Population-based analysis of sociodemographic predictors, health-related quality of life and health service use associated with obstructive sleep apnoea and insomnia in Australia
E. Hoon A I , D. A. González-Chica A , A. Vakulin B C , D. McEvoy B , N. Zwar D , R. Grunstein C E , C. Chai-Coetzer B F , L. Lack B , R. Adams B F , P. Hay G , S. Touyz H and N. Stocks AA Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Helen Mayo North Building, Frome Road, Adelaide, SA 5000, Australia.
B Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, SA 5049, Australia.
C Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
D Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Qld 4226, Australia.
E Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital 50 Missenden Road, Camperdown, NSW 2050, Australia.
F Respiratory and Sleep Service, Southern Adelaide Local Health Network, Flinders Medical Centre, Bedford Park, SA 5049, Australia.
G Translational Health Research Institute, School of Medicine, University of Western Sydney, Building 3, David Pilgrim Avenue, Campbelltown, NSW 2560, Australia.
H School of Psychology, University of Sydney, Brennan MacCallum Building, A18 Manning Road, Camperdown, NSW 2050, Australia.
I Corresponding author. Email: elizabeth.hoon@adelaide.edu.au
Australian Journal of Primary Health 27(4) 304-311 https://doi.org/10.1071/PY20216
Submitted: 25 September 2020 Accepted: 28 December 2020 Published: 3 March 2021
Abstract
Although there is growing recognition of the effects of living with sleep disorders and the important role of primary care in their identification and management, studies indicate that the detection of sleep apnoea (OSA) and insomnia may still be low. This large representative community-based study (n = 2977 adults) used logistic regression models to examine predictors of self-reported OSA and current insomnia and linear regression models to examine the association of these sleep conditions with both mental and physical components of health-related quality of life (HRQoL) and health service use. Overall, 5.6% (95% confidence interval (CI) 4.6–6.7) and 6.8% (95% CI 5.7–7.9) of subjects self-reported OSA (using a single-item question) and current insomnia (using two single-item questions) respectively. Many sociodemographic and lifestyle predictors for OSA and insomnia acted in different directions or showed different magnitudes of association. Both disorders had a similar adverse relationship with physical HRQoL, whereas mental HRQoL was more impaired among those with insomnia. Frequent consultations with a doctor were associated with a lower physical HRQoL across these sleep conditions; however, lower mental HRQoL among those frequently visiting a doctor was observed only among individuals with insomnia. The adverse relationship between sleep disorders and physical and mental HRQoL was substantial and should not be underestimated.
Keywords: primary care, sleep conditions.
References
Adams R, Appleton S, Taylor A, McEvoy D, Wittert G (2016) Are the ICSD-3 criteria for sleep apnoea syndrome too inclusive? The Lancet. Respiratory Medicine 4, e19–e20.| Are the ICSD-3 criteria for sleep apnoea syndrome too inclusive?Crossref | GoogleScholarGoogle Scholar | 27304561PubMed |
Amiri S, Behnezhad S (2020) Smoking and risk of sleep-related issues: a systematic review and meta-analysis of prospective studies. Canadian Journal of Public Health 111, 775–786.
| Smoking and risk of sleep-related issues: a systematic review and meta-analysis of prospective studies.Crossref | GoogleScholarGoogle Scholar | 32185746PubMed |
Appleton SL, Vakulin A, McEvoy RD, Vincent A, Martin SA, Grant JF, Taylor AW, Antic NA, Catcheside PG, Wittert GA, Adams RJ (2015) Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort. Sleep and Breathing 19, 1309–1316.
| Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort.Crossref | GoogleScholarGoogle Scholar | 25896898PubMed |
Appleton SL, Gill TK, Lang CJ, Taylor AW, McEvoy RD, Stocks NP, González-Chica DA, Adams RJ (2018) Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health 4, 13–19.
| Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey.Crossref | GoogleScholarGoogle Scholar | 29332673PubMed |
Australian Bureau of Statistics (2016a) ‘Census of Population and Housing: Census Dictionary, 2016.’ Available at https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/2901.0Chapter23002016#SA1 [Verified 17 February 2021]
Australian Bureau of Statistics (2016b) Census of Populations and Surveys Community Profiles. Available at https://www.abs.gov.au/websitedbs/D3310114.nsf/Home/2016%20Census%20Community%20Profiles [Verified 17 February 2021]
Australian Bureau of Statistics (2017) ‘Patient Experiences in Australia: Summary of Findings, 2016–17, 4839.0.’ Available at https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4839.0~2016-17~Main%20Features~General%20practitioners~2 [Verified 25 November 2020]
Australian Bureau of Statistics (2018) ‘Smoking: 2017–18 financial Year.’ Available at https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release [Verified 26 November 2020]
Australian Bureau of Statistics (2019) ‘National Health Survey: Users’ Guide, 2017–18, 4363.0.’ Available at https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4363.0~2017-18~Main%20Features~Introduction~2 [Verified 24 November 2020]
Bin YS, Marshall NS, Glozier N (2012) The burden of insomnia on individual function and healthcare consumption in Australia. Australian and New Zealand Journal of Public Health 36, 462–468.
| The burden of insomnia on individual function and healthcare consumption in Australia.Crossref | GoogleScholarGoogle Scholar | 23025369PubMed |
Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L, Pan Y, Charles J, Pollack AJ, Wong CJG (2016) General practice activity in Australia 2015–16. General practice series no. 40. Sydney University Press, Sydney, NSW, Australia. Available at https://purl.library.usyd.edu.au/sup/9781743325131 [Verified 17 February 2021]
Cross NE, Harrison CM, Yee BJ, Grunstein RR, Wong KK, Britt HC, Marshall NS (2016) Management of Snoring and Sleep Apnea in Australian Primary Care: The BEACH Study (2000–2014). Journal of Clinical Sleep Medicine 12, 1167–1173.
| Management of Snoring and Sleep Apnea in Australian Primary Care: The BEACH Study (2000–2014).Crossref | GoogleScholarGoogle Scholar | 27397666PubMed |
Doghramji (2014) Integrating Modern concepts of insomnia and its contemporary treatment into primary care. Postgraduate Medicine 126, 82–101.
| Integrating Modern concepts of insomnia and its contemporary treatment into primary care.Crossref | GoogleScholarGoogle Scholar | 25295652PubMed |
Galea S, Tracy M (2007) Participation rates in epidemiologic studies. Annals of Epidemiology 17, 643–653.
| Participation rates in epidemiologic studies.Crossref | GoogleScholarGoogle Scholar | 17553702PubMed |
Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology 51, 1171–1178.
| Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment.Crossref | GoogleScholarGoogle Scholar | 9817135PubMed |
González-Chica DA, Vanlint S, Hoon E, Stocks N (2018) Epidemiology of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis among 1.5 million patients in Australian general practice: NPS MedicineWise MedicineInsight dataset. BMC Musculoskeletal Disorders 19, 20
| Epidemiology of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis among 1.5 million patients in Australian general practice: NPS MedicineWise MedicineInsight dataset.Crossref | GoogleScholarGoogle Scholar | 29347932PubMed |
Hartescu I, Morgan K (2019) Regular physical activity and insomnia: an international perspective. Journal of Sleep Research 28, e12745
Hayes AJ, Lung TW, Bauman A, Howard K (2017) Modelling obesity trends in Australia: unravelling the past and predicting the future. International Journal of Obesity 41, 178–185.
| Modelling obesity trends in Australia: unravelling the past and predicting the future.Crossref | GoogleScholarGoogle Scholar | 27671035PubMed |
Hein M, Lanquart J-P, Loas G, Hubain P, Linkowski P (2017) Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects. Respiratory Research 18, 135
| Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects.Crossref | GoogleScholarGoogle Scholar | 28683800PubMed |
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. The Lancet. Respiratory Medicine 3, 310–318.
| Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study.Crossref | GoogleScholarGoogle Scholar | 25682233PubMed |
Hillman DR, Lack LC (2013) Public health implications of sleep loss: the community burden. The Medical Journal of Australia 199, S7–S10.
| Public health implications of sleep loss: the community burden.Crossref | GoogleScholarGoogle Scholar | 24138358PubMed |
Hudgel DW, Patel SR, Ahasic AM, Bartlett SJ, Bessesen DH, Coaker MA, Fiander PM, Grunstein RR, Gurubhagavatula I, Kapur VK, Lettieri CJ, Naughton MT, Owens RL, Pepin JL, Tuomilehto H, Wilson KC (2018) The role of weight management in the treatment of adult obstructive sleep apnea. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine 198, e70–e87.
| The role of weight management in the treatment of adult obstructive sleep apnea. An Official American Thoracic Society Clinical Practice Guideline.Crossref | GoogleScholarGoogle Scholar | 30215551PubMed |
Jordan A, McEvoy RD (2003) Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms. Sleep Medicine Reviews 7, 377–389.
| Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms.Crossref | GoogleScholarGoogle Scholar | 14573374PubMed |
Lang CJ, Appleton SL (2017) Co-morbid OSA and insomnia increases depression prevalence and severity in men. 22, 1407–1415.
McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, Mediano O, Chen R, Drager LF, Liu Z, Chen G, Du B, McArdle N, Mukherjee S, Tripathi M, Billot L, Li Q, Lorenzi-Filho G, Barbe F, Redline S, Wang J, Arima H, Neal B, White DP, Grunstein RR, Zhong N, Anderson CS (2016) CPAP for prevention of cardiovascular events in obstructive sleep apnea. The New England Journal of Medicine 375, 919–931.
| CPAP for prevention of cardiovascular events in obstructive sleep apnea.Crossref | GoogleScholarGoogle Scholar | 27571048PubMed |
Miller CB, Valenti L, Harrison CM, Bartlett DJ, Glozier N, Cross NE, Grunstein RR, Britt HC, Marshall NS (2017) Time trends in the family physician management of insomnia: the Australian experience (2000–2015). Journal of Clinical Sleep Medicine 13, 785–790.
| Time trends in the family physician management of insomnia: the Australian experience (2000–2015).Crossref | GoogleScholarGoogle Scholar | 28454597PubMed |
Morin CM, Benca R (2012) Chronic insomnia. Lancet 379, 1129–1141.
| Chronic insomnia.Crossref | GoogleScholarGoogle Scholar | 22265700PubMed |
Ogeil RP, Chakraborty SP, Young AC, Lubman DI (2020) Clinician and patient barriers to the recognition of insomnia in family practice: a narrative summary of reported literature analysed using the theoretical domains framework. BMC Family Practice 21, 1
| Clinician and patient barriers to the recognition of insomnia in family practice: a narrative summary of reported literature analysed using the theoretical domains framework.Crossref | GoogleScholarGoogle Scholar | 31901226PubMed |
Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE, Diener-West M, Sanders MH, Wolf PA, Geraghty EM, Ali T, Lebowitz M, Punjabi NM (2010) Obstructive Sleep Apnea–Hypopnea and Incident Stroke. American Journal of Respiratory and Critical Care Medicine 182, 269–277.
| Obstructive Sleep Apnea–Hypopnea and Incident Stroke.Crossref | GoogleScholarGoogle Scholar | 20339144PubMed |
Steier J, Martin A, Harris J, Jarrold I, Pugh D, Williams A (2013) ‘Predicted relative prevalence estimates for obstructive sleep apnoea and the associated health care provision across the UK’.
Taylor A, Dal Grande E, Wilson D (2006) The South Australian Health Omnibus Survey 15 years on: has public health benefited? South Australian Public Health Bulletin 3, 30–32.
Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR (2010) Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Medicine 11, 441–446.
| Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study.Crossref | GoogleScholarGoogle Scholar | 20362502PubMed |
Ware J, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220–233.
| A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.Crossref | GoogleScholarGoogle Scholar | 8628042PubMed |
