Annals of Behavioral Medicine

, Volume 22, Issue 2, pp 116–120 | Cite as

Sleep apnea and health-related quality of life in African-American elderly

  • Carl Stepnowsky
  • Sherella Johnson
  • Joel Dimsdale
  • Sonia Ancoli-Israel
Empirical Articles


The relationship between health-related quality of life (HRQOL) and sleep apnea was examined in a sample of elderly African-Americans screened for snoring and daytime sleepiness. Seventy African-Americans over the age of 65 years completed a comprehensive sleep questionnaire, the Quality of Well-Being Scale (QWB), and the Medical Outcomes Study (MOS) Core Measures of HRQOL (116-item Long Version) and had sleep recorded. Those with moderate-severe sleep apnea had significantly lower Physical Component summary scores than those with no sleep apnea (p<0.05). After controlling for medical conditions, sleep apnea was significantly related to both general physical functioning and general mental health functioning in those with mild apnea (apnea-hypopnea index [AHI] <15), but not in those with moderate to severe apnea. There was an initial decrease in HRQOL up to an AHI level of 15, at which point HRQOL remained at a lowered level. The QWB scores of our sleep apnea sample were similar to the QWB scores found in patients with depression and chronic obstructive pulmonary disease (COPD), suggesting that sleep disturbances may impact daily living and health as much as other medical conditions.


