To examine the association between sleep disorders, employment status and income among US adults aged 18-64.

The 2018-19 Medical Expenditure Panel Survey medical conditions file was queried for adults aged 18-64 years with a diagnosis of a sleep disorder (ICD-10 code G47.x) and linked to the household dataset. Comparisons in rates of wage, supplemental and social security income as well as mean wage income were made between those with and without sleep disorders. Multivariate analyses, adjusting for demographics and co-morbidities, were conducted.

A sleep disorder was diagnosed in 4.4%±0.2% of the study population (approximately 8.8±0.4 million adults aged 18-64 years in the U.S; mean age 46.9 years, 55.8% female). Adults with sleep disorders were less likely to have wage income from employment (adjusted odds ratio, 0.5, 95% CI 0.4-0.6, p<0.001) and more likely to have Supplemental Security (1.8, 1.4-2.4, p<0.001) and Social Security income (2.0, 1.6-2.4, p<0.001) when compared to those without sleep disorders. Among wage-earning adults, those with sleep disorders had $2,496 less mean annual wage income when compared to those without a sleep disorder ($20,445 vs $22941, p=0.007), adjusting for demographics and co-morbidities.

There are significantly higher indirect costs associated with sleep disorders. This study specifically demonstrates lower employment rates, lower wages, and higher welfare income utilization amongst those with sleep disorders despite using a very conservative estimate of sleep disorder prevalence.