The Quebec Sleep Questionnaire on quality of life in patients with obstructive sleep apnea: translation into Portuguese and cross-cultural adaptation for use in Brazil

Evaluation of arterial stiffness and quality of life in the treatment of moderate to severe obstructive sleep apnea with Continuous Positive Airway Pressure or Mandibular Advancement Appliance: a cross-sectional study

BACKGROUND

Obstructive sleep apnea (OSA) is highly associated with a significant reduction in the Quality of Life (QoL) and is associated with deleterious effects on the cardiovascular system. Arterial stiffness is characterized by morphofunctional changes in the arteries and its assessment can be obtained non-invasively mainly through the measurement of pulse wave velocity (PWV). Arterial stiffness has been proposed as a predictor of cardiovascular diseases.

OBJECTIVE

To compare arterial stiffness as well as QoL in patients diagnosed with moderate to severe OSA treated with Continuous Positive Airway Pressure (CPAP) or Mandibular Advancement Appliance (MAA) therapies.

METHODS

This is a cross-sectional study involving 105 participants diagnosed with moderate to severe OSA categorized into three independent groups: A Non-treated Control Group and CPAP and MAA treated Groups. QoL was assessed by the Quebec Sleep Questionnaire (QSQ) and arterial stiffness was assessed noninvasively by Mobil-O-Graph.

RESULTS

The groups were homogeneous, except for the polysomnographic parameters Apnea and Hypopnea Index (AHI) (p = 0.036) and Minimum O2 saturation (p = 0.011) (evaluated to diagnose the OSA condition before treatment) and Body Mass Index (BMI) (p < 0.001). The MAA group presented higher scores in all QoL domains (p < 0.05), except Social Interactions in relation to the Control group. For the CPAP group, only Nocturnal Symptoms presented significantly higher scores compared to the control group (p = 0.39). For Arterial Stiffness, no statistical differences were observed among comparisons.

CONCLUSIONS

Our results show better QoL scores in patients with OSA treated by CPAP and mainly by MAA. Differently, arterial stiffness parameters did not differ between the groups treated with CPAP and MAA and the control group.

Identification of quality-of-life clusters by the Quebec sleep questionnaire in sleep apnea patients

Patients with obstructive sleep apnea (OSA) may present different symptoms. The clinical importance of symptom clustering is supported by the difference in the incidence of cardiovascular diseases between hypersomnolent and non-hypersomnolent sleep apnea patients. The objective of this study was to determine if quality-of-life clusters could be identified from the Quebec Sleep Questionnaire (QSQ) in OSA patients. Latent class analysis was used to identify clusters in a multivariate analysis of dichotomic variables (presence or absence of symptoms) for each item the QSQ obtained from 147 patients who fulfilled the questionnaire during its validation and subsequent trials (75.5% males, age: 53 ± 11 years, body mass index (BMI): 30.4 ± 4.7 kg/m2, apnea/hypopnea index (AHI): 31.3 ± 14.8/h). Three clusters were identified. Quality of life was preserved in patients of cluster 1 (20.4% of patients). Patients of cluster 2 (32.6% of patients) had a moderately impaired quality of life, mainly due to daytime somnolence and poor sleep quality. Patients with impaired quality of life (cluster 3, 46.9% of patients) had an important impact in every domain of the QSQ with the highest sleepiness and daytime symptom impairments. Gender, BMI, and AHI did not differ between the three clusters. In conclusion, different quality-of-life clusters can be identified from the QSQ in sleep apnea patients. These clusters are similar to those reported previously. Further studies are needed to validate these clusters in larger and independent cohorts, to evaluate how they respond to OSA treatment, and their relationship with incident outcomes.

CPAP Treatment Improves Quality of Life and Self-perception of Voice Impairment in Patients with OSA

OBJECTIVE

The purpose of this study is to examine vocal fatigue and impairment, gastroesophageal symptoms, dysphagia risk, and sleep-related quality of life in individuals with obstructive sleep apnea (OSA) who have been treated with continuous positive airway pressure (CPAP) compared to those who have not received treatment.

METHODS

Fifty-four participants diagnosed with OSA completed an online research form. Of these, 29 were receiving CPAP treatment, while 25 were not undergoing treatment. The following instruments were used: Vocal Fatigue Index, Voice Handicap Index, Gastroesophageal symptoms, Eating Assessment Tool, and Quebec Sleep Questionnaire.

RESULTS

The group that received CPAP treatment had significantly lower scores in the functional domain and total Voice Handicap Index. They also experienced fewer symptoms of regurgitation, reduced daytime sleepiness, fewer nocturnal symptoms, and better emotional and social interactions in their quality of life compared to the untreated group. There were no significant differences in voice fatigue and dysphagia risk between the groups.

