OBJECTIVES: Obstructive sleep apnea (OSA) is a relatively common sleep disorder with an estimated prevalence of 3 to 7% in the US. There are limited recent data on the economic and clinical burden of OSA among the elderly. This study evaluated the costs of this disease using data from the Medicare program. METHODS: Patients newly diagnosed with OSA between January 1, 2011 and December 31, 2013 (“cases”) were identified using the Medicare 5% Standard Analytical Files. Non-OSA controls were identified in the same time period and matched 1:1 to cases. All patients were required to have continuous enrollment 12 months before index and at least 30 days post-index diagnosis. Resource utilization and medical costs were evaluated from index diagnosis to end of continuous enrollment. Matching (exact) variables included age group, sex, race, region, index quarter, and presence of obesity. RESULTS: Of approximately 3.2 million patients, 59,565 cases were identified. The final analysis included 38,737 matched patients in both cohorts; 57.8% were male and mean age was 67 years. In baseline, 34.2% patients were obese. Median follow-up duration was 32.4 months for cases and 33.1 months for controls. Compared to controls, patients with OSA had higher post-index hospitalization utilization (61.1% vs. 43.1%; p<0.001), higher mortality (15.3% vs. 12.8%; p<0.001), higher number of visits across all settings (inpatient: 2.12 vs 1.05, p<0.001; ED: 1.68 vs. 0.97, p<0.001; Office: 47.32 vs. 19.26, p<0.001; Outpatient: 18.02 vs. 7.85, p<0.001), and higher medical costs ($52,653.96 USD vs. $24,717.63 USD, p<0.001). CONCLUSIONS: Mortality, resource utilization, and medical costs for elderly patients with OSA are statistically significantly higher than matched patients without OSA. These results point to the need for interventions to better manage this population.