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Bhat A, Singh A, Durr ML, Chang JL. Patient Reported Outcome Measures used in Surgical Evaluation of Obstructive Sleep Apnea: A Systematic Review. Laryngoscope 2024. [PMID: 38982930 DOI: 10.1002/lary.31603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To identify patient-reported outcome measures (PROMs) used to measure adult obstructive sleep apnea (OSA)-related quality of life in sleep surgery and analyze key psychometric properties in the original design and development of each PROM. DATA SOURCES PubMed, Web of Science, Embase, PsychINFO, and CINAHL. REVIEW METHODS A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Disease-specific instruments assessing sleep-related quality of life that were used in sleep surgery studies and validated in patients with sleep disorders were included. The Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) criteria were used to evaluate methodological quality. RESULTS A total of 2494 abstracts were retrieved, and 216 underwent full-text review. Seven PROMs assessing sleep-related quality of life were identified. Only one (14%) PROM (SAQLI) was developed using both patient and physician input, and none were rated as "adequate" for content validity. Two PROMs utilized patients with sleep-disordered breathing during content development and none specifically queried patients considering surgery. Six (86%) PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and six (86%) included data on test-retest reliability. CONCLUSION Several PROMs are utilized in sleep-related quality-of-life assessments for patients treated with OSA surgery. The measurement properties of these PROMs are of variable quality, and notably, no PROMs meet adequate quality measurements for content validity. New and updated PROMs for OSA-related quality of life should consider input from sleep surgery patients and providers. Laryngoscope, 2024.
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Affiliation(s)
- Amrita Bhat
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Amritpal Singh
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Megan L Durr
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, U.S.A
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2
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Gao Y, Liu Y, Zhao S, Liu Y, Zhang C, Hui S, Mikkelsen M, Edden RAE, Meng X, Yu B, Xiao L. MRS study on the correlation between frontal GABA+/Glx ratio and abnormal cognitive function in medication-naive patients with narcolepsy. Sleep Med 2024; 119:1-8. [PMID: 38626481 DOI: 10.1016/j.sleep.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE To compare the GABA+/Glx (glutamate-glutamine) ratio in the prefrontal lobe under non-rapid eye movement sleep between patients with narcolepsy type 1 (NT1) and normal controls and explore the correlation between this difference and abnormal cognitive function, using synchronous electroencephalography-functional magnetic resonance spectroscopy (EEG-fMRS). METHODS MRS measurements of GABA+ and Glx concentrations as well as synchronous EEG data were obtained from 26 medication-naive patients with NT1 and 29 sex- and age-matched healthy community volunteers. Cognition was appraised with the Beijing version of the Montreal Cognitive Assessment, and daytime sleepiness was measured using the Epworth Sleepiness Scale. All subjects recorded a 2-week sleep log as well as an overnight polysomnography within 1 week before MR scanning to understand their sleep habits and determine sleep stages. After PSG, they also underwent multiple sleep latency trials. Patient/control group differences in the individual measurements of GABA+ and Glx and the GABA+/Glx ratio and their relationship with cognition were assessed. RESULTS The GABA+/Glx ratio and GABA + levels of patients with narcolepsy were higher than those of the control group (P<0.0001 and P = 0.0008, respectively). However, there was no significant difference in Glx levels (P = 0.6360). The GABA+/Glx ratio negatively correlated with abnormal cognitive function (r = -0.6710, P = 0.0002). Moreover, GABA + levels were inversely proportional to rapid eye movement sleep latency (REML) in patients with narcolepsy (r = -0.5019, P = 0.0106). CONCLUSION The GABA+/Glx ratio in the prefrontal lobe was higher in NT1 patients during N2 sleep than in normal controls, mainly caused by GABA + levels; this ratio was negatively related to abnormal cognitive function. In addition, GABA + levels were inversely proportional to REML.
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Affiliation(s)
- Yanan Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yanting Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Sihui Zhao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yishu Liu
- Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang, 110004, China; Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Chen Zhang
- MR Research Collaboration Team, Siemens Healthcare, Beijing, 100102, China
| | - Steve Hui
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Mark Mikkelsen
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Xiao Meng
- Clinical Medicine, Shanxi Medical University, Taiyuan, 030001, China
| | - Bing Yu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Li Xiao
- Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang, 110004, China; Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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3
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Manfredi Moreira APS, de Oliveira ERR, de Carvalho LBC, Colacioppo RC, Weaver T, Zancanella E, Crespo AN. Psychometric evaluation of the Brazilian-Portuguese version of the Functional Outcome of Sleep Questionnaire 10 (FOSQ-10) in patients with obstructive apnea. Braz J Otorhinolaryngol 2024; 90:101452. [PMID: 38991400 PMCID: PMC11295562 DOI: 10.1016/j.bjorl.2024.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/21/2024] [Accepted: 05/09/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE Perform the validation and psychometric evaluation of the Brazilian-Portuguese translation of the Functional Outcome of Sleep Questionnaire 10 (FOSQ10). MATERIALS AND METHODS 182 patients (65 females 48.3±14.4 years and 117 males 46.9±12.4 years), were evaluated by sleep physicians suspected of having Obstructive Sleep Apnea, underwent polysomnography and completed the FOSQ-10 and the Epworth Sleepiness Scale. APA & NCME, 2014 was used to validate the data as the American Educational Research Association recommended. RESULTS Quality indicators such as Bartlett's test of sphericity (χ2 = 1108.2; gL=45; p= 0.000010) and KMO (0.83), and adherence measures, attest to the quality of the model. The indicators TLI (0.97), CFI (0.98), and RMSEA (0.04) fall within the expected values. Using the Eigenvalue > 1 technique, two factors explain 53% and 13.3% of the variances. In the Parallel Analysis technique, a single factor explained 59.4653% of the random variance, and the Unidimensionality indicators UniCo = 0.921, ECV = 0.822, and MIREAL = 0.253, were supported. Construct Validity: reliability coefficients Cronbach's α = 0.87, McDonald's ordinal Omega index 0.9, and the Composite Reliability 0.891 were satisfactory. CONVERGENT VALIDITY There was a significant Spearman correlation between FOSQ-10 and the Epworth Sleepiness Scale (r = 0.364 [-0.487; -0.226]). CRITERION VALIDITY Was not possible to differentiate the groups based on the severity of AHI using FOSQ-10P. CONCLUSIONS The Brazilian translation of FOSQ-10 is valid and reliable for identifying significant effects of excessive daytime sleepiness in patients with Obstructive Sleep Apnea. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | | | | | | | - Edilson Zancanella
- Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
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4
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Kaambwa B, Woods TJ, Natsky A, Bulamu N, Mpundu-Kaambwa C, Loffler KA, Sweetman A, Catcheside PG, Reynolds AC, Adams R, Eckert DJ. Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review. PHARMACOECONOMICS 2024; 42:507-526. [PMID: 38340220 PMCID: PMC11039546 DOI: 10.1007/s40273-023-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions. OBJECTIVES This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences. RESULTS Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression. CONCLUSIONS This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Taylor-Jade Woods
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Andrea Natsky
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Norma Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Kelly A Loffler
- Health Data and Clinical Trials, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
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Steier JS, Bogan RK, Cano-Pumarega IM, Fleetham JA, Insalaco G, Lal C, Pépin JL, Randerath WJ, Redline S, Malhotra A. Recommendations for clinical management of excessive daytime sleepiness in obstructive sleep apnoea - A Delphi consensus study. Sleep Med 2023; 112:104-115. [PMID: 37839271 PMCID: PMC10841517 DOI: 10.1016/j.sleep.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
STUDY OBJECTIVE Excessive daytime sleepiness is common with obstructive sleep apnoea and can persist despite efforts to optimise primary airway therapy. The literature lacks recommendations regarding differential diagnosis and management of excessive daytime sleepiness in obstructive sleep apnoea. This study sought to develop expert consensus statements to bridge the gap between existing literature/guidelines and clinical practice. METHODS A panel of 10 international experts was convened to undertake a modified Delphi process. Statements were developed based on available evidence identified through a scoping literature review, and expert opinion. Consensus was achieved through 3 rounds of iterative, blinded survey voting and revision to statements until a predetermined level of agreement was met (≥80 % voting "strongly agree" or "agree with reservation"). RESULTS Consensus was achieved for 32 final statements. The panel agreed excessive daytime sleepiness is a patient-reported symptom. The importance of subjective/objective evaluation of excessive daytime sleepiness in the initial evaluation and serial management of obstructive sleep apnoea was recognised. The differential diagnosis of residual excessive daytime sleepiness in obstructive sleep apnoea was discussed. Optimizing airway therapy (eg, troubleshooting issues affecting effectiveness) was addressed. The panel recognised occurrence of residual excessive daytime sleepiness in obstructive sleep apnoea despite optimal airway therapy and the need to evaluate patients for underlying causes. CONCLUSIONS Excessive daytime sleepiness in patients with obstructive sleep apnoea is a public health issue requiring increased awareness, recognition, and attention. Implementation of these statements may improve patient care, long-term management, and clinical outcomes in patients with obstructive sleep apnoea.
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Affiliation(s)
- Joerg S Steier
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | | | - Irene M Cano-Pumarega
- Sleep Unit, Respiratory Department, Ramón y Cajal University Hospital, IRYCIS, CIBERES, Madrid, Spain
| | - John A Fleetham
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Giuseppe Insalaco
- Institute of Translational Pharmacology, Italian National Research Council, Palermo, Italy
| | - Chitra Lal
- Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, College of Medicine, Charleston, SC, USA
| | - Jean-Louis Pépin
- Grenoble Alpes University, INSERM, University Hospital Grenoble Alpes, HP2, Grenoble, France
| | - Winfried J Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
| | - Susan Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Atul Malhotra
- University of California, San Diego Health, La Jolla, CA, USA
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6
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Donovan LM, McDowell JA, Pannick AP, Pai J, Bais AF, Plumley R, Wai TH, Grunwald GK, Josey K, Sayre GG, Helfrich CD, Zeliadt SB, Hoerster KD, Ma J, Au DH. Protocol for a pragmatic trial testing a self-directed lifestyle program targeting weight loss among patients with obstructive sleep apnea (POWER Trial). Contemp Clin Trials 2023; 135:107378. [PMID: 37935303 DOI: 10.1016/j.cct.2023.107378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Obesity comprises the single greatest reversible risk factor for obstructive sleep apnea (OSA). Despite the potential of lifestyle-based weight loss services to improve OSA severity and symptoms, these programs have limited reach. POWER is a pragmatic trial of a remote self-directed weight loss care among patients with OSA. METHODS POWER randomizes 696 patients with obesity (BMI 30-45 kg/m2) and recent diagnosis or re-confirmation of OSA 1:1 to either a self-directed weight loss intervention or usual care. POWER tests whether such an intervention improves co-primary outcomes of weight and sleep-related quality of life at 12 months. Secondary outcomes include sleep symptoms, global ratings of change, and cardiovascular risk scores. Finally, consistent with a hybrid type 1 approach, the trial embeds an implementation process evaluation. We will use quantitative and qualitative methods including budget impact analyses and qualitative interviews to assess barriers to implementation. CONCLUSIONS The results of POWER will inform population health approaches to the delivery of weight loss care. A remote self-directed program has the potential to be disseminated widely with limited health system resources and likely low-cost.
