Psychological and quality of life factors in men with comorbid Obstructive Sleep Apnea (OSA) and insomnia (Ins): a population study

Abstract

OSA and Ins frequently coexist together but prevalence and risk factors in the community remain largely unknown. This study examined the prevalence and clinical profile of undiagnosed comorbid OSA and insomnia (COMISA) in a community-based population of Australian men. Methods: Men (N = 700) without a prior diagnosis of OSA completed full at home unattended polysomnography (PSG, Embletta Z100), the Pittsburgh Sleep Quality Index and SF-36 short form health survey (2010-12). Insomnia was defined according to the DSM-IV_TR Research Diagnostic Criteria for primary insomnia. Psychological and behavioural factors (e.g. Beck Depression Inventory- 1A/Centre for Epidemiological Studies Depression Scale, Patient Health Questionnaire-9 (PHQ-9), Pearlin Mastery Scale) were also assessed (2007-10). Univariate (X2, ANOVA) and multiple linear regressions were used to compare data from four groups of individuals: those with neither disorder, previously undiagnosed OSA (OSA) (AHI ≥ 10/h) or Ins alone, and those with COMISA. Results: Prevalence of OSA, Ins and COMISA was 41.3, 8.7 and 11.6%, respectively. The proportion of men with OSA who also had Ins was 21.9%. Depression prevalence was 6.6, 18.0 and 34.6% in OSA, Ins and COMISA, respectively. Men with COMISA had significantly higher (post-hoc, P < 0.05) depression scores (e.g. PHQ-9 mean SD, OSA: 11.1 2.7; Ins: 13.8 5.6, COMISA: 15.1 5.3) and lower mastery (OSA: 21.2 2.8; Ins: 20.6 2.9; COMISA: 19.7 2.9) and quality of life (physical: OSA: 51.7 7.1; Ins: 45.2 9.4; COMISA: 39.3 10.8; mental: OSA: 53.3 6.4; Ins: 44.8 9.2; COMISA: 39.7 12.2) component scores than both the Ins and OSA groups. This was despite having similar respiratory and arousal indices to that observed in the OSA group, and similar reductions in subjective sleep quality, efficiency, duration and day dysfunction scores to that observed in the Ins group. Associations with depression, mastery and both physical and mental quality of life remained significant in the COMISA group even after adjustment for age, obesity, chronic diseases, erectile dysfunction, sleepiness, mood and financial strain, where appropriate. Conclusions: Community-dwelling men with COMISA show significantly worse quality of life (both physical and mental), mastery and depression. The quality of life burden is profound and similar to other major chronic illnesses.