(PS8-6) Latent Sleep Profiles in Veterans Undergoing Sleep Apnea Assessment: Associations with Mental and Physical Health Outcomes

Background:
Sleep disturbances manifest in different ways, ranging from difficulty initiating or maintaining sleep to excessive daytime sleepiness and compensatory behaviors like daytime napping. Traditional diagnostic categories may not fully capture heterogeneity in sleep patterns, especially in those with obstructive sleep apnea (OSA) and comorbid insomnia. This study aimed to employ latent class analysis (LCA) to identify distinct sleep-related subgroups using indicators including nighttime insomnia symptoms, daytime sleepiness, daytime napping behavior, and apnea-hypopnea index (AHI), and examine how these classes differ in patient-reported health outcomes (PROs), such as depression, anxiety, and pain interference.

Methods:
Data were drawn from veterans (N=670) undergoing sleep apnea assessment at the Miami VA sleep center, with the final analytic sample (N=609) including only those with AHI ≥ 5. LCA was conducted using four indicators: (1) nighttime symptoms (sum of the first three ISI items: difficulty falling asleep, staying asleep, and early waking), (2) daytime napping (binary), (3) daytime sleepiness (Epworth Sleepiness Scale), and (4) AHI, an indicator of OSA severity obtained from home sleep apnea tests. Model selection was based on AIC, BIC, and entropy. PROs were measured by PROMIS-29 and regressed onto class memberships to examine differences in mental and physical health.

Results:
Three latent classes of sleep disturbance indicators emerged: (1) hyperarousal (38.9%) (moderately severe nighttime symptoms, low daytime sleepiness, low AHI, and no napping); (2) predominate insomnia (49.5%) (severe nighttime symptoms, severe daytime sleepiness, low AHI, and napping); (3) predominate OSA (11.6%) (moderately severe nighttime symptoms, moderate daytime sleepiness, high AHI, and napping. The hyperarousal and insomnia classes differed significantly in depression (χ² = 5.64, p = .02), anxiety (χ² = 8.89, p = .003), social role participation (χ² = 7.66, p = .006), and physical function (χ² = 4.56, p = .03). Additionally, predominate insomnia and OSA classes did not differ significantly PROs, indicating that despite differences in nighttime symptoms and daytime sleepiness, their overall psychological and physical well-being remained similar.

Conclusion:
This study identified distinct sleep-related subgroups among veterans undergoing sleep apnea assessment, highlighting significant differences in mental health, social functioning, and physical well-being across groups. Veterans experiencing greater daytime sleepiness and compensatory napping behaviors exhibited worse PROs, suggesting that daytime sleepiness and napping may play a role in these health disparities. Additionally, findings indicated that heightened sleep disturbances in Class 3 may be driven more by the severity of OSA rather than differences in mental or physical health status. These results underscore the need for personalized interventions targeting both sleep-related impairments and their downstream effects on mental and physical health. Future research should explore covariates, such as demographic, medical, and behavioral factors, to better understand the underlying mechanisms driving class differences.