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Affiliation(s)
- Lucas M Donovan
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
| | - Jennifer A McDowell
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Anna P Pannick
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - James Pai
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Tulane University, New Orleans, LA, USA
| | - Anthony F Bais
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Robert Plumley
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | | | | | - George G Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Christian D Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Katherine D Hoerster
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Jun Ma
- University of Illinois Chicago, Chicago, IL, USA
| | - David H Au
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
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7
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Phillips-Beyer A, Kawata AK, Kleinman L, Kinter DS. Meaningful Within-Patient Change on the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ): Analysis of Phase III Clinical Trial Data of Daridorexant. Pharmaceut Med 2023:10.1007/s40290-023-00484-w. [PMID: 37286927 DOI: 10.1007/s40290-023-00484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ) is a new validated 14-item patient-reported outcome (PRO) instrument for evaluating daytime functioning in people with insomnia. It comprises three domains: Alert/Cognition, Mood, and Sleepiness. OBJECTIVE The aim of this analysis was to estimate the minimum within-patient change for IDSIQ scores that an adult patient with insomnia would consider meaningful. METHODS Data were from a randomized, double-blind, placebo-controlled, phase III clinical trial of daridorexant in adults with insomnia. Subjects completed the IDSIQ daily in the evening, with a recall period of 'today', throughout the 3-month double-blind treatment period. Scores were calculated as a weekly average. Each IDSIQ item was scored on an 11-point numeric rating scale ranging from 0 (not at all/none at all) to 10 (very/a lot), with a higher score indicating a greater severity or impact. PRO measures with correlation coefficients ≥0.30 were included in a subsequent anchor-based analysis. For the IDSIQ total score and each IDSIQ domain, meaningful within-patient change was estimated as the minimum score change patients would consider meaningful in an anchor-based analysis using data from PRO instruments capturing daytime and night-time insomnia symptoms (the Insomnia Severity Index [four items, each scored 0-4, with a higher score indicating greater symptom severity; assessed at screening, baseline, month 1 and month 3], Patient Global Assessment of Disease Severity [6-point scale from 'none' to 'very severe'; assessed weekly], Patient Global Impression of Severity [4-point scale from 'none' to 'severe'; assessed weekly], and Patient Global Impression of Change [7-point scale from 'very much better' to 'very much worse'; assessed weekly for night-time and daytime symptoms separately]). A supplemental distribution-based analysis was also conducted to support the anchor-based analysis. RESULTS The analysis included 930 subjects aged 18-88 years. Spearman correlation coefficients for the relationships between score changes/ratings for anchors and the IDSIQ (0.36-0.44 at month 1, 0.45-0.57 at month 3) were all above the prespecified threshold of 0.30. Mean IDSIQ score changes at months 1 and 3 based on the different anchors supported meaningful within-patient change estimates starting at 17 points for the IDSIQ total score, 9 points for the Alert/Cognition domain, and 4 points for the Mood and Sleepiness domains. CONCLUSION This analysis demonstrates the meaningful within-patient change for the IDSIQ total score and domain scores, that the instrument is sensitive to changes in the patient experience of insomnia, and that it can be used in clinical trials to evaluate changes in daytime functioning. CLINICAL TRIALS REGISTRATION NCT03545191 (4 June 2018).
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Ou YH, Colpani JT, Chan SP, Loke W, Cheong CS, Kong W, Chin CW, Kojodjojo P, Wong P, Cistulli P, Lee CH. Mandibular advancement device versus CPAP in lowering 24-hour blood pressure in patients with obstructive sleep apnoea and hypertension: the CRESCENT trial protocol. BMJ Open 2023; 13:e072853. [PMID: 37258080 DOI: 10.1136/bmjopen-2023-072853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Although treatment of obstructive sleep apnoea (OSA) using continuous positive airway pressure (CPAP) reduces blood pressure (BP), adherence to CPAP is often suboptimal. A mandibular advancement device (MAD) is a guideline-endorsed alternative therapy for OSA. Still, there is limited evidence on the relative efficacy between MAD and CPAP on BP reduction. We evaluate whether treatment of moderate-to-severe OSA using MAD can improve BP and other health-related outcomes compared with CPAP. METHODS AND ANALYSIS This is a randomised, controlled, non-inferiority trial conducted. We will recruit 220 Asians with a history of hypertension and high cardiovascular risk for an overnight polysomnography screening. Those with moderate-to-severe OSA (apnoea-hypopnoea index ≥15 events/hour) will be randomised to treatment with either MAD or CPAP in a 1:1 ratio. Stratified by age (60 vs <60 years old), body mass index (25 vs <25 kg/m2) and apnoea-hypopnoea index (30 vs <30 events/hour), an adaptive randomisation scheme with permuted blocks constructed in real-time is implemented to restrict imbalance. The overall study duration is 12 months. The primary endpoint is the 24-hour mean arterial BP difference between baseline and 6-month follow-up. The secondary endpoints include other measures of ambulatory BP monitoring, arrhythmia based on a 4-day electrocardiographic monitoring, biomarker and proteomic analysis, cardiovascular magnetic resonance-derived myocardial fibrosis and remodelling and quality-of-life questionnaires. Recruitment began in October 2019 and ended in December 2022. Comparison between MAD and CPAP will be performed using covariance (ANCOVA) analysis of the changes in 24-hour mean arterial BP while adjusting for the baseline 24-hour mean arterial BP. We will compare the 95% CIs around the treatment difference point estimate with the prespecified non-inferiority margin (1.5 mm Hg). If the upper limit of the 95% CI is <1.5 mm Hg and crosses 0, non-inferiority of the MAD relative to CPAP will be established. ETHICS AND DISSEMINATION The Domain Specific Review Board-C, National Healthcare Group under approved the study protocol (NHG DSRB Ref: 2019/00359, approved on 28 August 2019). Study findings will be disseminated to various local, national, and international audiences through abstract presentations and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04119999.
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Affiliation(s)
- Yi-Hui Ou
- Department of Medicine, National University of Singapore, Singapore
| | - Juliana Tereza Colpani
- Department of Endodontics, Operative Dentistry and Prosthodontics, National University of Singapore, Singapore
| | - Siew-Pang Chan
- Department of Medicine, National University of Singapore, Singapore
- National University Heart Centre, Singapore
| | - Weiqiang Loke
- Department of Endodontics, Operative Dentistry and Prosthodontics, National University of Singapore, Singapore
| | - Crystal S Cheong
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
| | | | - Calvin W Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Philip Wong
- Department of Medicine, Raffles Hospital, Singapore
| | - Peter Cistulli
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Chi-Hang Lee
- Department of Medicine, National University of Singapore, Singapore
- National University Heart Centre, Singapore
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Sudarsan SS, Lohith Kumar MK, Bhumireddy Chalamaiahgari S, Kandaswamy S. Covid-19 and Obstructive Sleep Apnea: The Theatricals and Quality-of-Life Impact. Indian J Otolaryngol Head Neck Surg 2023:1-11. [PMID: 37362137 PMCID: PMC10115385 DOI: 10.1007/s12070-023-03730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/21/2023] [Indexed: 06/28/2023] Open
Abstract
COVID-19 caused by SARS-CoV2 has reached pandemic proportions. The fear of Covid-19 has deterred many to abandon efforts for seeking timely medical help. In this setting, Obstructive sleep apnea (OSA)-like covid/non-covid cohorts have presented. Atypical pathologies can present like OSA and take the clinician unawares. With this series of misfits suffering silently, it would be unwise to underestimate its impact on quality-of-life (QOL). To determine the effect on quality-of-life by pathologies mimicking OSA and assess Covid-19 as a cause for delayed presentation. This was a prospective cross-sectional study. 127(N). Recent onset of symptoms of OSA. Study duration March 2020 to September 2021. Pittsburgh Sleep Quality Index (PSQI) screening done. Study criteria defined. Sleep parameters calculated. Primary surgical intervention given. Non-responders were put on CPAP therapy. QOL assessment done with sf-36 and SAQLI. Fear of Covid-19 scale (FCV-19S) quantified to study cause for temporal delay. Correlations computed. Level of Evidence-Level 3. 97 candidates completed study. Demographic and anthropometric details noted. Mean range was 43.85 ± 11.39 years. Male predominance. Overall AHI-19.73 ± 8.72. Moderate impact on QOL by sf-36/SAQLI. 78n Primary surgical candidates fared well. Polysomnography (PSG) and Continuous positive airway pressure (CPAP) titration/trial characteristics for 19n available. Statistically significant improvement in QOL after treatment completion. Correlations were meaningful. Body Mass Index (BMI) as a single factor was not influential on OSA-mimickers. Fear of Covid-19 significantly impacted emergency medical aid acquisition. OSA mimicking atypical airway pathologies may need emergent treatment not only from a surgical point-of-view but also from the QOL of the patient. On the contrary, these also unmask sub-clinical OSA, especially in patients with low/normal BMI. This category of recent onset OSA, if fortunately picked up at the earliest possible presentation, may hopefully not go through the significant QOL impact suffered by chronic OSA candidates.
