Are disease severity, sleep-related problems, and anxiety associated with work functioning in patients with obstructive sleep apnoea?
Vladimira Timkova ORCID Icon, Iveta Nagyova ORCID Icon, Sijmen A. Reijneveld ORCID Icon, Ruzena Tkacova ORCID Icon, Jitse P. van Dijk ORCID Icon & Ute Bültmann ORCID Icon
Pages 2164-2174 | Received 18 Aug 2017, Accepted 30 Mar 2018, Published online: 17 Apr 2018
Download citation  https://doi.org/10.1080/09638288.2018.1460626 

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Abstract
Purpose: To examine whether Obstructive Sleep Apnoea severity, sleep-related problems, and anxiety are associated with work functioning in Obstructive Sleep Apnoea patients, when controlled for age, gender and type of occupation. To investigate whether anxiety moderates the associations between sleep-related problems and work functioning.

Materials and methods: We included 105 Obstructive Sleep Apnoea patients (70% male; mean age 46.62 ± 9.79 years). All patients completed the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Beck Anxiety Inventory, and the Work Role Functioning Questionnaire-2.0.

Results: Obstructive Sleep Apnoea-severity, poor nighttime sleep quality, and anxiety were univariately associated with impaired work functioning. Multivariate analyzes revealed that poor perceived sleep quality was more strongly associated with work functioning than sleep efficiency and daily disturbances. Anxiety was strongly associated with impaired work functioning. After adding anxiety, the explained variance in work functioning increased from 20% to 25%. Anxiety moderated the association between low and medium levels of nighttime sleep quality problems and work functioning.

Conclusions: Poor perceived sleep quality and anxiety were strongly associated with impaired work functioning in Obstructive Sleep Apnoea patients. These findings may help to optimize management, standard treatment, and work functioning in people with Obstructive Sleep Apnoea when confirmed in longitudinal studies.

Implications for Rehabilitation
Studies show an impairment of functional status, including work functioning, in obstructive sleep apnea patients.

Aside from physical disorders, obstructive sleep apnea patients often experience mental problems, such as anxiety.

As many people with obstructive sleep apnea are undiagnosed, our results demonstrate to employers and healthcare professionals the need to encourage patients for obstructive sleep apnea screening, especially in the situation of impaired work functioning, increased anxiety, and poor sleep quality.

The associations between obstructive sleep apnea, sleep and anxiety might increase the awareness of health professionals towards optimizing diagnostic accuracy and standard treatment.

Keywords: Sleep apnea, work functioning, anxiety, nighttime sleep quality, daytime sleepiness
Additional information
Funding
This work was supported by the Slovak Research and Development Agency under contracts [APVV-15–0719] (80%) and by the Agency of the Ministry of Education of the Slovak Republic for the Structural Funds of the European Union, Operational Programme Research and Development [Contract No. 034/2009/2.1/OPRandD] (20%).
Acknowledgements
We wish to thank the people with obstructive sleep apnea who participated in this study. Furthermore, we wish to express gratitude to Dr I. Tomeckova and Dr I. Paranicova for the recruitment of patients, their clinical management and the scoring of the sleep studies, and to Mrs A. Schejbalova and Z. Lazarova for all the technical work in the Sleep Laboratory, Department of Pneumology and Phtiseology, Faculty of Medicine, PJ Safarik University and L. Pasteur University Hospital, Kosice, Slovakia, as well as to Dr. F.I. Abma for providing the Work Role Functioning Questionnaire (WRFQ) 2.0., the syntax and guidance in the analyzes regarding the WRFQ 2.0.

Disclosure statement
The authors report no conflicts of interest.