Obstructive sleep apnea during rapid eye movement sleep, daytime sleepiness, and quality of life in older men in Osteoporotic Fractures in Men (MrOS) Sleep Study

Akram Khan, Stephanie L Harrison, Eric J Kezirian, Sonia Ancoli-Israel, Daniel O'Hearn, Eric Orwoll, Susan Redline, Kristine Ensrud, Katie L Stone
Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine 2013 March 15, 9 (3): 191-8

STUDY OBJECTIVES: Assess the association between REM predominant obstructive sleep apnea (OSA), sleepiness, and quality of life in a community-based cohort of men ≥ 65 years-old. DESIGN INTERVENTION AND MEASUREMENTS: A cross-sectional analysis of 2,765 subjects from the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study was performed to identify subjects with an apnea hypopnea index (AHI) < 15 (n = 2,044). Subjects were divided into groups based on the AHI in REM sleep (< 5 [referent group], 5 to < 15, 15 to < 30, and ≥ 30). Daytime somnolence, sleep-related quality of life, sleep disturbance, general quality of life, depressive symptoms, and health status were quantified using Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Pittsburgh Sleep Quality Index (PSQI), Short Form-12 (SF-12), Geriatric Depression Scale-15 (GDS), and self-perceived health status, respectively.

RESULTS: Prevalence of REM-predominant OSA (AHI-REM ≥ 5) was 42.8% if OSA was defined as AHI ≥ 15 and 14.4% if OSA was defined as AHI ≥ 5. Higher AHI-REM was associated with polysomnographic indices of poorer sleep architecture (reduced total sleep time, sleep efficiency, REM sleep duration and proportion). Adjusting for age, BMI, and study site, higher AHI-REM was not associated with subjective sleep measures (ESS, FOSQ, PSQI), lower quality of life (SF-12), or greater depressive symptoms (GDS).

CONCLUSIONS: In a community-based sample of older adult men ≥ 65 years-old, REM-predominant OSA was highly prevalent and was associated with objective indices of poorer sleep quality on polysomnography but not with subjective measures of daytime sleepiness or quality of life.

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