Sleep and Breathing

, Volume 19, Issue 4, pp 1309–1316 | Cite as

Undiagnosed obstructive sleep apnea is independently associated with reductions in quality of life in middle-aged, but not elderly men of a population cohort

  • Sarah L. AppletonEmail author
  • Andrew Vakulin
  • R. Douglas McEvoy
  • Andrew Vincent
  • Sean A. Martin
  • Janet F. Grant
  • Anne W. Taylor
  • Nick A. Antic
  • Peter G. Catcheside
  • Gary A. Wittert
  • Robert J. Adams
Original Article



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.


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.


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.


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.


SF-36 health-related quality of life Obstructive sleep apnea Excessive daytime sleepiness Depression Cohort study Men 



National Health and Medical Research Council of Australia grant number 627227; The Resmed Foundation, CA, USA. Embla Systems, CO, contributed a number of Embletta X100 devices for the duration of the study.

Conflict of interest

RA has received research funding from the National Health and Medical Research Council of Australia, and the ResMed Foundation, and nonfinancial support from Embla Systems, CO.

AV has received research funding from the National Health and Medical Research Council of Australia.

RDM has received research funding from the National Health and Medical Research Council of Australia, the ResMed Foundation, Philips Respironics, and Fisher and Paykel, equipment donations from ResMed, Philips Respironics and SomnoMed, and lecture fees from Philips Respironics.

NA has received research funding from the National Health and Medical Research Council of Australia, Philips Respironics, and Fisher and Paykel, equipment donations from ResMed, Philips Respironics and SomnoMed, and lecture fees and payment for development of educational presentations from ResMed.

PC has received research funding from the National Health and Medical Research Council of Australia, and the Australian Research Council, equipment support from Philips Respironics and AirLiquide Healthcare.

AT has received research funding from the National Health and Medical Research Council of Australia.

GW has received research funding from the National Health and Medical Research Council of Australia and the ResMed Foundation, and non-financial support from Embla Systems, Colorado.

SM, JG, and SA have no conflicts of interest to declare.

Supplementary material

11325_2015_1171_MOESM1_ESM.docx (51 kb)
ESM 1 (DOCX 51 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Sarah L. Appleton
    • 1
    Email author
  • Andrew Vakulin
    • 2
    • 3
  • R. Douglas McEvoy
    • 2
    • 4
  • Andrew Vincent
    • 5
  • Sean A. Martin
    • 5
  • Janet F. Grant
    • 6
  • Anne W. Taylor
    • 6
  • Nick A. Antic
    • 2
    • 4
  • Peter G. Catcheside
    • 2
    • 4
  • Gary A. Wittert
    • 1
    • 5
  • Robert J. Adams
    • 1
  1. 1.The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital CampusUniversity of AdelaideWoodvilleAustralia
  2. 2.Adelaide Institute of Sleep HealthRepatriation General HospitalDaw ParkAustralia
  3. 3.NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical SchoolUniversity of SydneySydneyAustralia
  4. 4.Department of MedicineFlinders UniversityAdelaideAustralia
  5. 5.Freemasons Foundation Centre for Men’s Health, Discipline of MedicineUniversity of AdelaideAdelaideAustralia
  6. 6.Population Research and Outcomes Study Unit, Discipline of MedicineUniversity of AdelaideAdelaideAustralia

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