Search

Background: Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions., Objectives: This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF)., Methods: A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences., Results: Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression., Conclusions: This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations., (© 2024. The Author(s).)

Study Objectives: In a population-based survey, we determined sex differences in health profiles and quality of life between individuals who have a confirmed diagnosis of obstructive sleep apnea (OSA) and those who are at high risk of OSA yet remain undiagnosed., Methods: An online survey of Australian adults ≥ 18 years (n = 3,818) identified participants with self-reported diagnosed OSA (n = 460) or high-risk, undiagnosed OSA (OSA50 score ≥ 5, n = 1,015). Ever-diagnosed comorbidities, sociodemographics, and quality of life (EQ-5D-5L, Functional Outcomes of Sleep Questionnaire-10) were assessed., Results: Women were more frequently represented in the high-OSA-risk group compared with those with diagnosed OSA (55.5%, n = 563, versus 43%, n = 198; P < .001). In sex-specific logistic regression analyses, diagnosed OSA was associated with increased likelihoods of ≥ 1 cardiovascular condition (odds ratio: 3.0; 95% confidence interval: 2.0-4.5), hypertension (1.9; 1.3-2.8), gout (1.8; 1.1-2.9), and chronic obstructive pulmonary disease (3.8; 2.1-6.9) in men. In women, an association with asthma (2.0; 1.3-3.0) was seen. Diabetes, arthritis, mental health conditions (ever-diagnosed), and all EQ-5D-5L dimensions were associated with an OSA diagnosis regardless of sex, except for EQ-5D-5L anxiety/depression, which was only associated with an OSA diagnosis in women. A diagnosis of OSA was associated with sleepiness-related impairment (lowest quartile of Functional Outcomes of Sleep Questionnaire-10) in men (1.6; 1.01-2.5) and women (2.2; 1.4-3.6)., Conclusions: Sex-specific health conditions may drive diagnosis of OSA; however, clinical suspicion of OSA needs to be increased in men and women. The impaired quality of life and persistent sleepiness in participants with diagnosed OSA observed at a population level requires greater clinical attention., Citation: Krishnan S, Chai-Coetzer CL, Grivell N, et al. Comorbidities and quality of life in Australian men and women with diagnosed and undiagnosed high-risk obstructive sleep apnea. J Clin Sleep Med . 2022;18(7):1757-1767., (© 2022 American Academy of Sleep Medicine.)

The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well-being in Australian adults. A cross-sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18-90 years. Composite scores of self-reported healthy sleep were based on Ru-SATED (R-SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 (<1 hr). Mental well-being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ-5D-5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well-being with sleep dimensions, and total R-SATED (range 0-11) and SATED scores (0-10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well-being. A 1 unit increase in the total SATED score (mean [SD] 6.6 [2.1]) was associated with less problems on the EQ-5D-5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08-1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17-1.23). These estimates did not differ when the total R-SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well-being., (© 2021 European Sleep Research Society.)

Understanding patient experiences, quality of life, and treatment needs in individuals with sickle cell disease (SCD) is essential in promoting health and well-being. We used measures from the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me), Patient Reported Outcomes Measurement Information System (PROMIS), and Quality of Life in Neurological Disorders (NeuroQol) to evaluate pain impact, sleep impact, social functioning, depressive symptoms, tiredness, and cognitive function (collectively, patient reported outcomes [PROs]) and to identify associated demographic and clinical characteristics. Participants (n = 2201) between 18 and 45 years were recruited through the eight Sickle Cell Disease Implementation Consortium (SCDIC) sites. In multivariate models, PROs were significantly associated with one another. Pain impact was associated with age, education, employment, time since last pain attack, hydroxyurea use, opioid use, sleep impact, social functioning, and cognitive function (F = 88.74, P < .0001). Sleep impact was associated with household income, opioid use, pain impact, social functioning, depressive symptoms, and tiredness (F = 101.40, P < .0001). Social functioning was associated with employment, pain attacks in the past year, autoimmune/inflammatory comorbidities, pain impact, sleep impact, depressive symptoms, tiredness, and cognitive function (F = 121.73, P < .0001). Depressive symptoms were associated with sex, sleep impact, social functioning, tiredness, and cognitive function (F = 239.51, P < .0001). Tiredness was associated with sex, education, sleep impact, social functioning, depressive symptoms, and cognitive function (F = 129.13, P < .0001). These findings reflect the baseline PRO assessments among SCDIC registry participants. Further research is needed to better understand these outcomes and new targets for interventions to improve quality of life and function in people with SCD., (© 2020 Wiley Periodicals LLC.)

