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Sleep-disorderedbreathingwasassociatedwithlowerhealth-
relatedqualityoflifeandcognitivefunctioninacross-sectional
studyofolderadults
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Ward,SA,Storey,E,Gasevic,D,Naughton,MT,Hamilton,GS,Trevaks,RE,Wolfe,R,O'Donoghue,FJ,
Stocks,N,Abhayaratna,WP,Fitzgerald,S,Orchard,SG,Ryan,J,McNeil,JJ,Reid,CM&Woods,RL2022,
'Sleep-disorderedbreathingwasassociatedwithlowerhealth-relatedqualityoflifeandcognitivefunctionin
across-sectionalstudyofolderadults',:///
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Received:22December2021Accepted:14April2022
DOI:
ORIGINALARTICLE
Sleep-disorderedbreathingwasassociatedwithlower
health-relatedqualityoflifeandcognitivefunctionina
cross-sectionalstudyofolderadults
,2,3|ElsdonStorey1|DanijelaGasevic1,4|
,6|,8||
RoryWolfe1|’Donoghue9,10|NigelStocks11|
,13|SharynFitzgerald1||
JoanneRyan1||,14|
1SchoolofPublicHealthandPreventiveMedicine,MonashUniversity,Melbourne,Victoria
2CentreforHealthyBrainAgeing(CHeBA),SchoolofPsychiatry,UniversityofNewSouthWales,Kensington,NewSouthWales
3DepartmentofGeriatricMedicine,PrinceofWalesHospital,Randwick,NewSouthWales
4CentreforGlobalHealthResearch,UsherInstitute,TheUniversityofEdinburgh,Edinburgh,UK
5DepartmentofRespiratoryMedicine,AlfredHospital,Melbourne,Victoria,Australia
6TheCentralClinicalSchool,MonashUniversity,Melbourne,Victoria,Australia
7DepartmentofLung,Sleep,AllergyandImmunology,MonashHealth,Clayton,Victoria,Australia
8SchoolofClinicalSciences,MonashUniversity,Clayton,Victoria,Australia
9InstituteforBreathingandSleep,AustinHealth,Heidelberg,Victoria,Australia
10FacultyofMedicine,DentistryandHealthSciences,UniversityofMelbourne,Parkville,Victoria,Australia
11DisciplineofGeneralPractice,AdelaideMedicalSchool,UniversityofAdelaide,Adelaide,SouthAustralia,Australia
12CollegeofHealthandMedicine,AustralianNationalUniversity,Acton,AustralianCapitalTerritory,Australia
13AcademicUnitofInternalMedicine,CanberraHospital,Garran,AustralianCapitalTerritory,Australia
14CurtinSchoolofPopulationHealth,CurtinUniversity,Perth,WesternAustralia,Australia
CorrespondenceAbstract

