Socioeconomic status and occupation as risk factors for obstructive sleep apnea in Sweden: A population-based study

doi:10.1016/j.sleep.2007.02.003

Sleep Medicine

Volume 9, Issue 2, January 2008, Pages 129-136

https://doi.org/10.1016/j.sleep.2007.02.003 Get rights and content

Abstract

Objectives

The aim of this study was to investigate whether there is an association between socioeconomic status, occupation and obstructive sleep apnea.

Methods

A nationwide database was constructed by linking the Swedish Census to the Hospital Discharge Register and the Cause of Death Register to obtain data on all first adult hospitalizations for obstructive sleep apnea diagnosed in Sweden during the study period from 1997 to 2001. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated.

Results

A total of 10,336 male and 2,602 female first hospitalizations during the study period for obstructive sleep apnea were retrieved for adults aged 35 and older. The overall SIRs for hospitalizations for obstructive sleep apnea were close to unity between different socioeconomic groups and regions. Among male occupations, increased risks were noted for several occupational groups such as sales agents, seamen, drivers, engine and motor operators, and cooks and stewards. For female occupations, an increased risk was observed only among drivers. Adjustment for obesity had no effect on the risk levels.

Conclusions

Socioeconomic status and occupation have a minor effect on the population’s likelihood of hospitalization for obstructive sleep apnea. Although the increased risks found for seamen, engine and motor operators, and cooks and stewards may be partly explained by their work-related exposure, residual confounding due to smoking and alcohol might be present.

Introduction

Obstructive sleep apnea (OSA) is a highly prevalent phenomenon [1], [2] and a serious threat to an individual’s health if not treated [3], [4], [5], [6]. OSA is a risk factor for cardiovascular disease, such as stroke, and premature mortality. [7], [8], [9]. The main daytime symptom of OSA, excessive daytime sleepiness, can lead to an increased risk of traffic accidents [10], [11], [12], and to a poor quality of life and impaired work performance. It should be considered as a serious chronic disease [4], [5], [13], [14].

The cause of OSA is still largely unknown. Some risk factors for OSA are well-known, such as obesity and alcohol and tobacco consumption [15], [16]. However, the role of occupation remains unclear. Although some occupational studies have found increased risks of OSA in occupations involving exposure to organic solvents [17], other occupational studies have not demonstrated any association between occupation and OSA [18]. Furthermore, no association has been found between exposure to neurotoxic substances, such as gasoline, diesel fuel, paint, varnish, and solvents, and the outcome variable OSA [18]. This study contributes to the increasing body of knowledge pertaining to occupational risks and OSA because the focus on a total population constitutes a novel approach.

To the best of our knowledge, no previous large-scale population-based study has investigated whether there is an association between occupation and the risk of OSA. The aim of this study is to analyze whether occupation is associated with a higher likelihood of hospitalization for OSA. We conducted a large-scale study of the economically active Swedish population aged 35 years and older. A key strength is the large sample size as we included the entire economically active population.

Section snippets

MigMed research database

Data used in this study were retrieved from the MigMed database, located at the Center for Family and Community Medicine at the Karolinska Institute in Stockholm. MigMed is a single, comprehensive database that contains individual-level information on all people in Sweden, including age, sex, occupation, geographic region of residence, hospital diagnoses and dates of hospital admissions in Sweden, date of emigration, and date and cause of death. This unique database was constructed using

Results

Men accounted for 80% of the hospitalized patients. There were a total of 10,336 men and 2,602 women over 35 years of age first hospitalized from 1997 to 2001 for OSA in Sweden according to the MigMed database. We do not know whether or not these patients had been hospitalized before 1997. Table 1 shows the number of cases and incidence rates by gender, socioeconomic status, residential region, and hospitalization for obesity. Obesity multiplied the incidence rates of OSA several times. SIRs for

Discussion

The main finding of this study is that occupation has a minor effect on the risk of OSA. In the present study, SIR was used as a measure of occupational risks and socioeconomic status for expressing the likelihood of an individual being affected, that is, given a diagnosed disease for hospitalization for OSA. To our knowledge, this is the first large-scale study that has investigated socioeconomic status and occupation as a risk for OSA.

This study has a number of strengths. For example, our

Acknowledgments

This work was supported by the National Institutes of Health (Grant No. R01-H271084-1), the Swedish Research Council (Grant No. K2004-21X-11651-09A to Dr. Jan Sundquist and K2005-27X-15428-01A to Dr. Kristina Sundquist), and the Swedish Council for Working Life and Social Research (Grant No. 2001-2373).

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Original articleSocioeconomic status and occupation as risk factors for obstructive sleep apnea in Sweden: A population-based study

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

MigMed research database

Results

Discussion

Acknowledgments

J Clin Epidemiol

Lancet

Respir Med

Eur J Cancer

Accid Anal Prev

The occurrence of sleep-disordered breathing among middle-aged adults

N Engl J Med

Daytime pulmonary hypertension in patients with obstructive sleep apnea: the effect of continuous positive airway pressure on pulmonary hemodynamics

Respiration

Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study

Jama

Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance

J Intern Med

Cardiovascular disorders and obstructive sleep apnea syndrome

Clin Exp Hypertens

Obstructive sleep apnea and cardiovascular disease and mortality: the argument for causality

J Insur Med

Obstructive sleep apnea as a risk factor for stroke and death

N Engl J Med

Daytime sleepiness and automobile accidents in patients with obstructive sleep apnea syndrome

Psychiatry Clin Neurosci

Falling asleep while driving and automobile accidents among patients with obstructive sleep apnea–hypopnea syndrome

Psychiatry Clin Neurosci

Drivers with untreated sleep apnea. A cause of death and serious injury

Arch Intern Med

Sleep-disordered breathing and self-reported general health status in the Wisconsin Sleep Cohort Study

Sleep

Association between obesity and obstructive sleep apnoea

Eur Heart J

Risk factors for obstructive sleep apnea in adults

Jama

Original article
Socioeconomic status and occupation as risk factors for obstructive sleep apnea in Sweden: A population-based study