Chronic non-cancer pain and its association with healthcare use and costs among individuals with obstructive sleep apnea

Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea

BACKGROUND

Psychoactive substance use (i.e., nicotine, alcohol, and caffeine) has substantial effects on sleep architecture in healthy individuals, but their effects in those with obstructive sleep apnea (OSA) have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA.

METHODS

We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and comorbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety).

RESULTS

Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Participants were on average 52.2±11.9 years old, 65.2% were male with a median BMI of 30.6 (IQR: 27.2, 35.9, kg/m2). Current smokers exhibited lower sleep duration (0.3 h), longer sleep latency (5 min) compared with non-smokers (all p-values < 0.05). People with heavy or moderate alcohol use exhibited more REM sleep (2.5 and 5% of total sleep time respectively), as did those with moderate caffeine use (2%, p-values < 0.05). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4 h, p-value < 0.05) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9) compared with non-users.

CONCLUSIONS

Psychoactive substance use is associated with sleep characteristics and clinically relevant correlates in people with untreated OSA. Further investigation into the effects that various substances have on this population may present opportunities to understand disease mechanisms more fully and increase the effectiveness of treatment in OSA.

The economic cost of obstructive sleep apnea: A systematic review

Obstructive sleep apnea (OSA) is a common disease associated with a high prevalence of costly comorbidities and accidents that add to the disease's economic impact. Although more attention has been focused on OSA in recent years, no previous systematic reviews have synthesized findings from existing studies that provide estimates of the economic cost of OSA. This study aims to summarize the findings of existing studies that provide estimates of the cost of OSA. Two bibliographic databases, PubMed and Scopus, were used to identify articles on the costs of OSA. The systematic literature review identified 5,938 publications, of which 31 met the inclusion criteria. According to the results, adjusted for inflation and converted to euros, the annual cost per patient ranged from €236 (the incremental cost of OSA) for New Zealand to €28,267 for the United States. The total annual cost per patient in Europe ranged from €1,669 to €5,186. OSA causes a significant burden on society, and OSA-related costs increase many years before the diagnosis and remain elevated for a long time after the diagnosis. Despite some well-conducted studies, the cost estimates for OSA are uncertain and specific to the context in which the study was conducted.

Subjective Sleep Disruption and Mood Disorders are Associated with the Risk of Chronic Pain in Patients with Obstructive Sleep Apnea

OBJECTIVE

This study aimed to determine the prevalence of chronic pain and its risk factors in patients with obstructive sleep apnea (OSA).

METHODS

A total of 145 patients diagnosed with OSA were consecutively recruited from the Sleep Medicine Center in West China Hospital. All patients were divided into two groups including OSA with and without chronic pain. They were assessed the subjective sleep (Pittsburgh Sleep Quality Index, Insomnia Severity Index), objective sleep (polysomnography), mood symptoms (Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale), and pain characteristics (Short-Form McGill Pain Questionnaire). Demographic, clinical, subjective and objective sleep parameters were compared between OSA patients with and without chronic pain. Binary logistic regression models and linear regression models were used to examine the risk factors of chronic pain in OSA.

RESULTS

Fifty-five (37.9%) patients with OSA were diagnosed with chronic pain. There were more severe subjective sleep disruption and symptoms of anxiety and depression in patients with chronic pain compared to those without chronic pain. After controlling for potential confounders, poor subjective sleep quality and severe insomnia and mood disorders (all ps < 0.05), but not objective sleep fragmentation or nocturnal hypoxemia (all ps > 0.05) were associated with the increased risk of pain and pain intensity, respectively.

CONCLUSION

More than one-third of patients with OSA had chronic pain. Subjective sleep disruption and mood disorders are the risk factors of chronic pain in OSA. Our findings suggest that subjective sleep quality should be valued highly in the relationship between OSA and pain.