Financial Hardship Linked With Impaired Sleep Quality in Patients With OSA, T2D

Financial hardship was found to be a significant risk factor for worse sleep quality in patients with concomitant obstructive sleep apnea (OSA) and type 2 diabetes (T2D)

Patients with concomitant obstructive sleep apnea (OSA) and type 2 diabetes (T2D) may be at greater risk of impaired sleep quality if they experience financial hardship, which was shown to disproportionately impact African Americans, women, and people of younger ages. Findings were published this week in Chronic Illness.

In measuring sleep quality, researchers note that there are objective (polysomnography or actigraphy) and subjective (self-reported) measurements, in which subjective perceptions are associated with various health conditions and lifestyle factors such as occupation, social role expectations, and perceived stress.

“Patients with multiple chronic conditions often require more complex medical care, which can impede disease self-management and lead to increased health care utilization and costs,” they added. “The day-to-day burden of disease self-management in people with both OSA and T2D contributes to financial hardship, time lost in self-management routines, and possible stigma, all of which can contribute to stress and poor sleep quality.”

With uncertainty on whether disease severity or social determinants of health (SDOH), such as financial hardship, race, age, sex, education, and marital status, increase the risk for poor sleep quality in people with T2D and OSA, they conducted a cross-sectional secondary analysis of baseline data derived rom a multisite randomized sham-controlled trial study that included these populations (N = 209; mean [SD] age, 57.6 [10.0] years; 66% White; 34% African American; 46% women).

Participants with T2D and comorbid OSA were assessed for disease severity via the Apnea-Hypopnea Index (AHI ≥ 5) and glycated hemoglobin A1C (HbA1c) for glycemic control. Subjective and objective measurements of SDOH were analyzed, including for financial hardship, race, sex, marital status, education, and age. Sleep quality was measured by the Pittsburgh Sleep Quality Index.

Among the study cohort, a high burden of disease was identified for both OSA (mean AHI, 20.7 [18.1]) and T2D (mean HbA1c, 7.9% [1.7%]), but disease severity was not found to be significantly associated with sleep quality (all P > .05).

Conversely, impaired sleep quality was associated with both worse subjective (b = -1.54; P = .015) and objective (b = 2.58; P < .001) financial hardship. Characteristics of patients significantly associated with both subjective and objective financial hardships included being African American, being female, having 2 years or less of post–high school education, and being younger ages (all P < .01).

Based on the study findings, the researchers cited financial hardship as a more important predictor of sleep quality than disease severity, age, sex, race, marital status, and educational attainment, in patients with OSA and T2D.

“Our exploratory findings support the need for future studies to further identify SDOH risk factors and mechanisms that influence these key health outcomes in the rising numbers of individuals with comorbid disease, such as those with the commonly experienced combination of T2D and OSA,” concluded the researchers. “The SDOH that correlated with financial hardship in this study can be used to guide future inquiry to facilitate early identification of individuals with T2D and OSA who may be at greatest risk for financial hardship.”


Morris JL, Belcher SM, Jeon B, et al. Financial hardship and its associations with perceived sleep quality in participants with type 2 diabetes and obstructive sleep apnea. Chronic Illn. Published online December 6, 2021. doi:10.1177/17423953211065002

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