The effect of CPAP therapy on excessive daytime sleepiness and quality of life in subjects with obstructive sleep apnoea: an AB design study

Is the Epworth Sleepiness scale a valid outcome measure to evaluate the effectiveness of positive airway pressure treatments on daytime sleepiness? Psychometric insights from measurement invariance and response shifts

PURPOSE

Although the validity of the Epworth Sleepiness Scale (ESS) as an effectiveness measure for sleep apnea treatments such as continuous positive airway pressure (CPAP) has been supported by multiple studies, some researchers continue to challenge it. They suggest that in addition to its impact on relieving patients' daytime sleepiness, CPAP also alters the internal standards patients use to evaluate their sleepiness (i.e., response shift; RS), confounding the meaning of the difference in the ESS scores. We believe an issue yet to be addressed in this debate is that all existing evidence of RS has been obtained through the then-test approach, a retrospective method sensitive to various cognitive mechanisms. Thus, in the current study, we re-examined this issue using the structural equation modeling (SEM) approach, a method that can be directly applied to randomized clinical trial (RCT) data without retrospective measures.

METHODS

With the ESS data from two independent RCTs, we conducted cross-sectional and longitudinal measure invariance tests in SEM to examine whether CPAP would lead to RS.

RESULTS

The ESS demonstrated cross-sectional and longitudinal scalar invariance against CPAP treatments. Its factorial pattern, loadings, and thresholds were invariant between the treatment and control groups and pre- and post-treatment, supporting the comparability of the observed mean ESS scores across time and groups.

CONCLUSION

Our results support the validity of the average difference scores of the ESS for quantifying the effectiveness of CPAP on group-level daytime sleepiness in RCTs with relatively large sample sizes.

Solriamfetol enhances wakefulness and improves cognition and anxiety in a murine model of OSA

BACKGROUND

Obstructive sleep apnea (OSA) is a chronic condition characterized by intermittent hypoxia (IH). Excessive daytime sleepiness (EDS) is a common consequence of OSA and is associated with cognitive deficits and anxiety. Modafinil (MOD) and Solriamfetol (SOL) are potent wake-promoting agents clinically used to improve wakefulness in OSA patients with EDS.

METHODS

Male C57Bl/6J mice were exposed to either IH or room air (RA) controls during the light phase for 16 weeks. Both groups were then randomly assigned to receive once-daily intraperitoneal injections of SOL (200 mg/kg), MOD (200 mg/kg) or vehicle (VEH) for 9 days while continuing IH exposures. Sleep/wake activity was assessed during the dark (active) phase. Novel object recognition (NOR), elevated-plus maze test (EPMT), and forced swim test (FST) were performed before and after drug treatment.

RESULTS

IH exposure increased dark phase sleep percentage and reduced wake bouts lengths and induced cognitive deficits and anxiogenic effects. Both SOL and MOD treatments decreased sleep propensity under IH conditions, but only SOL promoted improvements in NOR performance (explicit memory) and reduced anxiety-like behaviors.

CONCLUSION

Chronic IH, a hallmark feature of OSA, induces EDS in young adult mice that is ameliorated by both SOL and MOD. SOL, but not MOD, significantly improves IH-induced cognitive deficits and promotes anxiolytic effects. Thus, SOL could potentially benefit OSA patients beyond EDS management.

Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers?

Quality of life (QoL) is one of the outcomes that can be measured as a component of the required standards for sleep facility accreditation by the American Academy of Sleep Medicine. Utilization of a psychometrically robust QoL instrument is recommended; however, clinicians face a challenge balancing psychometric properties with questionnaire completion and scoring characteristics. This article provides an overview of common QoL instruments as a reference for clinicians when selecting a QoL tool for use in the clinical setting for adult patients with obstructive sleep apnea.

CITATION

Colvin L, Collop N, Lorenz R, Morgenthaler T, Weaver TE. Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers? J Clin Sleep Med. 2023;19(6):1145-1155.

Continuous positive airway pressure adherence in people with obstructive sleep apnoea

OBJECTIVES

This cross-sectional study aimed to identify whether five factors of the health belief model were related to continuous positive airway pressure adherence in Thai people with obstructive sleep apnoea.

BACKGROUND

Obstructive sleep apnoea is a disorder impacting health, social wellbeing and the economy. Continuous positive airway pressure is a gold standard of treatment; however, poor adherence to treatment is an important issue that is related to a multiplicity of psychological and behavioural factors.

METHODS

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was used to report the study. Purposive sampling was used to recruit 94 patients newly diagnosed with sleep apnoea and using CPAP devices from a sleep clinic. Participants completed a demographic record, the Thai versions of the Functional Outcomes of Sleep Questionnaire, the Perceived Barriers Questionnaire and the Self-Efficacy Measure for Sleep Apnea. CPAP adherence was measured by using information downloaded from the smart card of the devices. Data were analysed using descriptive statistics and logistic regression.

RESULTS

Only 54.3% of participants adhered to CPAP treatment using standard protocols. Perceived seriousness of their condition was significantly associated with CPAP adherence, whereas perceived susceptibility, benefits, barriers and self-efficacy were not.

CONCLUSIONS

We found a low rate of CPAP adherence among participants. The only factor related to CPAP adherence was perceived seriousness.

RELEVANCE FOR THE CLINICAL PRACTICE

With a low rate of CPAP adherence, healthcare professionals, especially nurses, should encourage patients to use CPAP regularly by providing them with support and education regarding the severity of the disease if untreated and the benefits of CPAP treatment on the disease. Healthcare professionals should be aware of psychological factors impacting patients' perception of sleep apnoea and CPAP treatment. Interventions dealing with these factors should be developed and implemented in practice.