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