Chronic Obstructive Pulmonary Disease Obstructive Sleep Apnea Sleep Apnea Continuous Positive Airway Pressure Mental Component Summary 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. (1).
    Guyatt G, Feeny D, Patrick D: Measuring health-related quality of life.Annals of Internal Medicine. 1993,118:622–629.PubMedGoogle Scholar
  2. (2).
    Kaplan RM, Anderson J: The general health policy model: An integrated approach. In Spilker B (ed),Quality of Life Assessments in Clinical Trials. New York: Raven, 1990, 131–149.Google Scholar
  3. (3).
    Tsevat J, Solzan JG, Kuntz KM, et al: Health values of patients infected with human immunodeficiency virus.Medical Care. 1996,34:44–57.PubMedCrossRefGoogle Scholar
  4. (4).
    Kaplan, RM, Anderson JP, Wu AW, et al: The Quality of Well-Being Scale: Applications in AIDS, cystic fibrosis, and arthritis.Medical Care (Supplement). 1989,27(3):S27-S43.CrossRefGoogle Scholar
  5. (5).
    Guilleminault C: Clinical features and evaluation of obstructive sleep apnea. In Kryger MH, Roth T, Dement WC, eds,Principles and Practice of Sleep Medicine. Philadelphia, PA: W.B. Saunders Company, 1989, 552–558.Google Scholar
  6. (6).
    Dement WC, Carskadon MA, Richardson G: Excessive daytime sleepiness in the sleep apnea syndrome. In Guilleminault C, Dement WC (eds),Sleep Apnea Syndromes. New York: Alan R. Liss, 1978, 23–46.Google Scholar
  7. (7).
    Roth T, Roehrs TA, Carskadon MA, Dement WC: Daytime sleepiness and alertness. In Kryger MH, Roth T, Dement WC (eds),Principles and Practice of Sleep Medicine (2nd Ed.). Philadelphia, PA: W.B. Saunders Company, 1994, 40–49.Google Scholar
  8. (8).
    Johns MW: A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale.Sleep. 1991,14(6):540–545.PubMedGoogle Scholar
  9. (9).
    Cheshire K, Engleman H, Deary I, Shapiro C, Douglas NJ: Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome.Archives of Internal Medicine. 1992,152:538–541.PubMedCrossRefGoogle Scholar
  10. (10).
    Reisberg B, Borenstein M: Behavioral symptoms in Alzheimer's Disease: Phenomenology and treatment.Journal of Clinical Psychiatry. 1987,48:9–15.PubMedGoogle Scholar
  11. (11).
    Reynolds CFI, Kupfer DJ, McEachran AB, et al: Depressive psychopathology in male sleep apneics.Journal of Clinical Psychiatry. 1984,45:287–290.PubMedGoogle Scholar
  12. (12).
    Kales A, Caldwell AB, Cadieux RJ, et al: Severe obstructive sleep apnea—II: Associated psychopathology and psychosocial consequences.Journal of Chronic Diseases. 1985,38:427–434.PubMedCrossRefGoogle Scholar
  13. (13).
    Horne JA: Human sleep, sleep loss, and behavior. Implications for the prefrontal cortex and psychiatric disorder.British Journal of Psychiatry. 1993,162:413–419.PubMedGoogle Scholar
  14. (14).
    Findley LJ, Unverzagt ME, Suratt PM: Automobile accidents involving patients with obstructive sleep apnea.American Review of Respiratory Disease. 1988,138:337–340.PubMedGoogle Scholar
  15. (15).
    Young T, Blustein J, Finn L, Palta M: Sleep-disordered breathing and motor vehicle accidents in population-based sample of employed adults.Sleep. 1997,20:608–613.PubMedGoogle Scholar
  16. (16).
    Partinen M, Jamieson A, Guilleminault C: Long-term outcome for obstructive sleep apnea syndrome patients—Mortality.Chest. 1988,94:1200–1204.PubMedCrossRefGoogle Scholar
  17. (17).
    Young T, Peppard P, Palta M, et al: Population-Based Study of Sleep-Disordered Breathing as a Risk Factor for Hypertension.Archives of Internal Medicine. 1997,157:1746–1752.PubMedCrossRefGoogle Scholar
  18. (18).
    He J, Kryger MH, Zorick FJ, Conway W, Roth T: Mortality and apnea index in obstructive sleep apnea: Experience in 385 male patients.Chest. 1988,94:9–14.PubMedCrossRefGoogle Scholar
  19. (19).
    Lindberg E, Janson C, Svardsudd K, et al: Increased mortality among sleep snorers: A prospective population-based study.Thorax. 1998,53:631–637.PubMedCrossRefGoogle Scholar
  20. (20).
    Ancoli-Israel S, Kripke DF, Klauber MR, et al: Morbidity, mortality and sleep disordered breathing in community dwelling elderly.Sleep. 1996,19:277–282.PubMedGoogle Scholar
  21. (21).
    Gall R, Isaac L, Kryger M: Quality of life in mild obstructive sleep apnea.Sleep. 1993,16:S59-S61.PubMedGoogle Scholar
  22. (22).
    Fornas C, Ballester E, Arteta E, et al: Measurement of general health status in obstructive sleep apnea hypopnea patients.Sleep. 1995,18:876–879.PubMedGoogle Scholar
  23. (23).
    D'Ambrosio C, Bowman T, Mohsenin V: Quality of life in patients with obstructive sleep apnea.Chest. 1999,115:123–129.PubMedCrossRefGoogle Scholar