Email:stephanie.******@:Theclinicalsignificanceofsleep-disorderedbreathing
(SDB)
FundinginformationofSDBwithmood,daytimesleepiness,qualityoflife(QOL)andcognitioninarela-
NationalHealthandMedicalResearchCouncil,tivelyhealthyolderAustraliancohort.
Grant/AwardNumbers:1028368,1127060,Methods:Across-sectionalanalysiswasconductedfromtheStudyofNeurocognitive
334047;NationalInstitutesofHealth,Grant/
AwardNumbers:U01AG029824,U19AG062682;Outcomes,
NHMRCPrincipalResearchFellowship,Grant/completedanunattendedlimitedchannelsleepstudytomeasuretheoxygen
AwardNumber:GNT1136372;VictorianCancerdesaturationindex(ODI)todefinemild(ODI5–15)andmoderate/severe(ODI≥15)
Agency;MonashUniversity
SDB,theCentreforEpidemiologicalStudiesScale,theEpworthSleepinessScale,the
AssociateEditor:;SeniorEditor:12-itemShort-FormforQOLandneuropsychologicaltests.
:Ofthe1399participants(),36%(273of753)ofmenand
25%(164of646)ofwomenhadmoderate/
physicalhealth-relatedQOL(mildSDB:betacoefficient[β]À,95%CIÀ
À,p<;moderate/severeSDB:βÀ,95%CIÀÀ,p=)and
ThisisanopenaccessarticleunderthetermsoftheCreativeCommonsAttribution-NonCommercial-NoDerivsLicense,whichpermitsuseanddistributioninanymedium,
providedtheoriginalworkisproperlycited,theuseisnon-commercialandnomodificationsoradaptationsaremade.
©&SonsAustralia,LtdonbehalfofAsianPacificSocietyofRespirology.
;1–
2WARDETAL.
withlowerglobalcompositecognition(mildSDB:βÀ,95%CIÀ,
p=;moderate/severeSDB:βÀ,95%CIÀ,p=)comparedto
.
Conclusion:SDBwasassociatedwithlowerphysicalhealth-relatedqualityoflifeand
,assessingQOLand
cognitionmaybetterdelineatesubgroupsrequiringfurthermanagement,andprovide
usefultreatmenttargetmeasuresforthisagegroup.
KEYWORDS
ageing,cognition,dementia,qualityoflife,sleep-disorderedbreathing
INTRODUCTION
SUMMARYATAGLANCE
Sleep-disorderedbreathing(SDB)referstotemporaryreduc-Theclinicalimplicationsforsleep-disorderedbreath-
tions(hypopnoeas)andcessations(apnoeas)inrespirationing(SDB)
thatoccurduringsleep,leadingtointermittentde-oxygena-ofhealthycommunity-dwellingolderAustralians
tion,intra-thoracicpressureswings,sympatheticactivationreportssignificantassociationsbetweenSDBanda
1
-age,theselowerphysicalhealth-relatedqualityoflife,incon-
mechanismsunderpinthecommonlyobservedassociationstrasttootherstudiesofSDBinolderage,and
23
ofSDBwithcardiovascularandcerebrovasculardiseases,betweenSDBandlowercognitivefunction.
daytimesleepiness,4depression5andreducedqualityof
life(QOL).6
SDBprevalenceincreaseswithage7andisfrequently
detectedinatleast50%ofindividualsaged70yearsand

,possi-multicentre,randomized,placebo-controlled,double-blind
blywithoutthesameimpactsondaytimesleepiness,11QOL6clinicaltrialconductedinAustraliaandtheUnitedStates
ormortalityrisk12asobservedinthemiddle--determiningtheeffectsofdailyaspirin100mgon
tia,however,isasignificanthealthissueforolderpeople,dementia-freeanddisability-,25TheSNORE-
andthereareseveralmechanismsbywhichSDBmaypoten-ASAsub-studywasofferedinAustraliaonly.
tiatetheneurodegenerativeprocessesthatleadtodementia
duetoAlzheimer’sdisease(AD)and/orvascular


bothimpairedcognitivefunction,whichusuallyprecedes

dementia,andofdementiaitself,,allaged70+years,wererec-
ResolvingtheclinicalimplicationsofSDBinolderageisruited,fromMarch2010toNovember2014,throughgen-
,
RadiologicalandretinalEffectsofAspirininSleepApnoeaocclusivecardiovasculardisease(CVD),atrialfibrillation
(SNORE-ASA)isinvestigatingtheassociationofSDBwith(AF),heartfailure,uncontrolledhypertension,currentanti-
cognitivedecline,andwithneuroimagingandretinalbio-thrombotictherapy,anaemia,dementia,ascoreof<78/100
-ASAwillalsoontheModifiedMini-MentalStateExamination(3MS)or
determinetowhatextentaspirin,withanti-plateletandanti-
inflammatoryproperties,attenuatescognitiveandimagingTheSNORE-ASAparticipationwasofferedduring
biomarkerchangesover3yearsinacohortwithoutmajorASPREEclinicaltrialrandomizationvisitsinVictoria,South
-AustraliaandtheAustralianCapitalTerritoryfromMarch
specificprevalenceofSDBinthislargeoldercommunity-
basedcohortandinvestigatestheassociationsofSDBwithaknowndiagnosisofobstructivesleepapnoea(OSA)and/or
QOL,mood,
(CPAP)
METHODS
Sleepmeasures
Studydesign
Alimitedchannel,unattendedhomesleepstudywas
Across-sectionalanalysisofbaselinedatafromtheASPirinobtainedusingtheApneaLinkPlusdevice(ResmedInc,
inReducingEventsintheElderly(ASPREE)andSNORE-Sydney,Australia),containinganasalcannulatodetect
,apulseoximeterandthoracicbelt
SLEEP-DISORDEREDBREATHINGINOLDERAGE3

