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The Association of Sleep-Disordered Breathing and Sleep Symptoms with
Quality of Life
in The Sleep Heart Health Study.
ABSTRACT
This study assessed the extent to which sleep-disordered breathing (SDB), difficulty initiating and maintaining
sleep (DIMS), and excessive daytime sleepiness (EDS) were associated with impairment of quality of life (QoL) using
the SF-36. Participants (n=5,816; mean age=63 years; 52.5% women) were enrolled in the nation-wide population-based
Sleep Heart Health Study (SHHS) implemented to investigate sleep-disordered breathing as a risk factor in the
development of cardiovascular disease. Each transformed SF-36 scale was analyzed independently using multiple logistic
regression analysis with sleep and other potential confounding variables (e.g., age, ethnicity) included as independent
variables. Men (11.6%) were significantly more likely to have SDB compared to women (5.6%), while women (42.4%) were
significantly more likely to report DIMS than men (32.5%). Vitality was the sole SF-36 scale to have a linear association
with the clinical categories of SDB (mild, moderate, severe SDB). However, individuals with severe SDB indicated
significantly poorer QoL on several SF-36 scales. Both DIMS and EDS were strongly associated with reduced QoL even after
adjusting for confounding variables for both sexes. Findings suggest 1) mild to moderate SDB is associated with reduced
vitality, while severe SDB is more broadly associated with poorer QoL, 2) subjective sleep symptoms are comprehensively
associated with poorer QoL, and 3) SF-36 mean score profiles for SDB and sleep symptoms are equivalent to other chronic
diseases in the U.S. general population.
