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Do symptoms of sleepiness and insomnia in US veterans with obstructive sleep apnea vary by age?

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Introduction

The influence of aging on the clinical presentation of obstructive sleep apnea (OSA) is not well characterized in US veterans. Our aims were to (1) examine age and established predictors of sleepiness and insomnia symptoms in veterans with OSA and (2) determine if the relationship between predictors of the Epworth sleepiness scale (ESS) and insomnia severity index (ISI) depended on age.

Methods

We performed a retrospective analysis of veterans diagnosed with OSA at the Miami VA in 2014. On polysomnography (PSG) night, questionnaires were completed querying socio-demographics, insomnia (ISI), sleepiness (ESS), and self-reported sleep duration. Regression modeling was performed to explore association of variables with (1) ESS and (2) ISI. Analyses were performed in two steps: (1) variables were tested for main effects and (2) product of age and each variable found to have an association at a significance level of p < 0.10 with primary outcome were entered separately to test for interaction.

Results

The sample consisted of 483 veterans (93% male, age 52 ± 13 years, 41% black, 34% Hispanic). Having a regular bed partner, higher weighted medical comorbidities, chronic pain diagnosis, and shorter sleep duration were associated with ESS. Age did not moderate the relationship between these variables and ESS. Younger age, Hispanic ethnicity, higher educational level, shorter sleep duration, mood, and pain diagnoses were each associated with the ISI. Furthermore, an age-sleep duration interaction term was associated with the ISI (b = − 0.03; p = 0.005). For all participants, there was an inverse relationship between sleep duration and ISI. However, for any sleep duration, older veterans reported lower levels of insomnia than younger veterans.

Discussion

Older veterans with OSA may report lower ISI scores. Alternative assessment methods for comorbid insomnia among older individuals with OSA may be needed.

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Author information

Authors and Affiliations

  1. Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA

    C. Agudelo, A. R. Ramos & D. M. Wallace

  2. Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL, 33125, USA

    C. Agudelo & D. M. Wallace

  3. Department of Population Health, New York Langone Health, Center for Healthful Behavior Change, New York, NY, USA

    N. J. Williams

Authors
  1. C. Agudelo
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  2. A. R. Ramos
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  3. N. J. Williams
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  4. D. M. Wallace
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Corresponding author

Correspondence to D. M. Wallace.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

As this study involved retrospective analysis of existing clinical data, informed consent was not obtained from participants.

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Comment

The prevalence of sleep-disordered breathing among current and former military service members appears high and novel techniques to ensure timely and accurate diagnosis remain important. In this study, the authors illustrate a negative relationship between age and the insomnia severity index (ISI) among a cohort of veterans with obstructive sleep apnea. This finding could impact the approach to OSA diagnosis in older veteran populations. Whether this finding reflects less insomnia symptoms in older OSA patients or simply less reliability of the ISI in this age group remains to be seen, though development of alternative insomnia assessment tools for this demographic seems appropriate.

Tyler Powell

San Antonio, USA

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Agudelo, C., Ramos, A.R., Williams, N.J. et al. Do symptoms of sleepiness and insomnia in US veterans with obstructive sleep apnea vary by age?. Sleep Breath 24, 159–166 (2020). https://doi.org/10.1007/s11325-019-01845-z

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  • DOI: https://doi.org/10.1007/s11325-019-01845-z

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