CONCLUSION

Individuals treated with CPAP experience reduced vocal impairment, fewer regurgitation symptoms, and improvement in the emotional and social interactions domains of their quality of life compared to individuals without treatment.

Effects of combined exercise training with sleep education in older adults with obstructive sleep apnea: protocol for a randomized clinical trial

Background

Obstructive sleep apnea (OSA) is a common disorder that affects approximately 1 billion people worldwide. Advanced age is a significant risk factor. Various treatment options have been explored to reduce the severity of OSA symptoms and physical exercise has emerged as a potential alternative therapy. Therefore, this study aims to investigate the effects of a combined exercise program with sleep education on sleep quality and on the severity of OSA in older adults.

Methods

This is a randomized clinical trial with two parallel groups that will involve individuals of both genders aged between 60 and 79 years who have an apnea-hypopnea index (AHI) of more than 15 events per hour and who have not received or are currently undergoing treatment for OSA. Older adults who have engaged in regular exercise in the last six months and individuals with contraindications to exercise will be excluded. The study will assess outcomes related to OSA, including AHI, oxygen desaturation index, minimum and mean oxyhemoglobin saturation, sleep efficiency, sleep latency, and the type of respiratory events. Additionally, sleep quality-related outcomes, daytime sleepiness, physical activity, physical fitness, aerobic capacity, cognitive status, anthropometric measures, and health-related quality of life will be analyzed. Participants will be randomized to two groups: a combined exercise group (involving both resistance and aerobic training) with sleep education, and a control group that will receive only educational recommendations for managing OSA. The intervention will last 12 weeks and will consist of three sessions per week, totaling 36 exercise sessions. Sample size calculation indicates a minimum number of 36 participants.

Discussion

If the hypothesis is confirmed, this clinical trial will indicate an effective non-pharmacological intervention for treating OSA in older adults. This intervention could be used as an adjunct to existing approaches designed to improve OSA management.

Clinical trail registration

Brazil Clinical Trials Registry (ReBEC), identifier RBR-9hk6pgz.

Improved Quality of Life After Mandibular Advancement by Bilateral Internal Ramus Distraction

BACKGROUND

Obstructive Sleep Apnea (OSA) is a significant health issue due to noncompliance with continuous positive airway pressure treatment. Therefore, evaluating alternative treatments is crucial.

PURPOSE

Analyze the impact of maxillomandibular advancement using bilateral internal ramus distraction (BIRD) on quality of life (QOL) in OSA patients.

STUDY DESIGN, SETTING, AND SAMPLE

A prospective cohort study was conducted at the Oral and Maxillofacial Surgery Department of the University Hospital "La Princesa." The study included patients with moderate to severe OSA who were treated with the BIRD approach.

PREDICTOR VARIABLE

Changes in measured variables were analyzed at three time points: before surgery (T1), after mandibular advancement (T2), and after maxillary advancement (T3).

MAIN OUTCOME VARIABLE(S)

QOL changes measured by Quebec Sleep Questionnaire and the Epworth Sleepiness Scale. Secondary outcomes included: apnea-hypopnea index (AHI), oxygen desaturation index, and percentage of time with saturation below 90%.

COVARIATES

Age, sex, continuous positive airway pressure treatment, cephalometric variables and cardiovascular risk parameters were considered.

ANALYSES

Statistical analysis employed the Friedman test and χ2 test, with a significance level of P ≤ .05.

RESULTS

The study included 32 patients (22% with moderate OSA, 78% with severe OSA). Epworth Sleepiness Scale scores significantly decreased between T1 (13.4 ± 4.4) and T2 (5.8 ± 3.6) and T3 (1.9 ± 1.8) (P < .001). QOL improvements were observed in all domains: daytime sleepiness T1 (3.0 ± 1.3) T2 (5.4 ± 1.4) T3 (6.3 ± 1.0); diurnal symptoms T1 (2.5 ± 1.4) T2 (5.2 ± 1.3) T3 (6.2 ± 1.1); nocturnal symptoms T1 (2.5 ± 1.1) T2 (5.6 ± 1.1) T3 (6.5 ± 0.8); emotions T1 (2.6 ± 1.6) T2 (5.3 ± 1.4) T3 (6.5 ± 0.9); and social interaction T1 (2.5 ± 1.6) T2 (5.4 ± 1.6) T3 (6.3 ± 1.2) (P < .001). AHI decreased between T1 (47.9 ± 23.1) and T2 (14.4 ± 14.3) and T3 (4.7 ± 5.6) h-1 (P < .001), with a final cure rate of 81.2% (defined as final AHI<5 h-1). Oxygen desaturation index and percentage of time with saturation below 90% also showed significant reductions (P < .001).

CONCLUSIONS AND RELEVANCE

BIRD approach for OSA demonstrated a high cure rate and significant QOL improvements. It shows promise as an effective surgical option. Further research and long-term follow-up are needed.