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Affiliation(s)
- Shyam Sudhakar Sudarsan
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Manoj Kumar Lohith Kumar
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Surekha Bhumireddy Chalamaiahgari
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Shoba Kandaswamy
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
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Peterson AM, Miller B, Ioerger P, Hentati F, Doering MM, Kallogjeri D, Piccirillo JF. Most-Cited Patient-Reported Outcome Measures Within Otolaryngology-Revisiting the Minimal Clinically Important Difference: A Review. JAMA Otolaryngol Head Neck Surg 2023; 149:261-276. [PMID: 36729451 PMCID: PMC10729312 DOI: 10.1001/jamaoto.2022.4703] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Patient-reported outcome measures (PROMs) allow clinicians and researchers to assess health-related information from a patient's perspective. These measures have been used more frequently over the last several decades, but an associated minimal clinically important difference (MCID) is needed to optimize their utility. This narrative review identified the top 100 most-cited otolaryngology-related PROM development and validation publications and assessed the presence and characteristics of the PROMs' associated MCID. Observations In this narrative review, a literature search in Scopus and Web of Science was conducted on June 29, 2022, using keywords related to PROM development and validation studies in otolaryngology and reference lists. Studies that met the definition of a PROM and assessed an otolaryngologic disorder or study population were included for full-text review. After full-text review of 188 articles, the top 100 most-cited PROM development and validation publications, resulting in 106 total PROMs, were chosen for review. A total of 39 (37%) of the identified PROMs had an associated MCID. Of those reporting an MCID, 14 (35.9%) used an anchor-based method, 12 (30.8%) used a distribution-based method, 10 (25.6%) used both, and 3 (7.7%) did not specify or used neither method. Rhinology had the greatest number of PROMs with an associated MCID (16 of 24, 66%), and pediatrics had the fewest (1 of 13, 7.7%). The median number of citations of PROMs with an MCID was higher than those without an MCID. Conclusions and Relevance The majority of the most-cited PROMs in otolaryngology lack an associated MCID. These data indicated that there are a multitude of PROMs that have been cited hundreds of times and used for decades without the ability to identify whether a particular change in score on the instrument is clinically meaningful. There is a need to determine and validate MCIDs for commonly used PROMs to aid clinical research and trial interpretation.
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Affiliation(s)
- Andrew M. Peterson
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Brevin Miller
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Patrick Ioerger
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- University of Kansas Medical Center, Kansas City, Kansas
| | - Firas Hentati
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Case Western Reserve University, Cleveland, Ohio
| | - Michelle M. Doering
- Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jay F. Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Vogler K, Daboul A, Obst A, Fietze I, Ewert R, Biffar R, Krüger M. Quality of life in patients with obstructive sleep apnea: Results from the study of health in Pomerania. J Sleep Res 2023; 32:e13702. [PMID: 36053870 DOI: 10.1111/jsr.13702] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023]
Abstract
Obstructive sleep apnea is known to be an overall public health problem that, among other things, increases morbidity and mortality. Risk factors as well as symptoms of this multidimensional sleep-related breathing disorder negatively affect quality of life. With our study we aimed to expose the association between obstructive sleep apnea and quality of life in the population of Pomerania, Germany. We utilized data from the population-based Study of Health in Pomerania (SHIP). Information on health status and risk factors about 4420 participants (2275 women) were gathered within the cohort SHIP-TREND, of which 1209 (559 women) underwent an overnight polysomnography and completed sleep questionnaires. The quality of life of the participants was measured using the Short-Form 12 questionnaire. For our study, an ordinal regression analysis with age, sex, body mass index and the Short-Form 12 health survey as predictors for apnea-hypopnea index was computed. The potential factors affecting quality of life are different between physical and mental dimensions of quality of life. Significant effects were found regarding age, sex, body mass index and the Short-Form 12 Mental Component Score, but not the Physical Component Score.
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Affiliation(s)
- Katharina Vogler
- Department of Prosthodontics, Gerodontolgy, and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Amro Daboul
- Department of Prosthodontics, Gerodontolgy, and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Anne Obst
- Department of Prosthodontics, Gerodontolgy, and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Fietze
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Ewert
- Department for Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Reiner Biffar
- Department of Prosthodontics, Gerodontolgy, and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Markus Krüger
- Department of Prosthodontics, Gerodontolgy, and Biomaterials, University Medicine Greifswald, Greifswald, Germany
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Patient-Reported Outcome Measurements in Patients with COPD-Obstructive Sleep Apnea Overlap Syndrome: Time for Action? J Pers Med 2022; 12:jpm12121951. [PMID: 36556172 PMCID: PMC9783659 DOI: 10.3390/jpm12121951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/04/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSA) are common conditions that often coexist [Overlap syndrome (OS)]. OS has important implications in the diagnosis, treatment, and patient outcome of both disorders. Patient-reported outcomes (PROs) are essential to evaluate symptoms, impact of symptoms on activities of daily living, and treatment response. The present review aims to display the potential usefulness of PROs measurements (PROMs) regarding the initial evaluation and treatment of both conditions (COPD and OSA) in OS patients. More specifically, we review PROMs regarding symptoms, mental health indices and health-related quality of life in patients with OS. These PROMs have the potential to add value to clinical research and daily practice in certain aspects that are important to patients.
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Bazurto Zapata MA, Bastidas Goyes AR, Giraldo Cadavid LF, Botero Palacios MP, Castellanos Caro GL, Matiz Ibarra TL, Romero Colmenares WS, Garcia Manrrique JG, Granados Moreno D, Perez Vivas OE, Gomez Mendoza OC, Tuta Quintero E. Evaluación psicométrica del cuestionario “Sleep Apnea Quality of Life Index” (SAQLI) para la valoración de calidad de vida en personas con apnea obstructiva del sueño en Colombia. REVISTA DE LA FACULTAD DE MEDICINA 2022. [DOI: 10.15446/revfacmed.v71n2.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introducción: El cuestionario Sleep Apnea Quality of Life Index (SAQLI) es el instrumento específico más completo para evaluar la calidad de vida en pacientes con apnea obstructiva del sueño (AOS); sin embargo, no existe una adaptación cultural en Colombia, ni su validación psicométrica y, por tanto, se desconoce su rendimiento.
Objetivo: Realizar la evaluación psicométrica de la versión en español del cuestionario SAQLI culturalmente adaptada al contexto colombiano.
Materiales y métodos: Estudio de validación de escala realizado en 173 pacientes que, entre junio de 2017 y abril de 2019, asistieron a la Clínica Universidad de la Sabana (Chía, Colombia) y la Fundación Neumológica Colombiana (Bogotá, Colombia) a realizarse una polisomnografía (PSG). La versión del cuestionario SAQLI adaptada culturalmente se administró 3 veces: antes de la PSG; 15 días después, y 3 meses después de iniciar tratamiento con CPAP (esta última en 22 pacientes). La consistencia interna, la fiabilidad y la sensibilidad al cambio fueron evaluadas mediante el coeficiente alfa de Cronbach (α), el coeficiente de correlación intraclase (CCI) y la prueba T de student para muestras pareadas, respectivamente.
Resultados: Se observaron diferencias en las puntuaciones obtenidas en los 4 dominios evaluados (A-D) antes y después de iniciar el tratamiento, siendo estadísticamente significativas en A (4.92 vs. 5.70; p=0.038) y C (4.61 vs. 5.52; p=0.003). Además, se observó una adecuada consistencia interna y fiabilidad en los dominios A, B y C (α=0.884-0.935 y CCI=0.793-0.826, respectivamente).
Conclusión: La versión en español del cuestionario SAQLI adaptada al contexto cultural y lingüístico colombiano es adecuada para la evaluación objetiva de la calidad de vida en pacientes con AOS y es sensible al cambio luego de iniciar el tratamiento con CPAP.
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Agarwal P, Garg K, Saini V, Singh I. Pulmonary rehabilitation: A novel adjunct in management of obstructive sleep apnea. Monaldi Arch Chest Dis 2022; 93. [PMID: 35723643 DOI: 10.4081/monaldi.2022.2260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Pulmonary rehabilitation (PR) is being used in the routine management of patients of obstructive sleep apnea (OSA) at some centers. However, the studies documenting benefits of PR in OSA lack standardization in terms of outcome measures. A study was hence planned to determine the efficacy of PR on exercise capacity, health related quality of life (HRQOL), day time sleepiness and sleep-quality of life (QOL) in patients of OSA. As a part of comprehensive therapy, patients diagnosed with OSA are managed with continuous positive airway pressure (CPAP), 8 weeks thrice weekly outpatient hospital-based PR and medical treatment at the Pulmonary Medicine Department, Government Medical College and Hospital, Chandigarh. However, some patients refuse for PR because of time constraints and travel issues. Patients with newly diagnosed OSA without co-existing respiratory disease, who agreed for the CPAP, PR and medical management were enrolled in group A. The patients who refused for PR but were ready for CPAP and medical management were enrolled in Group B; 30 patients were taken in each group. Exercise capacity, HRQOL, day time sleepiness and sleep-QOL were determined at baseline and at 8-weeks follow-up by 6-minute walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ) and compared amongst the two groups. Four patients from group A were excluded as they did not complete PR; 26 patients from group A and 30 patients from group B were finally analyzed. At baseline, both groups were matched with respect to age, gender, apnea-hypopnea index (AHI), body mass index (BMI), FEV1%predicted, 6MWD, SGRQ, ESS and FOSQ. At follow up at 8 weeks, BMI, 6MWD, SGRQ, ESS and FOSQ improved significantly from baseline in group A (p<0.001). FEV1%predicted also improved but non significantly. In group B, FEV1%predicted, BMI, 6MWD, SGRQ, ESS and FOSQ score did not improve significantly from baseline. Mean improvement from baseline in BMI, 6MWD, SGRQ, ESS and FOSQ was significantly more in group A than group B (p<0.001, p<0.001, p=0.041, p<0.001 and p<0.001, respectively). PR, being beneficial, should be incorporated in standard management of OSA.
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Affiliation(s)
- Prakhar Agarwal
- Department of Pulmonary Medicine Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Bhopal.
| | - Kranti Garg
- Department of Pulmonary Medicine, Government Medical College, Patiala.
| | - Varinder Saini
- Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32, Chandigarh.
| | - Isha Singh
- Business Administration in Hospital Management, Panjab University, Chandigarh.
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Perrone APF, Ferreira VR, Prado LFD, Prado GFD, Machado MA, Carvalho LBCD. Translation and adaptation of the sleep apnea quality of life index (SAQLI) to Brazilian Portuguese. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:616-619. [PMID: 35946712 PMCID: PMC9387197 DOI: 10.1590/0004-282x-anp-2021-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) is characterized by episodes of upper airway obstruction during sleep, with a risk of cardiovascular and cerebrovascular diseases. There is no tool in Brazil to measure the impact of treatment on patients with OSAS. OBJECTIVE To translate and culturally adapt the Sleep Apnea Quality of Life Index (SAQLI) into Brazilian Portuguese. METHODS The translation and cultural adaptation were carried out in five steps: translation, synthesis of the translations, back translation, review committee and pretesting. RESULTS A version of a culturally compatible SAQLI was constructed after lexical changes, along with changes to the sentence structures, visual format, instructions and cards. The essence of the questionnaire and its social, emotional, and disease impact in treatment measures was maintained, with 80% understanding. CONCLUSIONS The questionnaire was translated and adapted culturally to Brazilian Portuguese, and presented good comprehension in the study population.
