Date of Award

January 2020

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Lori Bastian


Obstructive sleep apnea and pain intensity in young patients

Wardah Athar; Mary E. Card; Antonios Charokopos; Kathleen Akgün; Eric C. DeRycke; Sally G Haskell; Henry K. Yaggi; Lori A. Bastian. Yale University School of Medicine, New Haven, CT.

Objective: This study aims to examine whether young patients who are diagnosed with obstructive sleep apnea (OSA) are more likely to report higher pain intensity when compared to young patients without OSA.

Design/Participants: To do so, we conducted a cross-sectional analysis of a cohort study of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans who had at least one clinical encounter within a Veterans Health Administration (VHA) primary care clinic between 2001 and 2014.

Methods: OSA was then identified using one inpatient or two outpatient International Classification of Diseases (ICD)-9 codes from VHA electronic medical records. Pain intensity, as scored based on the 0-10 numeric rating scale, was categorized as no pain/mild (0-3; no pain) and moderate/severe (4-10; significant pain). Covariates examined included age, sex, race, mental health diagnoses, headache diagnosis, body mass index (BMI), and smoking status. Multivariate logistic regression models were built to examine interactions of covariates and multiple imputation was performed to generate values for missing variables. CPAP utilization rates within this cohort were also analyzed.

Results: We identified 858,226 patients (mean age 30 years [SD=7 yrs]), of whom 91,244 (10.6%) had a diagnosis of OSA and 240,065(31.3%) reported moderate/severe pain intensity. Compared to those patients without OSA, those with OSA were more likely to report moderate/severe pain intensity (OR=1.26; 95% Confidence Intervals 1.24-1.28), even after controlling for covariates. Of those patients diagnosed with OSA, we found that 35,058 (39.9%) were prescribed CPAP, and those patients who were obese were more likely to be prescribed CPAP (OR=1.34; 95% CI 1.30-1.38).

Conclusion: We found that patients with OSA have greater odds of comorbid significant pain. Due to the high prevalence of chronic pain in younger patients, this study highlights the need to understand the impact of OSA diagnosis and treatment on pain intensity.


This thesis is restricted to Yale network users only. It will be made publicly available on 09/10/2021