Objective: To assess the suitability for use within economic evaluation of a widely used sleep-related instrument (the Epworth Sleepiness Scale [ESS]) by examining its convergent and discriminant validity with two widely used generic preference-based instruments (Short-Form 36 [SF-36] and the Assessment of Quality of Life 4 dimensions [AQoL-4D])., Methods: Data from a cross-section of 2,236 community-dwelling Australian men were analyzed. Convergent validity was investigated using Spearman's correlation, intraclass correlation, and modified Bland-Altman plots, while discriminant validity was examined using Kruskal Wallis tests., Results: All instruments showed good discriminant validity. The ESS was weakly correlated to the Short Form 6 dimension, or SF-6D (derived from the SF-36) and AQoL-4D utilities (r = 0.20 and r = 0.19, respectively). Correlations between ESS and SF-36/AQoL-4D dimensions measuring the same construct were all in the hypothesized directions but also weak (range of absolute r = 0.00 to 0.18). The level of agreement between the ESS and AQoL-4D was the weakest, followed by that between the ESS and SF-6D. Moderate convergent validity was seen between the utilities., Conclusions: The lack of convergent validity between the ESS and the preference-based instruments shows that sleep-related constructs are not captured by the latter. The ESS has, however, demonstrated good discriminant validity comparable to that of the AQoL-4D and the SF-36/SF-6D and would therefore be equally useful for measuring subgroup differences within economic evaluation. We therefore recommend using the ESS within cost-effectiveness analysis as a complement to preference-based instruments in order to capture sleep-specific constructs not measured by the latter.

Background: Few studies have investigated the relationship between physical activity (PA) of low intensity and duration with quality of life (QoL) among individuals at risk or with cardiovascular disease (CVD)., Objectives: To investigate whether PA of different intensity and duration moderates the relationship between CVD and its risk factors (obesity, hypertension, diabetes, dyslipidaemia) and QoL in adults., Methods: Population-based cross-sectional studies using data from the EpiFloripa Cohort Study (Southern Brazil; n = 1,220, 38.8±12.0 years, 48.2% males) and the North West Adelaide Health Study (NWAHS, South Australia; n = 1,661, 43.7±11.1 years, 49.7% males). The physical and psychological domains of QoL were assessed using the WHOQOL-Bref (EpiFloripa) or the SF-36 (NWAHS) questionnaires. The diagnosis of CVD and its risk factors were self-reported. PA was self-reported and quantified by its intensity ["walking" or moderate/vigorous (MVPA)] and duration (none, 1-150, ≥150 min/week). Both studies were analysed separately, and results were adjusted for sociodemographic variables., Results: Participants at risk or with CVD from both studies showed a lower QoL than 'healthy' individuals with a stronger relationship for the physical domain. PA duration showed a direct-trend relationship with QoL, but the associations were stronger for MVPA in both studies. However, when stratified by health status, the magnitude of the association between "walking" duration and a higher physical QoL was greater among those at risk or with CVD compared to 'healthy' individuals. Conversely, among Australians with CVD, MVPA was associated with a better physical QoL only when its duration was ≥150 min/week. All associations were stronger in the NWAHS than in the Brazilian study., Conclusions: "Walking" was more prevalent than MVPA and was consistently associated with a better physical QoL among those at risk or with CVD. These findings should be considered in the design of public health interventions designed to increase PA and improve QoL., Competing Interests: The authors have declared that no competing interests exist.

