Epidemiology and Economic Burden of Sleep Disorders in Europe.

Background
Sleep and sleep disorders (SD) have a major impact on brain (neurological and psychiatric), body and societal health. Despite this, the epidemiological and economic burden of SD have not been sufficiently analyzed. This study investigates the epidemiology and costs of SD across 47 European countries and identifies knowledge gaps in the literature.
Methods
Systematic literature reviews on PubMed (between January 2010 and April 2023) and expert communications identified relevant epidemiological and cost-of-illness (COI) studies on five major SD: insomnia, obstructive sleep apnea (OSA), narcolepsy, restless legs syndrome (RLS), and REM sleep behavior disorder (RBD). Four epidemiological parameters, including prevalence, were investigated. Economic analyses stratified direct, indirect, and informal care costs, and employed an imputation procedure that accounts for several country-specific economic factors. Costs were expressed as purchasing power parity (PPP)-adjusted 2019 Euros.
Results
Eleven COI and six epidemiological studies were identified. Estimated prevalence for OSA, insomnia, RLS, narcolepsy, and RBD in the adult population was 18%, 10%, 3%, 0.03%, and 0.009%, respectively. Economic data were exclusively available for high-income Europe. OSA was the most costly SD (€184 billion), followed by insomnia (€158 billion), RLS (€79 billion), narcolepsy (€905 million), and RBD (€436 million). Direct and indirect costs contributed 48% and 52%, respectively, with no available data on informal care costs.
Conclusions
The unexpected high prevalence and substantial economic burden associated with SD contrast with the universally neglected role of sleep health and SD in public health strategies. More research on the burden of SD is needed.