Sleep quality mediates the relationship between risk of obstructive sleep apnea and acute stress in young adults

Abstract

Purpose: Intermittent hypoxia and transient arousals in obstructive sleep apnea (OSA) can lead to poor sleep quality and acute stress. Rising levels of obesity and increased incidence of OSA in young adults predisposes them to acute stress. We propose a mediation model to assess if risk of OSA is associated with acute stress and if the relationship between risk for OSA and acute stress is mediated by sleep quality. Methods: 493 healthy individuals (F=237, M=256) from 18-25 years of age (mean age=20.3+/-1.53 years) were screened for OSA, sleep quality and acute stress using STOP-BANG questionnaire, Pittsburg Sleep Quality Index and American Psychiatry Associations National Stressful Events Survey Acute Stress Disorder Short Scale (NSESS-S) respectively. Binary and logistic regression were used establish the relationships between the variables. Sobel test for mediation analysis was conducted. Results: 73 participants (17.3%) were found at an intermediate and high risk of OSA by STOP BANG questionnaire. 79 (16%) participants reported level of stress as None. Mild, moderate and severe stress was present in 248 (50.3%), 109 (22.1%), 51 (10.3%) and 16 (3.2%) participants respectively. The odds of having severe and extreme stress among those at risk of sleep apnea is 2.18 times higher than that among those not at risk of sleep apnea (OR: 2.18, 95% Confidence Interval: 1.37-3.51). Sobel test established that the relationship between OSA and acute stress is mediated by sleep quality. Conclusion Sleep quality mediates the relationship between risk for sleep apnea and acute stress. This highlights the importance of screening for OSA in young adults, particularly young men with high BMI, presenting with high stress levels.

A cross-sectional observational study for ethno-geographical disparities in sleep quality, brain morphometry and cognition (a SOLACE study) in Indians residing in India, and South Asians and Europeans residing in the UK – a study protocol

“…During sleep, synaptic pruning and plasticity refine neural connections ( Paolicelli et al, 2011 ), while hormone release, particularly growth hormone and cortisol, influences brain development and maintenance ( Kim et al, 2015 ). In young adults, poor sleep quality may be associated with a significant risk of developing obstructive sleep apnoea ( Aggarwal et al, 2021 ) and frequent arousals ( Bhat et al, 2022 ). Sleep supports neuroplasticity, reorganizing neural networks, and promoting gray matter changes.…”

“…Sleep supports neuroplasticity, reorganizing neural networks, and promoting gray matter changes. The hippocampus is closely tied to sleep, aiding memory consolidation, while sleep facilitates the clearance of toxic substances like beta-amyloid ( Aggarwal et al, 2021 ). Proper sleep maintains optimal brain connectivity, supports myelin sheath integrity, and may even promote neurogenesis ( Payne and Nadel, 2004 ; de Vivo and Bellesi, 2019 ).…”

Systematic Review of Prevalence of Sleep Problems in India: A Wake- up Call for Promotion of Sleep Health

“…Some were done on caregivers and attendants 9,10,97 of patients while they were in hospital or attending on a patient while in outpatient department. Few studies worked on general population using representative samples of college students 13,14,35,42,80,92,104 and some targeted the population in general 12,16,37,38,40,67,78,79,81,93,94 .…”

“…Data also exists about its prevalence in general population. Methods employed ranged from questionnaires 5,6,8–10,12–14,16,18–21,24,25,29–32,34,38–40,42,44,47,48,51,52,55,56,59,60,63,64,67,70–75,80,82,84,87,88,90–97,99–104 , home testing to overnight sleep studies 34,49,51,52,55,58–66,68,69,98,99 . In some studies, screening using questionnaires was done followed by polysomnography 10,26,48,51,52,59,64,99 .…”