Women are less likely than men to be diagnosed with obstructive sleep apnea (OSA). We examined contemporary gender differences in symptoms, health status, and quality of life associated with diagnosed OSA and OSA symptoms in a population-based sample. A 2015 postal/on-line questionnaire of 2889 active participants of The North West Adelaide Health Study (response rate = 54%, male n = 704; female n = 856; age 30⁻100 years) assessed previously diagnosed OSA, OSA symptoms, insomnia, doctor-diagnosed medical conditions, and the SF-36. In weighted analyses, self-reported diagnosed OSA (men: 12.6%, n = 95; women: 3.3%, n = 27) and OSA symptoms (men: 17.1%; women: 9.7%) were more common in men. Diagnosed OSA showed stronger adjusted associations with typical OSA features in women, including obesity (women-odds ratio (OR), 95% CI: 5.7, 1.9⁻17.1, men: 2.2, 1.2⁻4.0), daytime sleepiness (women: 6.4, 2.7⁻15.6, men: 3.3, 2.1⁻5.4), and loud snoring (women: 25.4, 9.4⁻69.1, men: 8.7, 5.2⁻14.4). Diagnosed OSA was independently associated with cardiovascular disease (CVD) in men, and in women with high cholesterol, respiratory disease, insomnia, and reduced SF-36 Physical Component Summary score. In both sexes, OSA symptoms were significantly associated with depression, insomnia, and moderate to severe impairments in SF-36 physical and mental component summary scores. Diagnosed women showed clinical characteristics overtly related to OSA. A higher index of clinical suspicion of OSA may be required in women for a condition regarded as male-predominant to increase equity in health outcomes.

Objective: To determine the suitability of using the International Prostate Symptom Score (IPSS), a condition-specific instrument, within economic evaluation of lower urinary tract symptom (LUTS) interventions., Methods: Data were obtained from a cohort of 2236 community-dwelling Australian men. Using correlations and a modified Bland-Altman plot, we investigated the convergent validity of the IPSS with two generic quality of life (GQol) instruments: the Assessment of Quality of Life 4 Dimensions (AQoL-4D) and the Short-Form 36 (SF-36). Discriminant validity was investigated using Wilcoxon-Mann-Whitney and Kruskal-Wallis tests, comparing instrument scores and utilities between subgroups varying in age, marital status, history of illness, smoking status and self-assessed general health., Results: Discriminant validity was confirmed for all instruments by finding statistically significant differences in summary scores and utilities between nearly all subgroups. Convergent validity between the summary scores/utilities of the IPSS and the GQoL instruments was weak (absolute correlation value range, 0.11-0.23) but differed considerably between dimensions of the instruments (absolute correlation value range, 0.01-0.24). Weak to moderate correlation between the GQoL instruments was seen (absolute correlation value range, 0.01-0.49)., Conclusion: Our findings suggest that the IPSS has comparable discriminant validity to the GQoL instruments and therefore useful for assessing subgroup differences related to urinary symptoms. The weak convergence between the IPSS and the GQoL instruments however suggests that, within economic evaluation, the IPSS should be viewed as a complement rather than a substitute to the GQoL instruments because it captures different quality of life constructs., (© 2016 John Wiley & Sons Australia, Ltd.)

Purpose: To investigate if sociodemographic characteristics increase the adverse effects of cardiovascular diseases (CVD) and cardiometabolic risk factors (CMRF) on health-related quality of life (HRQoL)., Methods: Cross-sectional, face-to-face survey investigating 2379 adults living in South Australia in 2015 (57.1 ± 14 years; 51.7% females). Questions included diagnosis of CMRF (obesity, diabetes, hypertension, dyslipidaemia) and CVD. Physical and mental HRQoL were assessed using the SF-12v1 questionnaire. Multiple linear regression models including confounders (sociodemographic, lifestyle, use of preventive medication) and interaction terms between sociodemographic variables and cardiometabolic conditions were used in adjusted analysis., Results: The prevalence of CMRF (one or more) was 54.6% and CVD was 13.0%. The physical HRQoL reduced from 50.8 (95%CI 50.2-51.4) in healthy individuals to 45.1 (95%CI 44.4-45.9) and 39.1 (95%CI 37.7-40.5) among those with CMRF and CVD, respectively. Adjustment for sociodemographic variables reduced these differences in 33%, remaining stable after controlling for lifestyle and use of preventive medications (p < 0.001). Differences in physical HRQoL according to cardiometabolic conditions were twice as high among those with lower educational level, or if they were not working. Among unemployed, having a CMRF or a CVD had the same impact on the physical HRQoL (9.7 lower score than healthy individuals). The inverse association between cardiometabolic conditions and mental HRQoL was subtle (p = 0.030), with no evidence of disparities due to sociodemographic variables., Conclusions: A lower educational level and unemployment increase the adverse effects of cardiometabolic conditions on the physical HRQoL. Targeted interventions for reducing CMRF and/or CVD in these groups are necessary to improve HRQoL.

