Healthy Lifestyle Index Developed for Prevention of Obstructive Sleep Apnea

A new investigation from China into obstructive sleep apnea (OSA) found that the combined effects of multiple-dimensional lifestyle factors had an inverse effect on OSA risk.

No prior research investigated the whole effect of modifiable lifestyle factors on OSA risk, despite rising prevalence globally.

However, several risk factors have been associated with the condition, including being overweight, male, older age, and certain hereditary factors. Additionally, recent studies have shown that lifestyle factors such as aerobic physical activity, diet, smoking, and alcohol drinking were correlated with the occurrence and severity of OSA.

As such, investigators led by Xueru Duan, MD, Department of Epidemiology at the School of Public Health, Sun Yat-Sen University, developed a healthy lifestyle index consisting of several potential modifiable lifestyle factors including active and passive smoking, alcohol, diet, waist-hip ratio, leisure-time physical activity, and mental status, to examine the combined effect on OSA among Chinese adults.

The Methods

Duan and colleagues collected data from the baseline survey of Guangzhou Heart Study (GZHS), which was an ongoing cohort study.

The baseline survey was conducted from 2015 to 2017, and consisted of 12,013 patients aged 35 years or older who were recruited through a multi-stage sampling method.

Among these participants, 9733 were included for analysis in the present study. From there, OSA was determined by the Berlin Questionnaire (BQ). The tool contained 10 questions in 3 categories: snoring and cessation of breathing, symptoms of excessive daytime sleepiness, body mass index (BMI), and hypertension.

Investigators conducted additional questionnaires with participants in-person, followed by a physical examination. Each participant was asked to report their current and prior smoking status, as well as if they were exposed to smoke in daily life or in the workplace.

Dietary information was obtained through a 22-item food frequency questionnaire (FFQ), and leisure-time physical activity was assessed by a modified Global Physical Activity Questionnaire.

Mental health status, which included depression and anxiety, was measured by the Center for Epidemiologic Studies Depression Scale, (CES-D) and Zung’s self-rating anxiety scale (SAS), respectively.

After data from the potential modifiable lifestyle factors were collected, the healthy lifestyle score was created. Each lifestyle factor included was dichotomized as healthy or unhealthy before being assigned a score (0 being unhealthy, 1 being healthy).

The Findings

Among the total number of participants included in the study, 8107 were divided into the non-OSA group and 1626 participants into the OSA group.

Investigators observed no passive smoking (OR 0.83, 95% CI 0.74–0.94), healthy waist-hip ratio (OR 0.67, 95% CI 0.58–0.77) and healthy mental status (OR 0.45, 95% CI 0. 29–0.73) were associated with a reduced risk of OSA after adjusting for confounders.

Additionally, participants with a higher healthy lifestyle score were negatively associated with OSA risk (P-trend < 0.001).

In comparison to the participants with 0–3 HLS, the odds ratio for participants with 4, 5, 6, and 7 HLS was 0.68 (95% CI 0.56–0.84), 0.71 (95% CI 0.59–0.86), 0.62 (95% CI 0.51–0.76) and 0.49 (95% CI 0.37–0.65) after adjusting for confounders.

Finally, every 1-score increment of HLS was associated with a 13% lower risk of OSA.

Investigators believed the data highlighted an “urgent need” for the development of dietary guidelines specific to OSA.

“Preventive strategies integrating multiple lifestyle factors may provide a more feasible approach for OSA prevention,” the team wrote.

The study, "Association of healthy lifestyle with risk of obstructive sleep apnea: a cross-sectional study," was published online in BMC Pulmonary Medicine.