  24. (24).
    Bennett LS, Barbour C, Langford B, Stradling JR, Davies RJO: Health status in patients with obstructive sleep apnea.American Journal of Respiratory and Critical Care Medicine. 1999,159:1884–1890.PubMedGoogle Scholar
  25. (25).
    Jenkinson C, Stradling J, Petersen S: Comparison of three measures of quality of life outcome in the evaluation of continuous positive airway pressure therapy for sleep apnea.Journal of Sleep Research. 1997,6:199–204.PubMedCrossRefGoogle Scholar
  26. (26).
    Engleman HM, Kingshott RN, Wraith PK, et al: Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome.American Journal of Respiratory and Critical Care Medicine. 1999,159:461–467.PubMedGoogle Scholar
  27. (27).
    Jenkinson C, Davies RJO, Mullins R, Stradling JR: Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnea: A randomised prospective parallel trial,Lancet. 1999,353:2100–2105.PubMedCrossRefGoogle Scholar
  28. (28).
    Ballester E, Badia J, Hernandez I, et al: Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome.American Journal of Respiratory and Critical Care Medicine. 1999,152:1946–1949.Google Scholar
  29. (29).
    Grunstein RR, Stenlof K, Hedner JA, Sjostrom L: Impact of self-reported sleep-breathing disturbances on psychosocial performance in the Swedish Obese Subjects (SOS) study.Sleep. 1995,18:635–643.PubMedGoogle Scholar
  30. (30).
    Winkelman J, Gliklich R, Pradhan P, et al: Health-related quality of life in patients presenting for polysomnography.Sleep Research. 1996,25:388.Google Scholar
  31. (31).
    Ancoli-Israel S, Klauber MR, Stepnowsky C, et al: Sleep-disordered breathing in African-American elderly.American Journal of Respiratory and Critical Care Medicine. 1995,152:1946–1949.PubMedGoogle Scholar
  32. (32).
    Redline S, Tishler PV, Hans MG, et al: Racial differences in sleep-disordered breathing in African-American and Caucasians.American Journal of Respiratory and Critical Care Medicine. 1997,155:186–192.PubMedGoogle Scholar
  33. (33).
    Ancoli-Israel S: Ambulatory cassette recording of sleep apnea. In Ebersole JS (ed).Ambulatory EEG Monitoring. New York: Raven Press, 1989, 299–315.Google Scholar
  34. (34).
    Ancoli-Israel S, Kripke DF, Mason W, Messin S: Comparisons of home sleep recordings and polysomnograms in older adults with sleep disorders.Sleep. 1981,4(3):283–291.PubMedGoogle Scholar
  35. (35).
    Kaplan RM, Bush JW, Berry CC: Health status: Types of validity for an index of well-being.Health Services Research. 1976,11:478–507.PubMedGoogle Scholar
  36. (36).
    Kaplan RM: Quantification of health outcomes for policy studies in behavioral epidemiology. In Kaplan RM, Criqui MH (eds),Behavioral Epidemiology and Disease Prevention. New York: Plenum, 1985, 31–54.Google Scholar
  37. (37).
    Stewart AL, Ware JE (eds):Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Durham, NC: Duke-University Press, 1992.Google Scholar
  38. (38).
    Hays RD, Sherbourne CD, Mazel RM (eds):User's Manual for the Medical Outcomes Study (MOS) Core Measures of Health-Related Quality of Life. Santa Monica, CA: RAND, 1995.Google Scholar
  39. (39).
    Ware JE, Kosinski M, Keller SD (eds):SF-36 Physical & Mental Health Summary Scales: A User's Manual. Boston, MA: New England Medical Center, 1994.Google Scholar
  40. (40).
    Holbrook TL, Hoyt DB, Anderson JP, Hollingsworth-Fridlund P, Shackford SR: Functional limitation after major trauma: A more sensitive assessment using the Quality of Well-Being Scale: The Trauma Recovery Pilot Project.Journal of Trauma. 1994,36:74–78.PubMedCrossRefGoogle Scholar
  41. (41).
    Ries AL, Kaplan RM, Limberg TM, Prewitt LM: Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.Annals of Internal Medicine. 1995,122:823–832.PubMedGoogle Scholar
  42. (42).
    Bombardier C, Ware JE, Russell IJ, et al: Auranofin therapy and quality of life for patients with rheumatoid arthritis: Results of a multi-center trial.American Journal of Medicine. 1986,81:565–578.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2000

Authors and Affiliations

  • Carl Stepnowsky
    • 1
    • 2
  • Sherella Johnson
    • 2
    • 3
  • Joel Dimsdale
    • 2
  • Sonia Ancoli-Israel
    • 2
    • 3
  1. 1.San Diego State UniversitySan DiegoUSA
  2. 2.San Diego Joint Doctoral Program in Clinical PsychologyUniversity of CaliforniaSan DiegoUSA
  3. 3.Department of Psychiatry (116A)Veterans Affairs San Diego Healthcare SystemLa Jolla

Personalised recommendations