- Educational level stratifies clinical and psychological profiles but is not independently associated with ODI in middle aged and elderly Chinese SDB patients.
- BMI and average monthly income are independent correlates of ODI, with BMI accounting for 27.3% of the income ODI association.
- In lower educated patients anxiety (GAD-7) independently associates with higher ODI, whereas in higher educated patients BMI and income predominate.
Acta Psychol (Amst). 2026 Nov 5;271:108089. doi: 10.1016/j.actpsy.2026.108089. Online ahead of print.
ABSTRACT
BACKGROUND: This study aimed to explore differences in demographic, clinical, and psychological characteristics among middle-aged and elderly Chinese patients with moderate-to-severe sleep-disordered breathing (SDB) across educational levels, and to identify factors associated with the oxygen desaturation index (ODI) as well as potential statistical indirect effects. We further examined whether educational level moderates the relationship between psychological symptoms and ODI.
METHODS: A total of 306 patients with moderate-to-severe SDB were recruited with strict exclusion criteria. All participants underwent overnight monitoring with a wrist pulse oximeter to calculate ODI (oxygen desaturation events ≥3% lasting ≥3 s per hour). Demographic information, medical history, and questionnaire scores (sleepiness, insomnia, anxiety, depression, fatigue, quality of life) were collected. Patients were divided into lower (primary school or unschooled) and higher (junior high school or above) educational level groups. A predefined multivariable linear regression model and statistical mediation analysis were used. Age- and sex-adjusted group comparisons were performed.
RESULTS: Among 306 patients, 178 were in the lower educational level group and 128 in the higher educational level group. After age and sex adjustment, the higher educational level group had higher ODI, BMI, monthly income, alcohol use, daytime sleepiness, insomnia, anxiety, and depression scores, but less fatigue. Educational level was not independently associated with ODI after multivariable adjustment. In the overall sample, BMI (standardized beta = 0.252, P < 0.001) and average monthly income (standardized beta = 0.24, P = 0.001) were independent correlates of ODI. BMI statistically accounted for 27.3% of the association between average monthly income and ODI. Subgroup analyses using the predefined regression model showed that GAD-7 anxiety score was positively associated with ODI in the lower educational level group (standardized beta = 0.372, P < 0.05), while BMI (standardized beta = 0.324, P = 0.002) and average monthly income (standardized beta = 0.219, P = 0.048) were positively associated with ODI in the higher educational level group. The higher education subgroup findings were consistent with the overall sample results.
CONCLUSION: Educational level is not directly associated with ODI but stratifies distinct clinical and psychological profiles and heterogeneous ODI-associated factors in patients with SDB. In the lower education group, anxiety (GAD-7) emerges as an independent correlate of ODI, while in the higher education group, BMI and income predominate, findings consistent with the overall sample. BMI and income are independent correlates with ODI, with BMI statistically accounting for a portion of the income-ODI association. These cross-sectional findings highlight the need for education-stratified approaches to SDB assessment, with particular attention to anxiety symptoms in lower-educated populations.
PMID:42987605 | DOI:10.1016/j.actpsy.2026.108089
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