Theoutputwasreviewedbyoneofthethreesleepmedicinemultivariatelinearregressionmodels,reportingallthese
physicians(MTN,GHandFJO).Aminimumtracedurationresultsasbetacoefficients(β).Allmodelswereadjustedfor
of4hours,freeofsignificantartefact,,gender,education,alcoholuse,smokingstatusandbody
SDBwasdefinedusingtheoxygendesaturationindexmassindex(BMI).Diabetesandhypertensionareincluded
3%(ODI)—acountofhowmanytimesperhourthebase-inTable1foradescriptionofthecohort;however,asboth
lineoxygensaturationleveldropsbyaminimumof3%.maybecausallyrelatedtoSDB,theywerenotincludedin
SDBseveritycategorieswerebasedonstandardcut-offs:modelstoavoidover-
mild(ODI5to<15),moderate(ODI15to<30)andseverebetweenmeasuresofSDBandgenderweretestedandfound
(ODI≥30).10Formultivariableanalyses,moderateandnon-significantinallexcepttwomodels(MCSandHVLT-
severeSDB(basedonanODI≥15),27R);resultswerestratifiedbygenderonlyforthesetwoout-
ThesecondsleepexposureofinterestwastheOSAsyn-
drome,definedasanODI≥5anddaytimesleepiness,asmulticollinearityandinallmodelsthevarianceinflationfac-
definedbyanEpworthSleepinessScale28scoreof≥10torswerelessthan2,indicatingthattherewasno
(range0–24).
measureswerealsopresentedasdescriptorsofthestudyperformedwithStata(-
:,CollegeStation,TX).Sta-
tisticalsignificancewasconsideredatp<.
Studyoutcomes
RESULTS
The10-question/30-pointCenterforEpidemiological
Studies-DepressionScale,29withacut-offof≥8,indicatedAtotalof7830participantswererecruitedtoASPREEfrom
-ASApartici-
12assessedQOLwithtwosummaryscores:,347wereineligibleduetoaknowndiagno-
healthcomponentscore(PCS)andmentalhealthcompo-sisofOSAandmanywereuninterestedinthesub-study
nentscore(MCS)(scores0–100,median50,SD10,with(Figure1).Onethousandeighthundredandthirty-four
higherscoresindicatingbetterQOL).31completedadditionalcognitivetestsforSNORE-ASA;how-
Cognitionwasassessedbythe3MS(globalcognition,ever,only1592chosetocompletethehomesleepstudy,of
maximalscore100)32;theHopkinsVerbalLearningTest-whom1399hadatleast4hofApneaLinkrecordingfreeof
Reviseddelayedrecall(HVLT-R)(episodicmemory,maxi--ASA
malscore12)33;thesingleletterControlledOralWordcohort(Figure1).
AssociationTest(COWAT-F)(executivefunction,higherComparedtoASPREEparticipantsrecruitedatthesame
scoreindicatingbetterperformance)34;andtheSymbolDigitstudysites,butwhowerenotpartofthefinalcohort
ModalitiesTest(SDMT)(forpsychomotorspeed,maximal(n=6431),SNORE-ASAparticipantswereyoungeron
score110).35Acompositeofthesetestsusingstandardizedaverage(),andahigherpropor-
z-(%%)andhadgreaterthan
11yearsofformaleducation(%%)(TableS1in
theSupporti