and more days spent in bed (Simon and VonKorff, 1997). One study revealed a dose-response relationship, with higher levels of insomnia being associated with greater impairments in the ability to accomplish daily tasks and decreased enjoyment of interpersonal relationships (Roth and Ancoli-Israel, 1999).

Individuals with severe OSA also report significantly poorer quality of life, and mild OSA is also associated with reduced vitality (Baldwin et al., 2001). These effects are similar to those of other chronic diseases in the general population in the United States. Individuals with OSA who are compliant with CPAP treatment report improved changes in vitality and quality of life 2 months after the onset of CPAP treatment (Redline et al., 1998).

Symptoms of restless legs syndrome are associated with lower quality of life (Unruh et al., 2004), similar to the quality of life of individuals with type 2 diabetes mellitus and acute heart attack (Allen et al., 2003). Restless legs syndrome also affects marital relationships. Approximately one-third of couples sleep in separate beds due to the discomfort of their partner’s repetitive leg movements (Montplaisir et al., 2005).

Approximately a quarter of children and adolescents report difficulty with sleep (Stein et al., 2001; Archbold et al., 2002). However, very few studies have assessed the association between sleep loss and sleep disorders and health-related quality of life in children. Analysis of a widely used parent report measure of children’s physical, emotional, and social functional status and well being—the CHQ-PF50—found the quality of life of their children deteriorated with the severity of OSA (Rosen et al., 2002). This is consistent with a negative association between sleep difficulties and health-related quality of life that was observed a similar analysis of 80 parents of children referred to a pediatric sleep disorders clinic (Hart et al., 2005). Thus, sleep difficulties may broadly affect a child’s development through its impact on children’s social, emotional, and physical functioning.

Family and Community Function

The consequences of sleep loss and sleep disorders are not restricted to affected individuals; they also disrupt families and communities. Although relatively sparse, the research described in this section points to widespread impact on the health and well-being of sleep partners and/or other family members. Their sleep quality and health can be disrupted, as can their wellbeing, income, and capacity to care for children or ill family members. Adverse effects on family cohesiveness, in turn, can lead to severe family turmoil and divorce. Similarly, sleep disruption of family caregivers has broader societal effects by contributing to hospitalization or nursing home placement of ill family members for whom they provide care.

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