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Affiliation(s)
- Amélia Paula Fávero Perrone
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Vanessa Ruotolo Ferreira
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Lucila Fernandes do Prado
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
- Hospital São Paulo, Laboratório de Sono, São Paulo SP, Brazil
- Laboratório de Pesquisa Neuro-Sono, São Paulo SP, Brazil
| | - Gilmar Fernandes do Prado
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Marco Antonio Machado
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
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Ni K, Liu Y, Zhu X, Tan H, Zeng Y, Guo Q, Xiao L, Yu B. Changed Cerebral White Matter Structural Network Topological Characters and Its Correlation with Cognitive Behavioral Abnormalities in Narcolepsy Type 1. Nat Sci Sleep 2022; 14:165-173. [PMID: 35140538 PMCID: PMC8818963 DOI: 10.2147/nss.s336967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE In the current study we investigated topological abnormalities of the cerebral white matter networks in narcolepsy type 1 (NT1) patients and its relationship with their cognitive abnormalities using diffusion tensor imaging (DTI) technology. METHODS DTI and the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) were applied to 30 NT1 patients and 30 age-matched healthy controls. DTI studies were also carried using the 3T MRI system. Next, DTI data was used to establish a cerebral white matter network for all subjects and graph theory was applied to analyze the topological characteristics of the white matter structural network. Topographical parameters (such as local efficiency (Eloc), global efficiency (Eglob) and small-world (σ)) between NT1 patients and controls were then compared. The correlation between MoCA-BJ scores and topological parameters was also analyzed. RESULTS MoCA-BJ scores in NT1 patients were lower than those in the healthy controls. Compared with healthy controls, the global efficiency of the white matter network and attributes of the small world network were significantly reduced in NT1 patients. Finally, the global efficiency of the white matter structural network was related to the MoCA-BJ score of NT1 patients. CONCLUSION The abnormal topological characteristics of the white matter structural network in NT1 patients may be associated with their cognitive impairment.
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Affiliation(s)
- Kunlin Ni
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Yishu Liu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Xiaoyu Zhu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Huiwen Tan
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Yin Zeng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Li Xiao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
- Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
| | - Bing Yu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110004, People’s Republic of China
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18
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Pascoe M, Wang L, Aylor J, Mehra R, Kominsky A, Foldvary-Schaefer N, Shah V, Waters T, Walia HK. Association of Hypoglossal Nerve Stimulation With Improvements in Long-term, Patient-Reported Outcomes and Comparison With Positive Airway Pressure for Patients With Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2021; 148:61-69. [PMID: 34762105 DOI: 10.1001/jamaoto.2021.2245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hypoglossal nerve stimulation (HNS) and positive airway pressure (PAP) have been shown to improve patient-reported outcomes (PROs) in obstructive sleep apnea (OSA). However, to our knowledge, there are no data that compare change in PROs between HNS and PAP or that indicate whether HNS improves comorbid insomnia or depression in the long term. Objectives To determine whether HNS is associated with improvements in patient-reported sleepiness, insomnia, and depression in the long term and to compare the respective associations of HNS and PAP with improved PROs. Design, Setting, and Participants This retrospective cohort study used data from patients treated at the Cleveland Clinic for OSA. Participants received either HNS (referred sample) from November 1, 2015, to September 31, 2018, or PAP (previous cohort) from January 1, 2010, to December 31, 2014, for OSA. Patients were matched 3:1 for PAP:HNS based on age, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), sex, and apnea hypopnea index (AHI). Data were collected at baseline and at prespecified follow-up points. Data were analyzed from March 26, 2020, to September 9, 2021. Exposures Treatment with HNS vs PAP. Main Outcomes and Measures Data collected included AHI and Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI), and Patient Health Questionnaire-9 (PHQ-9; depression) scores. Results Among 85 patients receiving HNS (mean [SD] age, 62.8 [9.5] years; 59 men [69.4%]; 77 White patients [90.6%]; mean [SD] BMI, 28.8 [3.1]), compared with 217 matched patients receiving PAP (mean [SD] age, 62.1 [9.9] years; 157 men [72.4%]; 173 White patients [81.2%]; mean [SD] BMI, 29.5 [3.1]) included in the analysis, significant improvements were seen in PHQ-9 scores for HNS vs PAP (least square means, -4.06 [95% CI, -5.34 to -2.79] vs -2.58 [95% CI, -3.35 to -1.82]; mean difference, -1.48 [95% CI, -2.78 to -0.19]) with comparable improvements in ESS, FOSQ, and ISI scores. Clinically meaningful differences were observed in 42 of 65 HNS group patients (64.6%) vs 118 PAP group patients (54.5%) for ESS scores, 29 of 49 HNS group patients (59.2%) vs 67 of 217 PAP group patients (30.9%) for FOSQ scores, 14 of 48 HNS group patients (29.2%) vs 53 of 217 PAP group patients (24.4%) for PHQ-9 scores, and 23 of 49 HNS group patients (46.9%) vs 79 of 217 PAP group patients (36.4%) for ISI scores. At the 1-year post-HNS assessment, meaningful improvements were seen in 17 of 28 patients (60.7%) for ESS scores, 11 of 20 patients (55.0%) for FOSQ scores, 7 of 23 patients (30.4%) for PHQ-9 scores, and 11 of 25 patients (44.0%) for ISI scores. Conclusions and Relevance In this cohort study of patients with OSA, sustained improvements in PROs were observed 1 year after HNS and were comparable to those for PAP at 3 months. These findings suggest that HNS is a viable treatment for improving insomnia and depression in patients with OSA.
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Affiliation(s)
- Maeve Pascoe
- Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio
| | - Lu Wang
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Joan Aylor
- Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio
| | - Alan Kominsky
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio
| | | | - Vaishal Shah
- Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio
| | - Tina Waters
- Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio
| | - Harneet K Walia
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami
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19
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Pevernagie D, Bauters FA, Hertegonne K. The Role of Patient-Reported Outcomes in Sleep Measurements. Sleep Med Clin 2021; 16:595-606. [PMID: 34711384 DOI: 10.1016/j.jsmc.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Several questionnaires aka patient-reported outcome measures (PROMs) have been developed for specific use in sleep medicine. Some PROMS are "disease-specific," that is, related to a specific sleep disorder, whereas others are generic. These PROMS constitute a valuable add-on to the conventional history taking. They can be used in the areas of research, clinical practice, and quality of health care appraisal. Still, these instruments have inherent limitations, requiring proficient application in the various areas of interest. Disease-specificity includes a risk for nosologic bias that may confound diagnostic and therapeutic results. Future research should provide solutions for shortcomings of presently available questionnaires.
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Affiliation(s)
- Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Corneel Heymanslaan 10, Gent 9000, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium.
| | - Fré A Bauters
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Corneel Heymanslaan 10, Gent 9000, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium
| | - Katrien Hertegonne
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Corneel Heymanslaan 10, Gent 9000, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium
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20
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Weaver TE, Mathias SD, Crosby RD, Bron M, Bujanover S, Menno D, Villa KF, Drake C. Relationship between sleep efficacy endpoints and measures of functional status and health-related quality of life in participants with narcolepsy or obstructive sleep apnea treated for excessive daytime sleepiness. J Sleep Res 2021; 30:e13210. [PMID: 33051943 PMCID: PMC8244115 DOI: 10.1111/jsr.13210] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/20/2022]
Abstract
This study examined the correlation between improvements in excessive daytime sleepiness in participants with obstructive sleep apnea or narcolepsy and changes in functional status, work productivity and health-related quality of life. Data from two 12-week randomized controlled trials of solriamfetol were analyzed. Participants completed the Epworth Sleepiness Scale, 10-item Functional Outcomes of Sleep Questionnaire, Work Productivity and Activity Impairment questionnaire and 36-Item Short Form Health Survey and performed the Maintenance of Wakefulness Test at baseline and weeks 4, 8 and 12. Patient Global Impression of Change was assessed at weeks 4, 8 and 12. Pearson correlations were calculated for change in scores from baseline to week 12. For both studies, changes in the 10-item Functional Outcomes of Sleep Questionnaire were highly correlated (absolute value >0.5) with changes in Epworth Sleepiness Scale scores; changes in multiple domain scores of the 36-Item Short Form Health Survey and Work Productivity and Activity Impairment questionnaire were moderately correlated (0.3-0.5) with changes in Epworth Sleepiness Scale scores in both studies and highly correlated for participants with narcolepsy. Changes in Maintenance of Wakefulness Test scores correlated moderately with changes in Epworth Sleepiness Scale scores in both studies. At week 12, Patient Global Impression of Change ratings correlated highly with Epworth Sleepiness Scale and 10-item Functional Outcomes of Sleep Questionnaire scores for both disorders. Other correlations were low. Self-reported assessments of sleepiness and global improvement appear to be more strongly correlated with measures of functioning and health-related quality of life than objectively assessed sleepiness.
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Affiliation(s)
- Terri E. Weaver
- Department of Biobehavioral Nursing ScienceCenter for Sleep and Health ResearchCollege of Nursing; Division of Pulmonary, Critical Care, Sleep & Allergy, Department of Medicine, College of MedicineUniversity of Illinois at ChicagoChicagoILUSA
- Division of Pulmonary, Critical Care, Sleep & AllergyDepartment of MedicineCollege of MedicineUniversity of Illinois at ChicagoChicagoILUSA
| | | | - Ross D. Crosby
- Health Outcomes SolutionsWinter ParkFLUSA
- Sanford Center for Bio‐Behavioral ResearchFargoNDUSA
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21
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Tan SN, Abdullah B. The Association Between Obstructive Sleep Apnea and Allergic Rhinitis: Current Literature Review. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210304100358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
:
Sleep-disordered breathing (SDB) is now a significant health problem in today's culture.
It ranges from a spectrum of abnormal conditions during sleep from the primary snorer to mild,
moderate, or severe obstructive sleep apnea (OSA). SDB also comprises other conditions, such as
sleep-related hypoventilation, sleep-related hypoxemia, and central sleep apnea syndromes.
:
One of the components of the pathophysiology of OSA that remain unclear is the association of allergic
rhinitis (AR) in the evolution of OSA. Several studies relate the co-existence of OSA and
AR in the common clinical practice, but its correlation was not clear. This review article aimed to
review the pathophysiological relationship between OSA and AR in terms of the role of chemical
mediators and the effect of AR treatment in support of OSA.
:
The symptoms of AR further accelerate the clinical progression to OSA development. Inflammatory
mediators such as histamine, cysteinyl leukotrienes, and interleukins are found at a high level in
AR, which can aggravate AR symptoms such as nasal obstruction, rhinorrhea, and itchiness, which
can then lead to sleep disruption in OSA patients. In addition, OSA patients also have increased
chemical mediators such as tumor necrosis factor, interleukin 6, and 1, which would activate the T
helper 2 phenotypes that can aggravate AR symptoms. This vicious cycle can potentiate each other
and worsen the condition. Few studies have shown that treatment of AR can improve OSA, especially
the use of intranasal steroid and leukotriene receptor antagonists.
