Association between multimorbidity and undiagnosed obstructive sleep apnea severity and their impact on quality of life in men over 40 years old

Abstract

Background: Multimorbidity is common but little is known about its relationship with obstructive sleep apnea (OSA).

Methods: Men Androgen Inflammation Lifestyle Environment and Stress Study participants underwent polysomnography. Chronic diseases (CDs) were determined by biomedical measurement (diabetes, dyslipidaemia, hypertension, obesity), or self-report (depression, asthma, cardiovascular disease, arthritis). Associations between CD count, multimorbidity, apnea-hyponea index (AHI) and OSA severity and quality-of-life (QoL; mental & physical component scores), were determined using multinomial regression analyses, after adjustment for age.

Results: Of the 743 men participating in the study, overall 58% had multimorbidity (2+ CDs), and 52% had OSA (11% severe). About 70% of those with multimorbidity had undiagnosed OSA. Multimorbidity was associated with AHI and undiagnosed OSA. Elevated CD count was associated with higher AHI value and increased OSA severity.

Conclusion: We demonstrate an independent association between the presence of OSA and multimorbidity in this representative sample of community-based men. This effect was strongest in men with moderate to severe OSA and three or more CDs, and appeared to produce a greater reduction in QoL when both conditions were present together.

Keywords: Apnea-hypopnea index; chronic disease; comorbidity; obstructive sleep apnea; quality of life.

Fig. 1.

Flow chart of the sleep substudy of the MAILES cohort. OSA, obstructive sleep apnea; PSG, polysomnography; and AHI, apnea hypopnea index.

Fig. 2.

Relationship between obstructive sleep apnea severity and the mean number of chronic disease and PCS and MCS SF-36 score in the 743 men. ^{1, 2 and 3}, significantly different from the absent, mild and moderate severity group, respectively. Data are adjusted for age, sedentary lifestyle, marital, gross income, working and smoking status.

Fig. 3.

Interaction between obstructive sleep apnea and chronic disease count on physical (panel a) and mental (panel b) components summary of the SF36 quality of life questionnaire in the 743 men. CD, chronic disease; OSA, obstructive sleep apnea; PCS, physical component summary; MCS, mental component summary.