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Predictors of Sleep Apnea in the Canadian Population 时间:2018-09-14 10:00 来源:未知作者:admin 点击: 次 Abstract:Older age, obesity, hypertension, snoring, and excessive daytime sleepiness have been associated with sleep apnea. The objective of this study was to determine the prevalence (crude and adjusted), as well as the risk factors, of sleep apnea in the adult Canadian population. Data from the 2009 Sleep Apnea Rapid Response (SARR) questionnaire were used to identify the risk factors, and all sleep-related questions in the SARR questionnaire were used. The outcome variable of interest was health professional-diagnosed sleep apnea. Covariates of interest were demographic variables, population characteristics, respiratory and cardiovascular diseases, and enabling resources. The multiple logistic regression model adjusted for the clustering effect was used to analyze the data. Sleep apnea was diagnosed in 858,913 adults (3.4% of the population), and more men (65.4%) than women (34.6%) were diagnosed with sleep apnea. Multivariable logistic regression analysis indicated that age (45 and older), loud snoring, sudden awakening with gasping/choking (rare/sometimes and once or more a week), and nodding off/falling asleep in driving in the past 12 months were significantly associated with diagnosed sleep apnea. Predictive probability demonstrated that in overweight and obese persons, ≥15 minutes of daily exercise significantly decreased the risk of diagnosed sleep apnea. The conclusion of this study is that in the Canadian population, sleep apnea is associated with older age, loud snoring, and sleeping problems. The protective effect of exercise warrants further investigation.
1. Introduction
Sleep apnea is defined as the complete cessation of airflow in the nose or mouth for 10 or more seconds during sleep [1]. Three types of sleep apnea, namely central [2], obstructive [3, 4], and mixed [5, 6] have been identified. Central sleep apnea occurs when the brain temporarily fails to send a signal to the muscles responsible for breathing control [2], and mixed sleep apnea occurs when both central and obstructive sleep apnea are present [5, 6]. Obstructive sleep apnea (OSA) is the most common form of sleep apnea and is defined as a disorder in which a person frequently stops breathing during sleeping because of an obstruction of the upper airway due to poor motor tone of the tongue and/or airway dilator muscles [3, 4].
Sleep apnea is a worldwide phenomenon [7–15]. Risk factors for sleep apnea include older age [4, 7, 16–20]; cardiovascular risk factors, namely, obesity [4, 7, 9, 10, 16, 17, 20–26], sedentary lifestyle [16, 24], hypertension [9, 15, 16, 18, 25, 27–29], and diabetes [9, 16–18, 25, 30–32]; alcohol use [9, 10, 18, 24, 30]; smoking [4, 10, 33, 34]; chronic pulmonary disease [35–38]; snoring [39–43]; excessive daytime sleepiness (EDS) [3, 23, 44]; anxiety [45–48]; depression [45, 48]; and low socioeconomic status [18, 25, 49]. Sleep apnea has been associated with cardiovascular diseases, namely, congestive heart failure [7, 9, 50, 51] and myocardial infarction [7, 52], sex (being male) [4, 9, 16, 18, 19, 23, 24], inferior driving and motor vehicle accidents [10, 53, 54], lower work efficiency [54–56], and high mortality [10, 26, 57].
Demographic [4, 7, 9, 16–20, 23, 24], environmental, and population characteristics [18, 25, 49, 54–56], predisposing as well as enabling resources, are associated with sleep apnea. The objective of this study was to determine the prevalence (crude and adjusted), as well as the risk factors, of sleep apnea in the adult Canadian population.
2. Materials and Methods
2.1. Design
The data of this study were from the 2009 Sleep Apnea Rapid Response (SARR) questionnaire [58], a component of the 2009 Canadian Community Health Survey (CCHS) [59]. The SARR was the first cross-sectional survey to estimate sleep breathing disorder among Canadians [8, 60]. Based on the sampling frame of the SARR module, 9523 Canadians of age 12 years and older were interviewed over two months (January and February 2009) for this survey. Residents of Indian Reserve, Crown lands, and the Territories, as well as full-time members of the Canadian Forces were excluded. The weighted sample amounted to about 98% of the Canadian population. This study concentrated on adult participants who were 18 years and older.