:
A detailed evaluation of rhinitis symptoms should be made for OSA patients so that they can benefit
not only from the improvement of AR but also the good sleep quality.
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Affiliation(s)
- Shi Nee Tan
- School of Medicine, KPJ University College, Lot PT 17010 Persiaran Seriemas, Kota Seriemas, 71800 Nilai, Negeri Sembilan, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology, Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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22
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Oh A, Grivell N, Chai-Coetzer CL. What is a Clinically Meaningful Target for Positive Airway Pressure Adherence? Sleep Med Clin 2021; 16:1-10. [PMID: 33485522 DOI: 10.1016/j.jsmc.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although good adherence to continuous positive airway pressure (PAP) traditionally is defined as greater than or equal to 4 hours/night, the origins and rationale for this remain unclear. Research studies report variation in optimal duration of PAP adherence, depending on outcome of interest. Evidence demonstrates benefit with PAP for daytime sleepiness, quality of life, neurocognitive outcomes, depression, and hypertension, predominantly in symptomatic, moderate-severe obstructive sleep apnea. Recent randomized controlled trials, however, have failed to demonstrate a reduction in cardiovascular and mortality risks. This review explores the question of what can be considered a clinically meaningful outcome for PAP adherence.
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Affiliation(s)
- Aaron Oh
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, South Australia 5042, Australia
| | - Nicole Grivell
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, South Australia 5042, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, South Australia 5042, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, SA Health, Flinders Drive, Bedford Park, South Australia 5042, Australia.
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23
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CPAP treatment in REM-related obstructive sleep apnea: a distinct clinical phenotype of sleep disordered breathing. Sleep Breath 2021; 25:1875-1884. [PMID: 33486668 DOI: 10.1007/s11325-021-02300-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/03/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE REM-related obstructive sleep apnea (REM-OSA), as defined using revised apnea-hypopnea index (AHI) criteria, might represent a specific OSA phenotype. However, there is a lack of data on outcomes of treatment in this population. This study evaluated the effects of CPAP treatment over 12 months on clinical outcomes for patients with the polysomnography phenotype of REM-OSA. METHODS We conducted a prospective observational study with the following inclusion criteria: subjective sleepiness and diagnostic polysomnography demonstrating AHIREM≥15 events/h, AHINREM<5 events/h, and ≥ 30 min of REM sleep. Clinical outcomes assessed included Epworth Sleepiness Scale (ESS), psychomotor vigilanc test reaction time (PVT-RT), and CPAP adherence at baseline, 1, 3, 6, and 12 months; Functional Outcomes of Sleep Questionnaire (FOSQ) and Depression Anxiety Stress Scales (DASS-21) at baseline, 1, 3 and 12 months. The reason is the first 3 outcomes (ESS, PVT, adherence) were assessed at baseline, 1, 3, 6, and 12 months, while the next 2 outcomes (FOSQ, DASS) were assessed at baseline, 1, 3, and 12 months. The edited version is not as clear in separating these outcomes into 2 groups; Functional Outcomes of Sleep Questionnaire (FOSQ); and Depression Anxiety Stress Scales (DASS-21) at baseline, 1, 3, and 12 months. Linear mixed effects models were used to investigate the joint effects of time and average CPAP adherence on our outcomes of interest. RESULTS Twenty participants completed a minimum of 1 month of CPAP treatment and were included for analysis. During the trial, 8 participants discontinued CPAP (4 before 3 months, 1 before 6 months, 3 before 12 months), and 19 participants completed 12 months of treatment. Baseline ESS was elevated at 12.6 units. Average CPAP usage for all 27 participants over 12 months was 2.9 ± 2.4 h. There was a significant decrease in ESS and increase in FOSQ at all time points, and the decrease in ESS was only seen in the CPAP-adherent subgroup. Decreases in DASS-21 and PVT-RT were not sustained. CONCLUSIONS CPAP treatment in sleepy patients with moderate to severe REM-OSA is associated with reduced sleepiness and improved quality of life. TRIAL REGISTRATION The trial was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12620000576921, 18/05/2020 (retrospectively registered).
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24
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Tan SN, Abdullah B. Phenotypes of Obstructive Sleep Apnea and Direct Targeted Therapy: A Literature Review. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x16999201016095352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obstructive sleep apnea (OSA) is a heterogenous chronic disorder causing hypoxemia,
excessive daytime sleepiness, non-refreshing sleep, nocturia, morning headache, irritability, and
memory loss. Cardiovascular disease, cognitive impairment, metabolic disorders, and depression
are its long-term consequences. The difficulty in treating patients is due to poor compliance, failure
to obtain the desired outcome, and complication arising from the multimodality treatment. Direct
targeted therapy may overcome these issues. Identification of its phenotypes improves understanding
of the disease mechanism, the risk for adverse effects, and predicting response to targeted therapy.
Phenotyping of OSA allows treating patients according to their inherent disease and not based
on a “one size fits all” method, which may not be applicable for all patients. This approach may improve
patients’ compliance with treatment, minimize the associated morbidities, and consequently
improve their quality of life.
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Affiliation(s)
- Shi Nee Tan
- Department of Otorhinolaryngology Head & Neck Surgery, Hospital Tawau, Sabah, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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25
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Zhu X, Ni K, Tan H, Liu Y, Zeng Y, Yu B, Guo Q, Xiao L. Abnormal Brain Network Topology During Non-rapid Eye Movement Sleep and Its Correlation With Cognitive Behavioral Abnormalities in Narcolepsy Type 1. Front Neurol 2021; 11:617827. [PMID: 33505350 PMCID: PMC7829333 DOI: 10.3389/fneur.2020.617827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) were applied to investigate the abnormalities in the topological characteristics of functional brain networks during non-rapid eye movement(NREM)sleep. And we investigated its relationship with cognitive abnormalities in patients with narcolepsy type 1 (NT1) disorder in the current study. Methods: The Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) and EEG-fMRI were applied in 25 patients with NT1 and 25 age-matched healthy controls. All subjects participated in a nocturnal video polysomnography(PSG)study, and total sleep time (TST), percentage of TST (%TST) for each sleep stage and arousal index were calculated. The Epworth Sleepiness Score (ESS) was used to measure the degree of daytime sleepiness. The EEG-fMRI study was performed simultaneously using a 3T MRI system and a 32-channel MRI-compatible EEG system during sleep. Visual scoring of EEG data was used for sleep staging. Cognitive function was assessed for all subjects using the MoCA-BJ. The fMRI data were applied to establish a whole-brain functional connectivity network for all subjects, and the topological characteristics of the whole-brain functional network were analyzed using a graph-theoretic approach. The topological parameters were compared between groups. Lastly, the correlation between topological parameters and the assessment scale using Montreal Cognition was analyzed. Results: The MoCA-BJ scores were lower in patients with NT1 than in normal controls. Whole-brain global efficiency during stage N2 sleep in patients with NT1 displayed significantly lower small-world properties than in normal controls. Whole-brain functional network global efficiency in patients with NT1 was significantly correlated with MoCA-BJ scores. Conclusion: The global efficiency of the functional brain network during stage N2 sleep in patients with NT1 and the correspondingly reduced small-world attributes were associated with cognitive impairment.
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Affiliation(s)
- Xiaoyu Zhu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kunlin Ni
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Huiwen Tan
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yishu Liu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yin Zeng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bing Yu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li Xiao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang, China
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MacKay S, Carney AS, Catcheside PG, Chai-Coetzer CL, Chia M, Cistulli PA, Hodge JC, Jones A, Kaambwa B, Lewis R, Ooi EH, Pinczel AJ, McArdle N, Rees G, Singh B, Stow N, Weaver EM, Woodman RJ, Woods CM, Yeo A, McEvoy RD. Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea-Hypopnea Index and Patient-Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive Sleep Apnea: The SAMS Randomized Clinical Trial. JAMA 2020; 324:1168-1179. [PMID: 32886102 PMCID: PMC7489419 DOI: 10.1001/jama.2020.14265] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Many adults with obstructive sleep apnea (OSA) use device treatments inadequately and remain untreated. OBJECTIVE To determine whether combined palatal and tongue surgery to enlarge or stabilize the upper airway is an effective treatment for patients with OSA when conventional device treatment failed. DESIGN, SETTING, AND PARTICIPANTS Multicenter, parallel-group, open-label randomized clinical trial of upper airway surgery vs ongoing medical management. Adults with symptomatic moderate or severe OSA in whom conventional treatments had failed were enrolled between November 2014 and October 2017, with follow-up until August 2018. INTERVENTIONS Multilevel surgery (modified uvulopalatopharyngoplasty and minimally invasive tongue volume reduction; n = 51) or ongoing medical management (eg, advice on sleep positioning, weight loss; n = 51). MAIN OUTCOMES AND MEASURES Primary outcome measures were the apnea-hypopnea index (AHI; ie, the number of apnea and hypopnea events/h; 15-30 indicates moderate and >30 indicates severe OSA) and the Epworth Sleepiness Scale (ESS; range, 0-24; >10 indicates pathological sleepiness). Baseline-adjusted differences between groups at 6 months were assessed. Minimal clinically important differences are 15 events per hour for AHI and 2 units for ESS. RESULTS Among 102 participants who were randomized (mean [SD] age, 44.6 [12.8] years; 18 [18%] women), 91 (89%) completed the trial. The mean AHI was 47.9 at baseline and 20.8 at 6 months for the surgery group and 45.3 at baseline and 34.5 at 6 months for the medical management group (mean baseline-adjusted between-group difference at 6 mo, -17.6 events/h [95% CI, -26.8 to -8.4]; P < .001). The mean ESS was 12.4 at baseline and 5.3 at 6 months in the surgery group and 11.1 at baseline and 10.5 at 6 months in the medical management group (mean baseline-adjusted between-group difference at 6 mo, -6.7 [95% CI, -8.2 to -5.2]; P < .001). Two participants (4%) in the surgery group had serious adverse events (1 had a myocardial infarction on postoperative day 5 and 1 was hospitalized for observation following hematemesis of old blood). CONCLUSIONS AND RELEVANCE In this preliminary study of adults with moderate or severe OSA in whom conventional therapy had failed, combined palatal and tongue surgery, compared with medical management, reduced the number of apnea and hypopnea events and patient-reported sleepiness at 6 months. Further research is needed to confirm these findings in additional populations and to understand clinical utility, long-term efficacy, and safety of multilevel upper airway surgery for treatment of patients with OSA. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12614000338662.
