2006–2013), insomnia was defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes. Treatment was operationalized as one or more prescription fills for an US Food and Drug Administration (FDA)-approved insomnia medication following diagnosis, in previously untreated individuals. To evaluate the economic impact of insomnia treatment on healthcare utilization (HCU) and costs in the year following insomnia diagnosis, a difference-in-differences approach was implemented using generalized linear models. Results A total of 23 079 beneficiaries with insomnia (M age = 71.7 years) were included. Of these, 5154 (22%) received one or more fills for an FDA-approved insomnia medication following insomnia diagnosis. For both treated and untreated individuals, HCU and costs increased during the 12 months prior to diagnosis. Insomnia treatment was associated with significantly increased emergency department visits and prescription fills in the year following insomnia diagnosis. After accounting for pre-diagnosis differences between groups, no significant differences in pre- to post-diagnosis costs were observed between treated and untreated individuals. Conclusions These results advance previous research into economics of insomnia disorder by evaluating the impact of medication treatment and highlighting important differences between treated and untreated individuals. Future studies should seek to understand why some individuals diagnosed with insomnia receive treatment but others do not, to identify clinically meaningful clusters of older adults with insomnia, and to explore the economic impact of insomnia and insomnia treatment among subgroups of individuals with insomnia, such as those with cardiovascular diseases, mood disorders, and neurodegenerative disease.

Road traffic injuries are a leading killer of youth (aged 15-29) and are projected to be the 7th leading cause of death by 2030. To better understand road traffic crash locations and characteristics in the city of Baltimore, we used police and census data, to describe the epidemiology, hotspots, and modifiable risk factors involved to guide further interventions.Data on all crashes in Baltimore City from 2009 to 2013 were made available from the Maryland Automated Accident Reporting System. Socioeconomic data collected by the US CENSUS 2010 were obtained. A time series analysis was conducted using an ARIMA model. We analyzed the geographical distribution of traffic crashes and hotspots using exploratory spatial data analysis and spatial autocorrelation. Spatial regression was performed to evaluate the impact of socioeconomic indicators on hotspots.In Baltimore City, between 2009 and 2013, there were a total of 100,110 crashes reported, with 1% of crashes considered severe. Of all crashes, 7% involved vulnerable road users and 12% had elderly or youth involvement. Reasons for crashes included: distracted driving (31%), speeding (6%), and alcohol or drug use (5%). After 2010, we observed an increasing trend in all crashes especially from March to June. Distracted driving then youth and elderly drivers were consistently the highest risk factors over time. Multivariate spatial regression model including socioeconomic indicators and controlling for age, gender and population size did not show a distinct predictor of crashes explaining only 20% of the road crash variability, indicating crashes are not geographically explained by socioeconomic indicators alone.In Baltimore City, road traffic crashes occurred predominantly in the high density center of the city, involved distracted driving and extremes of age with an increase in crashes from March to June. There was no association between socioeconomic variables where crashes occurred and hotspots. In depth analysis of how modifiable risk factors are impacted by geospatial characteristics and the built environment is warranted in Baltimore to tailor interventions.

Introduction Although several studies have evaluated the impact of board-certification in sleep medicine regarding obstructive sleep apnea treatment outcomes, no studies to date have identified predictive factors to determine which patients are evaluated by board-certified sleep medicine providers (BCSMP) in the clinical practice. Thus, the purpose of this study was to identify predictors of being seen by a BCSMP, relative to non-sleep specialist providers. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorder diagnoses such as insomnia, obstructive sleep apnea, restless legs syndrome, hypersomnias, and parasomnias, as well as medical comorbidities including cardiovascular, cerebrovascular, mood, pulmonary, and neurological disorders, were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographic data were obtained from the claims. BCSMP were identified using a novel cross-matching approach based on National Provider Identifier (NPI). Results A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013, but only 1,279 (2.2%) of these individuals were ever seen by a BCSMP. Within a multivariate logistic regression model, male gender, asthma, and heart failure were significantly associated with being seen by a BCSMP. Additionally, BCSMP were more likely to evaluate patients with two or more sleep diagnoses. Conclusion Complexity of sleep disorders and cardiovascular and lung comorbidities were predictive of being seen by a BCSMP. These results demonstrate the importance of BCSMPs in caring for complex sleep medicine patients. Support This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

Introduction Despite consensus recommendations regarding need for caution and careful management, sedative hypnotic insomnia therapies remain commonly prescribed among older adults. Further, sleep medications are often prescribed in the absence of a thorough sleep history or evaluation. However, little is known about delivery of sleep-related care following prescription of insomnia medications. Thus, the purpose of this study was to characterize the course of sleep-related care following a prescription fill for insomnia medication among older adults. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Insomnia medications were identified by searching the Part D prescription drug claims and included FDA-approved insomnia-related medication classes and drugs. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of insomnia medication users who received sleep disorder diagnoses. Results A total of 33,252 Medicare beneficiaries without prior history of sleep disorders received at least one FDA-approved insomnia medication fill between 2006-2013. Of these, 43.2% (n=14,354) eventually received a sleep disorder diagnosis. Among those receiving a sleep diagnosis after being prescribed insomnia medication, insomnia was the most common disorder (71.0%; n=10,198). Further, 15.0% (n=2,149) of individuals who were prescribed insomnia medication received an obstructive sleep apnea diagnosis, 6.6% (n=947) were diagnosed with sleep disturbances, and 5.9% (n=845) were diagnosed with restless legs syndrome. Of those who received a sleep disorder diagnosis, 95.1% (n=13,649) were diagnosed with one sleep disorder, 4.5% (n=639) were diagnosed with two sleep disorders, and 0.4% (n=66) were diagnosed with three or more sleep disorders. Conclusion Fewer than half of Medicare beneficiaries prescribed FDA-approved sedative hypnotic insomnia medications ever received a formal sleep-related diagnosis. These results suggest that clinicians prescribe sedative hypnotics without thoroughly evaluating sleep complaints. Support This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

Introduction Despite a growing literature regarding the impact of board-certification in sleep medicine, little is known about the complexity of patients seen by board-certified sleep medicine physicians (BCSMPs) relative to non-specialists. To address this gap, the purpose of the current study was to evaluate the differences in sleep complaints among Medicare beneficiaries seen by BCSMPs relative to individuals seen by non-specialists. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of sleep disorder diagnoses patients received by provider status. BCSMPs were identified using a cross-matching procedure based on National Provider Identifier (NPI). Results A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013. Of these, only 2.2% were seen by BCSMPs. Relative to beneficiaries seen by non-specialists, those seen by BCSMPs were more likely to be diagnosed with more than one sleep disorder (p Conclusion BCSMPs see more complex sleep patients than do non-specialists. These results suggest the possibility that more complex patients are referred for sleep specialty care. Further, these results demonstrate the value of board certification in sleep medicine in caring for complex sleep patients. Support This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).