title: The relationship between functional health literacy and obstructive sleep apnea and its related risk factors and comorbidities in a population cohort of men.
abstract: OBJECTIVE
  To examine the relationship between functional health literacy (FHL) and obstructive sleep apnea (OSA), its diagnosis, related risk factors, and comorbidities.
  
  
  METHODS
  Population cohort study.
  
  
  METHODS
  Adelaide, South Australia, 2011-12.
  
  
  METHODS
  1,021 Men Androgen Inflammation Lifestyle Environment and Stress Study participants aged ≥ 40 years, of whom 627 were identified with OSA by self-report (n = 184 previously diagnosed) or with in-home polysomnography in 837 randomly selected participants without self-reported OSA (n = 443 previously undiagnosed).
  
  
  METHODS
  The Newest Vital Sign assessed FHL in 88% of participants. Full in-home unattended polysomnography (Embletta X100) was scored by 2007 AASM (alternative) criteria.
  
  
  RESULTS
  FHL was adequate in 75.3% (n = 122) of previously diagnosed and 68.3% (n = 261) of previously undiagnosed OSA. Not having a previous diagnosis was independently associated with inadequate FHL (odds ratio [OR]:2.84, 95% confidence interval [CI]:1.25-6.45) and workforce participation (OR = 2.04, 95% CI = 1.01-4.00), and inversely associated with previous snoring (OR = 0.48, 95% CI = 0.29-0.81), obesity (OR = 0.35, 95% CI = 0.15-0.81), and cardiovascular disease (OR = 0.45, 95% CI = 0.24-0.85). In polysomnography participants, inadequate FHL was independently associated with previously undiagnosed OSA (OR = 2.43, 95% CI = 1.40-4.20). In undiagnosed men, less than adequate FHL was independently associated with sedentary lifestyle (OR = 2.42, 95% CI = 1.36-4.29), and depression (OR = 2.50, 95% CI = 1.23-5.09) and inadequate FHL was associated with current smoking (OR = 2.87, 95% CI = 1.21-6.84). The depression association was attenuated after additional adjustment for comorbidities and general health (OR = 2.04, 95% CI = 0.93-4.49, P = 0.076). In previously diagnosed OSA, less than adequate FHL was independently associated with cardiovascular disease (OR = 2.76, 95% CI = 1.09-7.01).
  
  
  CONCLUSIONS
  Limited functional health literacy was independently associated with obstructive sleep apnea (OSA), OSA diagnosis, lifestyle factors and comorbidities, highlighting the importance of developing and promoting national disease-specific health literacy policies.
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.
authors.forename: Joule J
authors.initials: JJ
authors.lastname: Li
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Appleton
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: The Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia ; NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vakulin
authors.affiliation: The Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: McEvoy
authors.affiliation: The Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D057220:Health Literacy; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D017286:Polysomnography; D012307:Risk Factors; D057566:Self Report; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D012913:Snoring / Q000453:epidemiology; D013021:South Australia / Q000453:epidemiology
keywords: Health literacy; Newest Vital Sign; cardiovascular disease; cohort study; depression; diagnosis; men; obstructive sleep apnea