Neurological Institute Outcomes

The effect of social determinants of health (SDH) on health outcomes is well-documented. However, the extent to which SDH influences sleep study completion is unknown.

A retrospective cohort study was conducted utilizing sleep study referrals at the Cleveland Clinic Sleep Disorders Center from January 3, 2017 to August 5, 2023. Adult patients who underwent sleep studies and completed at least one SDH screening questionnaire including food insecurity, financial strain, and housing instability were included.

Of N=113,843 patients referred for sleep testing, 55% (N=62,569) patients completed at least one SDH screening questionnaire. Of these, 40% (N=25,003), completed a sleep study. Patients who completed at least one SDH screening questionnaire and a sleep study were older (56.0±15.65 vs. 54.4±15.5, p<0.001), had a higher body mass index (34.4±8.8 vs. 33.8±8.3, p<0.001), and were more likely to be of Hispanic ethnicity (4.4% vs. 3.8%, p<0.001) compared to non-completers. Likewise, completers reported a higher risk for food insecurity (9.9% vs. 8.9%, p=0.027), financial strain (15.8% vs. 13.7%, p<0.001), and housing instability (11.5% vs 10.3%, p<0.001) compared to non-completers.

SDH screening questionnaires are not routinely completed by patients referred for sleep studies. However, patients who completed SDH screening questionnaires and sleep studies reported a high risk for food insecurity, financial strain, and housing instability. Systematic efforts are needed to investigate the feasibility and acceptability of implementing SDH screening in sleep clinics to understand the relationship between social needs, access, and utilization.