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VOLUME 32, ISSUE 08

SLEEP-DISORDERED BREATHING AND CHANGE IN QUALITY OF LIFE
Longitudinal Evaluation of Sleep-Disordered Breathing and Sleep Symptoms with Change in Quality of Life: The Sleep Heart Health Study (SHHS)

Graciela E. Silva, PhD, MPH1; Ming-Wen An, PhD2; James L. Goodwin, PhD3; Eyal Shahar, MD4; Susan Redline, MD5; Helaine Resnick, PhD6; Carol M. Baldwin, PhD RN1; Stuart F. Quan, MD3,7

1College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; 2Johns Hopkins School of Public Health, Baltimore, MD; 3Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ; 4Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ; 5Center for Clinical Investigation, Case Western Reserve University School of Medicine, Cleveland, OH; 6Department of Epidemiology and Biostatistics, MedStar Research Institute, Hayattsville, MD; 7Division of Sleep Medicine, Harvard Medical School, Boston, MA



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Study Objectives: Findings from population studies evaluating the progression and incidence of sleep disordered breathing have shown evidence of a longitudinal increase in the severity of sleep disordered breathing. The present study evaluates the association among changes in sleep disordered breathing, sleep symptoms, and quality of life over time.
Design: Prospective cohort study. Data were from the Sleep Heart Health Study.
Setting: Multicenter study.
Participants: Three thousand seventy-eight subjects aged 40 years and older from the baseline and follow-up examination cycles were included.
Measurements: The primary outcomes were changes in the Physical Component Summary and Mental Component Summary scales obtained from the Medical Outcomes Study Short-Form Health Survey. The primary exposure was change in the respiratory disturbance index obtained from unattended overnight polysomnograms performed approximately 5 years apart. Other covariates included measures of excessive daytime sleepiness and difficulty initiating and maintaining sleep.
Results: Mean respiratory disturbance index increased from 8.1 ± 11 SD at baseline to 10.9 ± 14 (P < 0.0001) at follow-up. The mean Physical Component Summary and Mental Component Summary scores were 48.5 and 54.1 at baseline and 46.3 and 54.8 at follow-up. No associations between change in respiratory disturbance index and changes in Physical Component Summary or Mental Component Summary scores were seen. However, worsening of difficulty initiating and maintaining sleep and excessive daytime sleepiness were significantly associated with lower quality of life.
Conclusions: A slight increase in severity of sleep disordered breathing was seen over 5 years; this was not associated with worsening of quality of life. However, subjective symptoms of quality of sleep and daytime sleepiness were associated with declining quality of life.
Keywords: Sleep disordered breathing, quality of life, longitudinal, quality of sleep, excessive daytime sleepiness
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