Purpose: Obstructive sleep apnea (OSA) is now highly prevalent but largely undiagnosed. Quality of life is an indicator of both the impact of undiagnosed OSA and the need for strategies to increase OSA diagnosis. We determined age-related impacts of undiagnosed OSA on health-related quality of life (HRQL) and whether this was independent of sleepiness and comorbidities., Methods: In 2010-2012, 837 participants from the Men Androgen Inflammation Lifestyle Environment and Stress Study (population cohort n = 1869, ≥40 years, Adelaide, Australia), without a prior OSA diagnosis underwent full in-home polysomnography (Embletta X100) and completed the Epworth Sleepiness Scale and SF-36 questionnaire. The effects of the apnea-hypopnea index (AHI) on SF-36 physical (PCS) and mental (MCS) component summary scores and standardized SF-36 scale z-scores were estimated using multiple linear regression adjusted for major comorbidities and sleepiness, stratified by age., Results: Men ≤69 years demonstrated significant (p < 0.05) decrements/event increase in AHI in PCS score [unstandardized B coefficient (SE) = -0.068 (0.023)], physical functioning, role physical, general health, and vitality z-scores in fully adjusted models. Severe OSA (AHI ≥30) was associated with significant reductions in PCS [B = -4.1 (1.1)] and MCS score [B = -3.6 (1.2)] independent of sleepiness and comorbidities which were attenuated but persisted in men <69 years without depression. In men aged ≥70 years, statistically significant AHI-associated impairments were generally not seen., Conclusions: Undiagnosed OSA was a major independent contributor to HRQL impairments in men <69 years. Improved strategies to identify undiagnosed OSA are indicated that may require a reduced focus on daytime sleepiness.

Purpose: To compare the measurement properties of the physical component summary (PCS) and mental component summary (MCS) scores of the SF-36 and SF-12 based on the traditional orthogonal scoring algorithms with the performance of the PCS and MCS scored based on structural equation model coefficients from a correlated model., Methods: This study used three large-scale representative population studies to compare the measurement properties of the PCS and MCS scores of the SF-36 and SF-12 with the performance of the PCS and MCS scores based on structural equation models producing coefficients from a correlated model. We assessed the relationships of these scores with selected important mental health measures and chronic conditions from three representative Australian population studies that address clinical conditions of high prevalence and health service importance., Results: Structural equation model scoring methods produced summary scores with higher correlations than the recommended orthogonal methods across a range of disease and health conditions. The problem experienced in using the orthogonal methods is that negative scoring coefficients are applied to negative z-scores for sub-scales, inflating the resulting summary scores. Effect sizes over a half of a standard deviation were common., Conclusions: If health policy or investment decisions are made based on the results of studies employing the recommended orthogonal scoring methods then the expected outcome of such decisions or investments may not be achieved.

Sleep and mental health problems are common in athletic cohorts; however, our knowledge is limited to current, elite athletes. We attempted to compare the symptomology of sleep and mental health problems across different playing statuses and competition levels. An online survey was completed by 946 adults from 37 sports (52.3% women) in seven countries. Athletes were currently competing, retired from competition (<20 years ago), or temporarily unable to play (i.e. injury/season postponed), from all competition levels. Retired athletes were at greater risk of sleep disordered breathing than current athletes (OR=2.30, 95% CI[1.66,3.20]) and those unable to play (OR=1.83, 95% CI[1.07,3.13]. Retired athletes (OR=1.54, 95% CI[1.11,2.15]) and those unable to play (OR=2.15, 95% CI[1.36,3.39]) were at greater risk of compromised wellbeing than current athletes. Sports institute/university/college level and semi-professional athletes were at greater risk of anxiety than professional athletes (OR=2.82, 95% CI[1.29, 6.17]; OR=2.38, 95% CI[1.10, 5.16]), respectively. Current and retired athletes had comparable risk of sleep difficulty, depression, and anxiety, while retired athletes were at the greatest risk for sleep apnoea, reflecting previous literature. Foreclosure of sport may explain reduced wellbeing in retired and temporarily unable to compete athletes. Emerging athletes were at elevated risk for depression and anxiety, with distinct barriers and stressors to elite athletes. The high risk prevalence observed has significant implications for the assessment and identification of sleep and mental health issues in athletic populations, highlighting the importance of intervention and prevention strategies. Findings underscore the necessity for longitudinal research, increased transparency from sporting organisations, and enhanced support during and beyond athletic careers. [ABSTRACT FROM AUTHOR]

