Presentation (CTI)

OBJECTIVES: The increasing prevalence of sleep disorders leads to a growing personal and societal burden. Given emerging evidence of biological and clinical sex-based heterogeneity, this study investigated whether these differences translate into real-world disparities in healthcare pathways and economic burdens among Korean adults, and how age and clinical subtypes influence these gaps.
METHODS: This retrospective study utilized the 2023 Health Insurance Review and Assessment Service database, including adults (≥20 years) with ≥2 claims for sleep disorders. Pathways (inpatient/outpatient, conventional/traditional medicine) and direct costs (total, drug, hypnotic-specific) were compared between sexes. Absolute standardized differences (ASD≥0.1) for categorical variables and t-tests for continuous variables evaluated significance.
RESULTS: Among 850,282 patients (54.3% women), insomnia was female-predominant (87.4% vs. 68.1%, ASD=0.47), whereas sleep apnea was male-predominant (26.6% vs. 5.0%, ASD=0.61). For insomnia, outpatient care dominated, alongside significantly higher traditional Korean medicine utilization in women (11.0% vs. 5.6%, ASD=0.19). For apnea, inpatient experience was generally higher, with a higher proportion observed in women (56.3% vs. 46.5%, ASD=0.20). Regarding medical costs, annual per-patient costs peaked in young adults (20-30s) and were higher in men, but this gap diminished with age. Subtype analysis demonstrated comparable per-claim insomnia costs between sexes, whereas per-claim apnea costs were higher for women (191,417 vs. 163,102 KRW). Although men incurred higher total annual expenditures (119.9 vs. 105.8 billion KRW), women bore substantially higher overall drug costs (45.2 vs. 33.8 billion KRW) and hypnotic-specific expenditures (11.2 vs. 8.3 billion KRW).
CONCLUSIONS: Sex disparities in healthcare utilization and economic burdens of sleep disorders are structurally distinct and vary substantially across age groups. The prominent economic gap in younger populations is driven by male-predominant apnea utilization, converging in older adults through a shared shift toward chronic, insomnia-driven pharmacotherapy. These findings highlight the need to consider sex- and age-specific characteristics when developing health policies and clinical strategies.