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Affiliation(s)
- Stuart MacKay
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- University of Wollongong, NSW, Australia
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia
| | - A. Simon Carney
- Southern ENT & Adelaide Sinus Centre, Flinders Private Hospital, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Peter G. Catcheside
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Michael Chia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter A. Cistulli
- Charles Perkins Centre, Faculty for Medicine and Health, University of Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - John-Charles Hodge
- Ear Nose and Throat Department, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew Jones
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- University of Wollongong, NSW, Australia
- Illawarra Sleep Medicine Centre, Wollongong, NSW, Australia
| | - Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard Lewis
- Hollywood Medical Centre, Perth, WA, Australia
- Department of Otolaryngology, Head & Neck Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Eng H. Ooi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Alison J. Pinczel
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Guy Rees
- The Memorial Hospital, Adelaide, SA, Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Faculty of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Nicholas Stow
- The Woolcock Clinic, University of Sydney, NSW, Australia
| | - Edward M. Weaver
- Department of Otolaryngology/Head and Neck Surgery, University of Washington, Seattle
- Staff Surgeon, Seattle Veterans Affairs Medical Center, Seattle, Washington
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Charmaine M. Woods
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Aeneas Yeo
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
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27
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Batool-Anwar S, Omobomi O, Quan SF. The effect of CPAP on HRQOL as measured by the Quality of Well-Being Self Administered Questionaire (QWB-SA). SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2020; 20:29-40. [PMID: 32190413 DOI: 10.13175/swjpcc070-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To examine the effect of continuous positive airway pressure (CPAP) on Health-related quality of life (HRQoL) as measured by the Quality of Well Being Self-Administered questionnaire (QWB-SA). METHODS Participants from The Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month multicenter randomized, double-blinded intention to treat study, were included in this analysis. The participants with an apnea-hypopnea index >10 events/hour initially randomized to CPAP or Sham group were asked to complete QWB-SA at baseline, 2, 4, and 6-month visits. RESULTS There were no group differences among either the CPAP or Sham groups. "Mean age was 52±12 [SD] years, AHI 40±25 events/hr, BMI 32±7.1 kg/m2, and Epworth Sleepiness Score (ESS) 10±4 of 24 points." QWB-SA scores were available at baseline, and 2, 4 & 6 months after treatment in CPAP (n 558) and Sham CPAP (n 547) groups. There were no significant differences in QWB scores among mild, moderate or severe OSA participants at baseline. Modest improvement in QWB scores was noted at 2, 4 and 6- months among both Sham and CPAP groups (P <0.05). However, no differences were observed between Sham CPAP and CPAP at any time point. Comparison of the QWB-SA data from the current study with published data in populations with chronic illnesses demonstrated that the impact of OSA is no different than the effect of AIDS and arthritis. CONCLUSION Although the QoL measured by the QWB-SA was impaired in OSA it did not have direct proportionality to OSA severity.ClinicalTrials.gov. Identifier: NCT00051363.
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Affiliation(s)
- Salma Batool-Anwar
- Division of Sleep and Circadian Disorders Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Olabimpe Omobomi
- Division of Sleep and Circadian Disorders Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
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Zinchuk A, Yaggi HK. Phenotypic Subtypes of OSA: A Challenge and Opportunity for Precision Medicine. Chest 2020; 157:403-420. [PMID: 31539538 PMCID: PMC7005379 DOI: 10.1016/j.chest.2019.09.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/13/2019] [Accepted: 09/01/2019] [Indexed: 12/21/2022] Open
Abstract
Current strategies for the management of OSA reflect a one-size-fits-all approach. Diagnosis and severity of OSA are based on the apnea-hypopnea index and treatment initiated with CPAP, followed by trials of alternatives (eg, oral appliances) if CPAP "fails." This approach does not consider the heterogeneity of individuals with OSA, reflected by varying risk factors, pathophysiological causes, clinical manifestations, and consequences. Recently, studies using analytic approaches such as cluster analysis have taken advantage of this heterogeneity to identify OSA phenotypes, or subtypes of patients with unique characteristics, that may enable more personalized approaches to prognostication and treatment. Examples include symptom-based subtypes such as "excessively sleepy" and "disturbed sleep" with differing impact of CPAP on symptoms and health-related quality of life. Polysomnographic subtypes, distinguished by respiratory event association with hypoxemia, arousals, or both, exhibit varying risks of cardiovascular disease and response to therapy. This review summarizes the findings from recent cluster analysis studies in sleep apnea and synthesizes common themes to describe the potential role (and limitations) of phenotypic subtypes in precision medicine for OSA. It also highlights future directions, including linking of phenotypes to clinically relevant outcomes, rigorous and transparent assessment of phenotype reproducibility, and need for tools that categorize patients into subtypes, to prospectively validate phenotype-based prognostication and treatment approaches. Finally, we highlight the critical need to include women and more racially/ethnically diverse populations in this area of research if we are to leverage the heterogeneity of OSA to improve patient lives.
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Affiliation(s)
- Andrey Zinchuk
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
| | - Henry K Yaggi
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Health Care System, West Haven, CT
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Hu ST, Tsao LI, Yu CC, Liu CY. Development and validation of a Chinese version of the Sleep Apnea Quality of Life Index. Sleep Breath 2020; 24:591-597. [PMID: 31938992 DOI: 10.1007/s11325-020-02012-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/25/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A Chinese version of the Sleep Apnea Quality of Life Index (SAQLI) for patients with obstructive sleep apnea (OSA) undergoing treatment with continuous positive airway pressure (CPAP) was developed and validated. No Chinese versions of the SAQLI have been previously validated. METHODS A convenience sample of 78 patients with OSA who received CPAP therapy at a Taiwanese teaching hospital was enrolled. The SAQLI is organized into four domains: daily functioning, social interactions, emotional functioning, and symptoms. This study evaluated the equivalence (forward translation and back translation), validity, and reliability of a Chinese version of the SAQLI. RESULTS The content validity index (CVI) values of the daily functioning, social interactions, emotional functioning, and symptom domains were .93, .93, .96, and 1.00, respectively. Construct validity of one factor was generated by exploratory factor analysis, and the factor explained the following: (A) daily functioning 54%, (B) social interactions 59%, (C) emotional functioning 64%, and (D) symptoms 75% of total explained variance. The Cronbach's α internal consistency values for the daily functioning, social interactions, emotional functioning, and symptom domains were 0.68, 0.94, 0.93, and 0.92, respectively. The repeatability of the SAQLI at 7 days and 30 days after the first administration showed reliability coefficients of .94 and .93 (p = 0.001), respectively. CONCLUSIONS The results indicate that the Chinese version of the SAQLI has good reliability and validity, as well as refined indicators for assessing the tool's accuracy. Clinicians may thus use the scale to examine the quality of life in Chinese-speaking patients with OSA undergoing CPAP therapy.
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Affiliation(s)
- Shui-Tao Hu
- Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan.
- College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Lee-Ing Tsao
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Chieh Yu
- Division of Pulmonary, Critical Care, & Sleep Medicine, and College of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Keelung/Taoyuan, Taiwan
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Kennedy B, Lasserson TJ, Wozniak DR, Smith I. Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2019; 12:CD003531. [PMID: 31792939 PMCID: PMC6888022 DOI: 10.1002/14651858.cd003531.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is the repetitive closure of the upper airway during sleep. This results in disturbed sleep and excessive daytime sleepiness. It is a risk factor for long-term cardiovascular morbidity. Continuous positive airway pressure (CPAP) machines can be applied during sleep. They deliver air pressure by a nasal or oronasal mask to prevent the airway from closing, reducing sleep disturbance and improving sleep quality. Some people find them difficult to tolerate because of high pressure levels and other symptoms such as a dry mouth. Switching to machines that vary the level of air pressure required to reduce sleep disturbance could increase comfort and promote more regular use. Humidification devices humidify the air that is delivered to the upper airway through the CPAP circuit. Humidification may reduce dryness of the throat and mouth and thus improve CPAP tolerability. This updated Cochrane Review looks at modifying the delivery of positive pressure and humidification on machine usage and other clinical outcomes in OSA. OBJECTIVES To determine the effects of positive pressure modification or humidification on increasing CPAP machine usage in adults with OSA. SEARCH METHODS We searched Cochrane Airways Specialised Register and clinical trials registries on 15 October 2018. SELECTION CRITERIA Randomised parallel group or cross-over trials in adults with OSA. We included studies that compared automatically adjusting CPAP (auto-CPAP), bilevel positive airway pressure (bi-PAP), CPAP with expiratory pressure relief (CPAPexp), heated humidification plus fixed CPAP, automatically adjusting CPAP with expiratory pressure relief, Bi-PAP with expiratory pressure relief, auto bi-PAP and CPAPexp with wakefulness detection with fixed pressure setting. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. We assessed the certainty of evidence using GRADE for the outcomes of machine usage, symptoms (measured by the Epworth Sleepiness Scale (ESS)), Apnoea Hypopnoea Index (AHI), quality of life measured by Functional Outcomes of Sleep Questionnaire (FOSQ), blood pressure, withdrawals and adverse events (e.g. nasal blockage or mask intolerance). The main comparison of interest in the review is auto-CPAP versus fixed CPAP. MAIN RESULTS We included 64 studies (3922 participants, 75% male). The main comparison of auto-CPAP with fixed CPAP is based on 36 studies with 2135 participants from Europe, USA, Hong Kong and Australia. The majority of studies recruited participants who were recently diagnosed with OSA and had not used CPAP previously. They had excessive sleepiness (ESS: 13), severe sleep disturbance (AHI ranged from 22 to 59), and average body mass index (BMI) of 35 kg/m2. Interventions were delivered at home and the duration of most studies was 12 weeks or less. We judged that studies at high or unclear risk of bias likely influenced the effect of auto-CPAP on machine usage, symptoms, quality of life and tolerability, but not for other outcomes. Primary outcome Compared with average usage of about five hours per night with fixed CPAP, people probably use auto-CPAP for 13 minutes longer per night at about six weeks (mean difference (MD) 0.21 hours/night, 95% confidence interval (CI) 0.11 to 0.31; 31 studies, 1452 participants; moderate-certainty evidence). We do not have enough data to determine whether auto-CPAP increases the number of people who use machines for more than four hours per night compared with fixed CPAP (odds ratio (OR) 1.16, 95% CI 0.75 to 1.81; 2 studies, 346 participants; low-certainty evidence). Secondary outcomes Auto-CPAP probably reduces daytime sleepiness compared with fixed CPAP at about six weeks by a small amount (MD -0.44 ESS units, 95% CI -0.72 to -0.16; 25 studies, 1285 participants; moderate-certainty evidence). AHI is slightly higher with auto-CPAP than with fixed CPAP (MD 0.48 events per hour, 95% CI 0.16 to 0.80; 26 studies, 1256 participants; high-certainty evidence), although it fell with both machine types from baseline values in the studies. Ten per cent of people in auto-CPAP and 11% in the fixed CPAP arms withdrew from the studies (OR 0.90, 95% CI 0.64 to 1.27; moderate-certainty evidence). Auto-CPAP and fixed CPAP may have similar effects on quality of life, as measured by the FOSQ but more evidence is needed to be confident in this result (MD 0.12, 95% CI -0.21 to 0.46; 3 studies, 352 participants; low-certainty evidence). Two studies (353 participants) provided data on clinic-measured blood pressure. Auto-CPAP may be slightly less effective at reducing diastolic blood pressure compared to fixed CPAP (MD 2.92 mmHg, 95% CI 1.06 to 4.77 mmHg; low-certainty evidence). The two modalities of CPAP probably do not differ in their effects on systolic blood pressure (MD 1.87 mmHg, 95% CI -1.08 to 4.82; moderate-certainty evidence). Nine studies (574 participants) provided information on adverse events such as nasal blockage, dry mouth, tolerance of treatment pressure and mask leak. They used different scales to capture these outcomes and due to variation in the direction and size of effect between the studies, the comparative effects on tolerability outcomes are uncertain (very low-certainty evidence). The evidence base for other interventions is smaller, and does not provide sufficient information to determine whether there are important differences between pressure modification strategies and fixed CPAP on machine usage outcomes, symptoms and quality of life. As with the evidence for the auto-CPAP, adverse events are measured disparately. AUTHORS' CONCLUSIONS In adults with moderate to severe sleep apnoea starting positive airway pressure therapy, auto-CPAP probably increases machine usage by about 13 minutes per night. The effects on daytime sleepiness scores with auto-CPAP are not clinically meaningful. AHI values are slightly lower with fixed CPAP. Use of validated quality of life instruments in the studies to date has been limited, although where they have been used the effect sizes have not exceeded proposed clinically important differences. The adoption of a standardised approach to measuring tolerability would help decision-makers to balance benefits with harms from the different treatment options available. The evidence available for other pressure modification strategies does not provide a reliable basis on which to draw firm conclusions. Future studies should look at the effects of pressure modification devices and humidification in people who have already used CPAP but are unable to persist with treatment.
