Original Research

Rethinking the distribution of sleep services: discrepancy of obstructive sleep apnoea in rural compared with metropolitan men in Australia – a large national survey


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Lauren A Booker
1 PhD, Research Officer * ORCID logo

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Brad Hodge
2 PhD, Lecturer

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Timothy C Skinner
3 PhD, Director


1 School of Psychology & Public Health, La Trobe University, Bendigo, Vic., Australia; and Institute for Breathing and Sleep, Austin Health, Melbourne, Vic., Australia

2 Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia

3 School of Psychology & Public Health, La Trobe University, Bendigo, Vic., Australia; and Department of Psychology, Centre for Health and Society, University of Copenhagen, Copenhagen, Denmark

ACCEPTED: 14 May 2023

early abstract:

Introduction: Geographical location is increasingly recognised as a contributor to health inequity, with barriers including travel distances and a shortage of healthcare services. Individuals living in rural areas are known to have increased illness and comorbidities. Obstructive sleep apnea (OSA) is one such illness. OSA is a condition where a person repeatedly pauses breathing while asleep due to their airways becoming wholly or partially blocked and is associated with various chronic diseases. Exploration into the effects of these barriers on OSA is limited. This study explores the proportion of diagnosed and undiagnosed OSA in men living in rural areas compared to metropolitan.
Methods: Cross-sectional, secondary analysis of the Australian Ten to Men dataset. The current study looked at men over 18 diagnosed with OSA in their lifetime from wave 2 (n=10525 ) and wave 3 (n=7402). Wave 2 data were collected between November 2015  and May 2016, and wave 3 between July 2020 and February 2021.
Results: In wave 2, a higher proportion of rural men were diagnosed with OSA than metropolitan (OR, 1.47, 95% CI, 1.22-1.78, p <.001) but not regional. In addition, a significantly higher proportion of men in rural areas were at risk for OSA than metropolitan men (37.7% vs 32.6%, p<.0001). However, men living rurally were older, had higher BMI and lower socioeconomic status. Location was no longer a significant predictor of OSA after controlling for age, BMI and socioeconomic status. In wave 3,  rate of diagnosis of OSA during the lifetime was no longer significantly associated with location (p = .057) or being diagnosed with OSA in the last 12 months (p= .062).
Conclusion: This study highlights the need to ensure adequate services in rural areas, given the higher proportion of men diagnosed with, or at risk of, OSA in rural areas. OSA is also associated with an increase risk of comorbidities such as heart disease, hypertension and diabates, which are diseases also seen more prevalent in rural men. Rethinking the distribution of healthcare services will go some way to addressing this problem.