title: Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is now highly prevalent but largely undiagnosed. Quality of life is an indicator of both the impact of undiagnosed OSA and the need for strategies to increase OSA diagnosis. We determined age-related impacts of undiagnosed OSA on health-related quality of life (HRQL) and whether this was independent of sleepiness and comorbidities.
  
  
  METHODS
  In 2010-2012, 837 participants from the Men Androgen Inflammation Lifestyle Environment and Stress Study (population cohort n = 1869, ≥40 years, Adelaide, Australia), without a prior OSA diagnosis underwent full in-home polysomnography (Embletta X100) and completed the Epworth Sleepiness Scale and SF-36 questionnaire. The effects of the apnea-hypopnea index (AHI) on SF-36 physical (PCS) and mental (MCS) component summary scores and standardized SF-36 scale z-scores were estimated using multiple linear regression adjusted for major comorbidities and sleepiness, stratified by age.
  
  
  RESULTS
  Men ≤69 years demonstrated significant (p < 0.05) decrements/event increase in AHI in PCS score [unstandardized B coefficient (SE) = -0.068 (0.023)], physical functioning, role physical, general health, and vitality z-scores in fully adjusted models. Severe OSA (AHI ≥30) was associated with significant reductions in PCS [B = -4.1 (1.1)] and MCS score [B = -3.6 (1.2)] independent of sleepiness and comorbidities which were attenuated but persisted in men <69 years without depression. In men aged ≥70 years, statistically significant AHI-associated impairments were generally not seen.
  
  
  CONCLUSIONS
  Undiagnosed OSA was a major independent contributor to HRQL impairments in men <69 years. Improved strategies to identify undiagnosed OSA are indicated that may require a reduced focus on daytime sleepiness.
authors.affiliation: The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville Rd, Woodville, South Australia, 5011, Australia. sarah.appleton@adelaide.edu.au.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Appleton
authors.affiliation: 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, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vakulin
authors.affiliation: Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.|Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: McEvoy
authors.affiliation: Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Martin
authors.affiliation: Population Research and Outcomes Study Unit, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Janet F
authors.initials: JF
authors.lastname: Grant
authors.affiliation: Population Research and Outcomes Study Unit, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.|Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.|Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Catcheside
authors.affiliation: The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville Rd, Woodville, South Australia, 5011, Australia.|Freemasons Foundation Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville Rd, Woodville, South Australia, 5011, Australia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*
keywords: Cohort study; Depression; Excessive daytime sleepiness; Men; Obstructive sleep apnea; SF-36 health-related quality of life