Obstructive sleep apnea related to mental health, health-related quality of life and multimorbidity: A nationwide survey of a representative sample in Republic of Korea

Abstract

Objectives: This study assessed the effects of obstructive sleep apnea (OSA) on mental health, health-related quality of life (HRQoL), and multimorbidity in Korean adults.

Methods: The study included 8030 participants from the Korea National Health and Nutrition Examination Survey Ⅷ (2019-2020). The risk of OSA was assessed using STOP-BANG questionnaire. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9), and stress was measured using a questionnaire. HRQoL was determined by EuroQol 5-dimension (EQ-5D) and Health-related Quality of Life Instrument with 8 Items (HINT-8) scores. Multimorbidity was defined as the presence of 2 or more chronic diseases. A complex sample multivariate logistic regression analysis was conducted.

Results: Participants with a high OSA risk were more likely to a have high PHQ-9 score (OR 4.31, 95% confidence interval [CI] 2.80-6.65), total depression (OR 4.07, 95% CI 2.67-6.19) stress (OR 2.33, 95% CI 1.85-2.95), lower EQ-5D (OR 2.88, 95% CI 2.00-4.15) and HINT-8 scores (OR 2.87, 95% CI 1.65-4.98), and multimorbidity (OR 2.62, 95% CI 2.01-3.41) than participants with low OSA risk. High OSA risk was significantly associated with all EQ-5D and HINT-8 items.

Conclusions: This study adds to the few population-based studies showing associations between mental health, HRQoL, and multimorbidity using nationwide data. OSA prevention might be helpful for good mental health, improving HRQoL, and comorbidity burdens. The results provide novel insights regarding the association between sleep apnea and multimorbidity.

Fig 1. Flow chart for the number of participants excluded and analyzed.

Abbreviations: KNHANES, Korea National Health and Nutrition Examination Survey; EQ-5D: EuroQol 5-dimension.

Fig 2. Prevalence of depression, stress, low EQ-5D and low HINT-8 scores, and multimorbidity according to OSA risk.

Abbreviations: EQ-5D, EuroQol 5-dimension; HINT-8, Health-related Quality of Life Instrument with 8 Items; OSA, obstructive sleep apnea; PHQ-9, Patient Health Questionnaire-9; QOL, quality of life.

Fig 3. Association between sleep apnea risk and mental health, quality of life based on EQ-5 and HINT-8 scores, and multimorbidity using a multivariate logistic regression analysis.

Age, sex, education, alcohol consumption, smoking status, and physical activity, year, BMI, hypertension, diabetes, and cardiovascular disease were adjusted when calculating odds ratio for depression and QOL by HINT-8. Age, sex, education, alcohol consumption, smoking status, and physical activity, year, BMI, hypertension, diabetes, and cardiovascular disease were adjusted when calculating odds ratio for stress and quality of life by EQ-5D, while age, sex, education, alcohol consumption, smoking status, and physical activity, year and BMI were adjusted when calculating odds ratio for multimorbidity. Abbreviations: QOL, quality of life; PHQ-9, Patient Health Questionnaire-9; EQ-5D, EuroQol Five-Dimension Questionnaire; HINT-8, Health-related Quality of Life Instrument with 8 Items.