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Affiliation(s)
- Barry Kennedy
- St. James's HospitalDepartment of Sleep MedicineDublinIreland
| | - Toby J Lasserson
- Cochrane Central ExecutiveEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Dariusz R Wozniak
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
| | - Ian Smith
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
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Educating Stroke/TIA Patients about Obstructive Sleep Apnea after Stroke: A Randomized Feasibility Study. J Stroke Cerebrovasc Dis 2019; 28:104317. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/19/2019] [Indexed: 11/19/2022] Open
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Xiao F, Lu C, Zhao D, Zou Q, Xu L, Li J, Zhang J, Han F. Independent Component Analysis and Graph Theoretical Analysis in Patients with Narcolepsy. Neurosci Bull 2019; 35:743-755. [PMID: 30421271 PMCID: PMC6616568 DOI: 10.1007/s12264-018-0307-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/03/2018] [Indexed: 02/04/2023] Open
Abstract
The present study was aimed to evaluate resting-state functional connectivity and topological properties of brain networks in narcolepsy patients compared with healthy controls. Resting-state fMRI was performed in 26 adult narcolepsy patients and 30 matched healthy controls. MRI data were first analyzed by group independent component analysis, then a graph theoretical method was applied to evaluate the topological properties in the whole brain. Small-world network parameters and nodal topological properties were measured. Altered topological properties in brain areas between groups were selected as region-of-interest seeds, then the functional connectivity among these seeds was compared between groups. Partial correlation analysis was performed to evaluate the relationship between the severity of sleepiness and functional connectivity or topological properties in the narcolepsy patients. Twenty-one independent components out of 48 were obtained. Compared with healthy controls, the narcolepsy patients exhibited significantly decreased functional connectivity within the executive and salience networks, along with increased functional connectivity in the bilateral frontal lobes within the executive network. There were no differences in small-world network properties between patients and controls. The altered brain areas in nodal topological properties between groups were mainly in the inferior frontal cortex, basal ganglia, anterior cingulate, sensory cortex, supplementary motor cortex, and visual cortex. In the partial correlation analysis, nodal topological properties in the putamen, anterior cingulate, and sensory cortex as well as functional connectivity between these regions were correlated with the severity of sleepiness (sleep latency, REM sleep latency, and Epworth sleepiness score) among narcolepsy patients. Altered connectivity within the executive and salience networks was found in narcolepsy patients. Functional connection changes between the left frontal cortex and left caudate nucleus may be one of the parameters describing the severity of narcolepsy. Changes in the nodal topological properties in the left putamen and left posterior cingulate, changes in functional connectivity between the left supplementary motor area and right occipital as well as in functional connectivity between the left anterior cingulate gyrus and bilateral postcentral gyrus can be considered as a specific indicator for evaluating the severity of narcolepsy.
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Affiliation(s)
- Fulong Xiao
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Chao Lu
- Department of Radiology, Peking University International Hospital, Beijing, 102206, China
| | - Dianjiang Zhao
- Department of Radiology, Peking University International Hospital, Beijing, 102206, China
| | - Qihong Zou
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Liyue Xu
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, 102206, China
| | - Jing Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, 100044, China.
| | - Fang Han
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China.
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Seethaler A, Rudack C, Spiekermann C. Structured literature review of patient-reported outcome (PRO) instruments in adult tonsillectomy or tonsillotomy. Health Qual Life Outcomes 2019; 17:122. [PMID: 31307495 PMCID: PMC6631536 DOI: 10.1186/s12955-019-1192-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/05/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Instruments that measure the patient-reported outcome and quality of life are essential to assess the treatment success of any medical intervention. This review represents valid and reliable outcome assessment instruments for tonsillectomy (TE) and tonsillotomy (TO) in adult patients as TE/TO still belong to one of the most common performed surgical procedures. METHODS A systematic review of the literature in the MEDLINE, PubMed, Web of Science and Cochrane Library was conducted. Studies describing reliable and valid patient-reported outcome measures (PROM) in adults with regard to the perioperative as well as postoperative follow-up after TE/TO were examined. Thus, studies without PROMs or PROMs only relating to children as well as studies in non-English/non-German language or without any detailed information were excluded. RESULTS Four thousand four hundred forty studies were identified. Thirteen reliable and valid patient-reported outcome assessment instruments presenting the perioperative and postoperative outcome were analysed. Four generic questionnaires are included that are used to measure the outcome after TE/TO in adults. Four disease-specific questionnaires relating to obstructive sleep apnea (OSA) and sleep disordered breathing (SDB) as well as two TE/TO specific questionnaires are validated for adults. With regard to the perioperative outcome including parameters like pain, nausea, vomiting, satisfaction three assessment instruments are analysed. CONCLUSION This review describes the currently available, reliable and valid generic and disease-specific instruments assessing the perioperative as well as postoperative outcome to evaluate the treatment success after TE/TO in adult patients. Therefore, this study improves the selection of the appropriate patient-reported outcome assessment instrument to assess the quality of life in adults undergoing TE/TO.
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Affiliation(s)
- Alicia Seethaler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, Münster, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Spiekermann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, Münster, Germany. .,Institute of Immunology, University Hospital Münster, Röntgenstr. 21, 48149, Münster, Germany.
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Lo Bue A, Salvaggio A, Iacono Isidoro S, Romano S, Insalaco G. OSA and CPAP therapy: effect of gender, somnolence, and treatment adherence on health-related quality of life. Sleep Breath 2019; 24:533-540. [PMID: 31309464 DOI: 10.1007/s11325-019-01895-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) often has a significant impact on health-related quality of life (HRQoL) with social and psychological implications. For most OSA patients, a reduction in their HRQoL is due to symptoms such as poor sleep quality, excessive daytime somnolence, and fatigue with differences between gender. PURPOSE This study explores the CPAP treatment effect on self-perceived HRQoL related to gender, somnolence, and CPAP adherence. METHODS Out of 1082 consecutive Italian outpatients, 125 (82 M) (60.3 ± 9.6 years) completed the prospective observational study and were evaluated at the first visit (T0), and the follow-up visit (T1). Two self-reported HRQoL questionnaires were administered: six subscales Psychological General Well-Being Index (PGWBI) and 12-Item Short-Form Health Survey (SF-12). RESULTS Scores of PGWBI and SF-12 MCS improved from T0 to T1. Patients with CPAP use ≥ 4 h/night showed a significant improvement in all dimensions evaluated, except for SF-12 PCS. At T1, participants with ESS > 10 improved in all scores, except SF-12 PCS. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up visit. Variation of PGWBI was significantly correlated with CPAP use, ESS at T0 and T1 (p < 0.0001; r2 = 0.26). CONCLUSIONS This study provides evidence on the effectiveness of CPAP treatment on perceived HRQoL. Participants with greater adherence to therapy, greater sleepiness, and greater improvement of daytime sleepiness with CPAP therapy, reported a higher quality of life improvement. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up, despite a more considerable improvement in females.
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Affiliation(s)
- Anna Lo Bue
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Adriana Salvaggio
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy.
| | - Serena Iacono Isidoro
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Salvatore Romano
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Giuseppe Insalaco
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
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Wang F, Meng LR, Zhang QE, Li L, Lam Nogueira BOC, Ng CH, Ungvari GS, Liu L, Zhao W, Jia FJ, Xiang YT. Sleep disturbance and its relationship with quality of life in older Chinese adults living in nursing homes. Perspect Psychiatr Care 2019; 55:527-532. [PMID: 30779143 DOI: 10.1111/ppc.12363] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To examine sleep disturbances in older adults in Macau and Guangzhou, China and their associated factors. DESIGN AND METHODS Four-hundred and thirty seven subjects in Guangzhou and 244 subjects in Macau were interviewed. FINDINGS In total, 681 older adults participated in the study, and 27.8% reported sleep disturbance, with 43.9% in Macau and 18.8% in Guangzhou. Physical quality of life was negatively associated with sleep disturbances. Severe depressive symptoms were positively related but living in Guangzhou was negatively related to sleep disturbances. Sleep disturbances are more common in Macau compared to Guangzhou. PRACTICE IMPLICATIONS Appropriate screening and treatment strategies are needed to address sleep disturbance in this population.
