Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent, under-detected, but preventable among older adults. The Common Sense Model of Illness postulates that illness representations are associated with coping and behavioural outcomes. This study investigated the associations between illness representations of OSA and behavioral intention of clinical diagnostic examination for OSA (BICDE-OSA) under two conditional/unconditional situations, stratified by high-risk versus low-risk OSA. METHODS: A random population-based telephone survey interviewed 945 Chinese people aged ≥ 50 years without OSA diagnosis in the Hong Kong general population from February to November 2021. RESULTS: The prevalence of unconditional BICDE-OSA based on the participants' current sleep situation was only 5.3%; that of conditional BICDE-OSA based on the hypothetical situation of having OSA was 54.3%. Significantly higher prevalence of conditional BICDE-OSA was found in the high-risk than the low-risk of OSA groups (64.4% versus 52.9%; p < 0.05); no significant between-group difference in unconditional BICDE-OSA was found. Illness representations of timeline chronic, timeline cyclical, consequences, and emotional representation were significantly associated with both conditional/unconditional BICDE-OSA (adjusted for background factors); illness coherence was significantly associated with conditional BICDE-OSA but not with unconditional BICDE-OSA. CONCLUSIONS: High proportions of older people did not indicate conditional/unconditional BICDE-OSA, possibly resulting in low detection and treatment rates. As OSA was prevalent in the study population and the unconditional group showed a much higher prevalence of BICDE-OSA than the conditional group, the prevalence of BICID-OSA might increase if the high-risk people are made aware of their risk. Interventions modifying illness representations may be considered.