While physical therapy may help improve function and quality of life in patients with neurofibromatosis (NF), a standard of care remains to be established. This case report describes the physical therapy management of an individual with NF who was at high fall risk. A 61-year-old male with NF and multiple comorbidities was determined to be at high fall risk by the Dynamic Gait Index, Berg Balance Scale, and Modified Falls Efficacy Scale. Deficits included coordination and strength which limited his ability to ascend and descend stairs or walk on uneven terrain. This reduced his independence at home and in his rural community. Interventions incorporated components of hip and trunk coordination, and addressed balance, strength, and functional mobility. The patient scored above the cutoff for high fall risk on all outcome assessments. This case report describes physical therapy management to reduce fall risk for an individual with NF. Due to the limited research on NF, the treatment plan was developed using evidence-based practice for fall-risk reduction in other neurological disorders. [ABSTRACT FROM AUTHOR]

Background frailty is a dynamic condition for which a range of interventions are available. Health state utilities are values that represent the strength of an individual's preference for specific health states, and are used in economic evaluation. This is a topic yet to be examined in detail for frailty. Likewise, little has been reported on minimally important difference (MID), the extent of change in frailty status that individuals consider to be important. Objectives to examine the relationship between frailty status, for both the frailty phenotype (FP) and frailty index (FI), and utility (preference-based health state), and to determine a MID for both frailty measures. Design and setting population-based cohort of community-dwelling Australians. Participant in total, 874 adults aged ≥65 years (54% female), mean age 74.4 (6.2) years. Measurements frailty was measured using the FP and FI. Utilities were calculated using the short-form 6D health survey, with Australian and UK weighting applied. MID was calculated cross-sectionally. Results for both the FP and FI, frailty was significantly statistically associated (P  < 0.001) with lower utility in an adjusted analysis using both Australian and UK weighting. Between-person MID for the FP was identified as 0.59 [standard deviation (SD) 0.31] (anchor-based) and 0.59 (distribution-based), whereas for the FI, MID was 0.11 (SD 0.05) (anchor-based) and 0.07 (distribution-based). Conclusions frailty is significantly associated with lower preference-based health state utility. Frailty MID can be used to inform design of clinical trials and economic evaluations, as well as providing useful clinical information on frailty differences that patients consider important. [ABSTRACT FROM AUTHOR]

Background: Readmissions within 30 days of discharge are prominent among patients with cardiovascular disease. Post hospital syndrome hypothesizes that sleep disturbance during the index admission contributes to an acquired transient vulnerability, leading to increased risk of readmission. This study evaluated the association of in-hospital sleep (a) duration and (b) quality with 30-day all-cause unplanned readmission. Methods: This prospective observational cohort study included patients admitted to the coronary care unit of a South Australian hospital between 2016-2018. Study participants were invited to wear an ActiGraph GT3X+ for the duration of their admission and for two weeks post-discharge. Validated sleep and quality of life questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), were administered. Readmission status and questionnaires were assessed at 30 days post-discharge via patient telephone interview and a review of hospital records. Results: The final cohort consisted of 75 patients (readmitted: n = 15, non-readmitted: n = 60), of which 72% were male with a mean age 66.9 ± 13.1 years. Total sleep time (TST), both in hospital (6.9 ± 1.3 vs. 6.8 ± 2.9 h, p = 0.96) and post-discharge (7.4 ± 1.3 h vs. 8.9 ± 12.6 h, p = 0.76), was similar in all patients. Patient's perception of sleep, reflected by PSQI scores, was poorer in readmitted patients (9.13 ± 3.6 vs. 6.4 ± 4.1, p = 0.02). Conclusions: Although an association between total sleep time and 30-day readmission was not found, patients who reported poorer sleep quality were more likely to be readmitted within 30 days. This study also highlighted the importance of improving sleep, both in and out of the hospital, to improve the outcomes of cardiology inpatients. [ABSTRACT FROM AUTHOR]

Background and Purpose: Documenting functional outcomes after reverse shoulder arthroplasty (RSA) is critical to advancing patient care. The interplay been self-reported and objectively measured outcome measures has not been widely described. The utilization of wearable devices to document upper extremity limb activity is a new approach for objectively measuring outcomes. Therefore, the purpose of this study was to evaluate changes in pain, and self-reported function and objectively measured limb activity after RSA. We also assessed the influence of pain on self-reported function and objectively measured limb activity to determine the impact of pain on outcomes after RSA. Materials: This study implemented a prospective, repeated-measures design. Fourteen patients undergoing RSA underwent testing before surgery, and 2 and 12 months after surgery. Patient-reported instruments included pain, Disabilities of Arm, Shoulder and hands (DASH), and physical component summary (PCS) of the 36-Item Short Form Health Survey. Objective limb activity (mean activity value, m/s2/min epoch; inactive time, %; low activity, %; and high activity, %) was captured with triaxial accelerometers worn on the upper and lower arm. A repeated-measures ANOVA tested for differences across time. The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH, PCS scores, and mean limb activity. Results: Patient-reported measures improved after surgery (pain, P <.01; DASH, P <.01; PCS, P =.01). No change in limb activity was found at 1 year compared with preoperative values for mean (forearm, P = 1.00; arm, P =.36), inactivity (forearm, P =.33; arm, P =.22), low (forearm, P =.77; arm, P =.11) or high (forearm, P = 1.00; arm, P =.20) activity. There was a relationship between pain and DASH scores 1 year after surgery (P =.04) but not before surgery (P =.16), or 2 months after surgery (P =.30). There was no relationship between pain and PCS scores at any time point (preoperative, P =.97; 2 months, P =.21; 1 year, P =.08) nor pain and limb activity (forearm: preoperative, P =.36; 2 months, P =.67; 1 year, P =.16; arm: preoperative, P =.97; 2 months, P =.59; 1 year, P =.51). Conclusions: RSA reduced pain and enhanced patient-perceived function. Objectively measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: Insomnia and obstructive sleep apnoea (OSA) are the two most prevalent sleep disorders, and frequently co-occur (COMISA) in sleep clinic samples. However, few studies have investigated the prevalence or associations of COMISA in the general population.Methods: We used population-based online survey data from 2044 Australian adults. The prevalence and associations of insomnia, OSA and COMISA were investigated according to symptom-level, and disorder-level definitions. Insomnia was defined according to chronic difficulties initiating and/or maintaining sleep (DIMS; symptom-level), and ICSD-3 chronic insomnia disorder (disorder-level). OSA was defined according to self-reported frequent obstructive events, snoring or doctor-diagnosed OSA (symptom-level), and doctor-diagnosed OSA (disorder-level). COMISA was defined if both conditions were met (for symptom-level, and disorder-level threshold). Associations with other conditions, and general health were investigated with Poisson regression analyses.Results: Chronic insomnia occurred more frequently among participants with doctor-diagnosed OSA (22.3%), compared to those without (14.3%, p = 0.010). Doctor-diagnosed OSA was more common among participants with chronic insomnia (10.2%) compared to those without (6.2%; p = 0.010). DIMS also occurred more frequently among participants with OSA symptoms (66.6%), compared to those without (47.2%; p < 0.001). Participants with symptom-level COMISA reported increased co-morbid conditions, and worse general health compared to participants with symptoms of insomnia-alone, OSA-alone, or neither insomnia/OSA.Conclusions: COMISA at symptom and disorder level were common and associated with increased medical and psychiatric co-morbidity, as well as poor general health. More investigation is required to understand bi-directional associations underpinning the high co-morbidity, and improve diagnostic and treatment approaches for COMISA to reduce associated morbidity. [ABSTRACT FROM AUTHOR]