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Affiliation(s)
- Fei Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong, China.,Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Li-Rong Meng
- School of Health Sciences, Macao Polytechnic Institute, Macao SAR, China
| | - Qing E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Lu Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Bernice O C Lam Nogueira
- School of Health Sciences, Macao Polytechnic Institute, Macao SAR, China.,Macao Sino-Portuguese Nurses Association, Macao SAR, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lianqi Liu
- Home for the Aged GuangZhou, Guangdong, China
| | - Wei Zhao
- Home for the Aged GuangZhou, Guangdong, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Richards KC, Gooneratne N, Dicicco B, Hanlon A, Moelter S, Onen F, Wang Y, Sawyer A, Weaver T, Lozano A, Carter P, Johnson J. CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea. J Am Geriatr Soc 2019; 67:558-564. [PMID: 30724333 DOI: 10.1111/jgs.15758] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Obstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial. DESIGN Quasi-experimental pilot clinical trial with CPAP adherence defined as CPAP use 4 hours or more per night over 1 year. SETTING Sleep and geriatric clinics and community. PARTICIPANTS Older adults, aged 55 to 89 years, with an apnea-hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI -CPAP), n = 25. INTERVENTION CPAP. MEASUREMENTS The primary cognitive outcome was memory (Hopkins Verbal Learning Test-Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, and Clinical Dementia Rating. RESULTS Statistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI -CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73-2.62), with a 6-month effect size (ES) of 0.46 and a 1-year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI -CPAP group. CONCLUSION Controlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition, compared with a nonadherent control group, and may slow the trajectory of cognitive decline. TRIAL REGISTRATION NUMBER Memories; NCT01482351; https://clinicaltrials.gov/ct2/show/NCT01482351?cond=MCI+and+OSA&rank=1 J Am Geriatr Soc 67:558-564, 2019.
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Affiliation(s)
| | - Nalaka Gooneratne
- Division of Sleep Medicine, Center for Sleep and Circadian Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barry Dicicco
- School of Medicine, Virginia Commonwealth University & Pulmonary and Critical Care Specialists of Northern Virginia, Richmond, Virginia
| | - Alexandra Hanlon
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Moelter
- Department of Psychology, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania
| | - Fannie Onen
- Division of Sleep Medicine, Center for Sleep and Circadian Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Geriatrics, CHU Bichat Claude Bernard, APHP, Paris, France.,INSERM 1178 & CESP, University of Paris Sud, Chatenay-Malabry, France
| | - Yanyan Wang
- School of Nursing, University of Texas at Austin, Texas, Austin.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Amy Sawyer
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Terri Weaver
- Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois.,Division of Pulmonary, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Alicia Lozano
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patricia Carter
- School of Nursing, University of Texas at Austin, Texas, Austin
| | - Jerry Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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37
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Boyd SB, Chigurupati R, Cillo JE, Eskes G, Goodday R, Meisami T, Viozzi CF, Waite P, Wilson J. Maxillomandibular Advancement Improves Multiple Health-Related and Functional Outcomes in Patients With Obstructive Sleep Apnea: A Multicenter Study. J Oral Maxillofac Surg 2019; 77:352-370. [DOI: 10.1016/j.joms.2018.06.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 01/27/2023]
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Baniak LM, Chasens ER, Luyster FS, Strollo PJ, Thunström E, Peker Y. Obstructive sleep apnea and self-reported functional impairment in revascularized patients with coronary artery disease in the RICCADSA trial. Sleep Breath 2018; 22:1169-1177. [PMID: 30324547 DOI: 10.1007/s11325-018-1733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/11/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Daytime sleepiness, a frequent symptom of obstructive sleep apnea (OSA), can impact functional status. In patients with coronary artery disease (CAD) and concomitant OSA, the distinction between sleep-related functional impairment from underlying CAD versus OSA is unclear. This study evaluated the impact of OSA on sleep-related functional impairment in patients with CAD and compared the effect of 1-year continuous positive airway pressure (CPAP) use on change in impairment between those with and without excessive daytime sleepiness (EDS) and OSA. We hypothesized that sleep-related functional impairment is impacted by EDS independent of OSA in patients with CAD. METHODS One hundred five CAD patients without OSA and 105 with moderate-to-severe OSA from the RICCADSA trial were matched on disease severity and included in the current substudy. Of those with OSA, 80 were allocated to CPAP. Functional Outcomes of Sleep Questionnaire (FOSQ) score < 17.9 corresponded to sleep-related functional impairment. RESULTS Following revascularization, CAD patients with and without OSA frequently report sleep-related functional impairment (35% and 27.3%, respectively; p = .29). Moderate-to-severe OSA was not related to baseline FOSQ scores < 17.9 in regression analyses; EDS was (OR 4.82, 95% CI 2.12-11.0; p < .001). CPAP use significantly improved FOSQ scores from baseline to 1-year follow-up in OSA patients with EDS (17.2 ± 2.0 to 18.15 ± 1.7, p = .002) despite suboptimal adherence. CONCLUSIONS Sleep-related functional impairment may be reflective of persistent EDS, independent of OSA. Diagnosing OSA and initiating treatment are worthwhile in individuals with CAD and EDS, as both are important to guide appropriate therapy in patients with CAD.
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Affiliation(s)
- Lynn M Baniak
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA.
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - Yüksel Peker
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul, Turkey.,Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
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Crook S, Sievi NA, Bloch KE, Stradling JR, Frei A, Puhan MA, Kohler M. Minimum important difference of the Epworth Sleepiness Scale in obstructive sleep apnoea: estimation from three randomised controlled trials. Thorax 2018; 74:390-396. [PMID: 30100576 DOI: 10.1136/thoraxjnl-2018-211959] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/21/2018] [Accepted: 07/23/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Epworth Sleepiness Scale (ESS) is a widely used tool for assessing sleepiness in patients with obstructive sleep apnoea (OSA). We aimed to estimate the minimal important difference (MID) in patients with OSA. METHODS We used individual data from three randomised controlled trials (RCTs) in patients with OSA where the preintervention to postintervention change in ESS was used as a primary outcome. We used anchor-based linear regression and responder analysis approaches to estimate the MID. For anchors, we used the change in domains of the Functional Outcomes of Sleep Questionnaire and 36-Item Short Form Health Survey. We also used the distribution-based approaches Cohen's effect size, SE of measurement and empirical rule effect size to support the anchor-based estimates. The final MID was determined by triangulating all estimates to a single MID. FINDINGS A total of 639 patients with OSA were included in our analyses across the three RCTs with a median (IQR) baseline ESS score of 10 (6-13). The median (IQR) ESS change score overall was -2 (-5 to 1). The anchor-based estimates of the MID were between -1.74 and -4.21 points and estimates from the responder analysis were between -1 and -3 points. Distribution-based estimates were smaller, ranging from -1.46 to -2.36. INTERPRETATION We propose an MID for the ESS of 2 points in patients with OSA with a disease severity from mild to severe. This estimate provides the means to plan trials and interpret the clinical relevance of changes in ESS. TRIAL REGISTRATION NUMBER Provent, NCT01332175; autoCPAP trial, NCT00280800; MOSAIC,ISRCTN (3416388).
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Affiliation(s)
- Sarah Crook
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pneumology, University Hospital of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Pneumology, University Hospital of Zurich, Zurich, Switzerland.,Center of Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - John R Stradling
- Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Campus, Oxford University, Oxford, UK
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pneumology, University Hospital of Zurich, Zurich, Switzerland.,Center of Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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Kurtis MM, Balestrino R, Rodriguez-Blazquez C, Forjaz MJ, Martinez-Martin P. A Review of Scales to Evaluate Sleep Disturbances in Movement Disorders. Front Neurol 2018; 9:369. [PMID: 29896152 PMCID: PMC5986889 DOI: 10.3389/fneur.2018.00369] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/07/2018] [Indexed: 01/09/2023] Open
Abstract
Patients with movement disorders have a high prevalence of sleep disturbances that can be classified as (1) nocturnal sleep symptoms, such as insomnia, nocturia, restless legs syndrome (RLS), periodic limb movements (PLM), obstructive sleep apnea (OSA), and REM sleep behavior disorder; and (2) diurnal problems that include excessive daytime sleepiness (EDS) and sleep attacks. The objective of this review is to provide a practical overview of the most relevant scales that assess these disturbances to guide the choice of the most useful instrument/s depending on the line of research or clinical focus. For each scale, the reader will find a brief description of practicalities and psychometric properties, use in movement disorder cohorts and analyzed strengths and limitations. To assess insomnia, the Pittsburgh Sleep Quality Index, a generic scale, and three disease-specific scales: the Parkinson Disease Sleep Scale (PDSS), the PDSS-2, and Scales for outcomes in Parkinson's disease (PD)-Sleep-Nocturnal Sleep subscale are discussed. To evaluate nocturia, there are no specific tools, but some extensively validated generic urinary symptom scales (the Overall Bladder Questionnaire and the Overactive Bladder Symptom Score) and some PD-specific scales that include a nocturia item are available. To measure RLS severity, there are currently four domain-specific generic scales: The International Restless Legs Scale, the Johns Hopkins Restless Legs Severity Scale, the Restless Legs Syndrome-6 measure, a Pediatric RLS Severity Scale, and the Augmentation Severity Rating Scale (a scale to evaluate augmentation under treatment) and several instruments that assess impact on quality of sleep and health-related quality of life. To evaluate the presence of PLM, no clinical scales have been developed to date. As far as OSA, commonly used instruments such as the Sleep Apnea Scale of the Sleep Disorders Questionnaire, the STOP-Bang questionnaire, and the Berlin Questionnaire are reviewed. Three scales have been extensively used to assess EDS: the generic Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and the PD-specific Scales for outcomes in PD-Sleep-Daytime sleepiness subscale. To date, only the Inappropriate Sleep Composite Score specifically evaluates propensity to sleep attacks.
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Affiliation(s)
- Mónica M. Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Roberta Balestrino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
| | - Maria João Forjaz
- National School of Public Health and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, Madrid, Spain
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Timkova V, Nagyova I, Reijneveld SA, Tkacova R, van Dijk JP, Bültmann U. Social support, mastery, sleep-related problems and their association with functional status in untreated obstructive sleep apnoea patients. Heart Lung 2018; 47:371-379. [PMID: 29778252 DOI: 10.1016/j.hrtlng.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/18/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Social support and mastery are important aspects in the treatment of chronic diseases, however their role in connection with Obstructive Sleep Apnoea (OSA) remains unclear. OBJECTIVES The study examined the associations between social support, mastery, sleep-related problems and functional status in untreated OSA patients. METHODS All patients in this cross-sectional study completed the Multidimensional Scale of Perceived Social Support, the Pearlin Mastery Scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire. Multiple linear regression and mediation analyses were used to analyse the data. RESULTS Participants were 150 newly diagnosed OSA patients (Apnoea-Hypopnoea Index-AHI≥5; 68% male; mean age 48.9 ± 9.5years). Compared with social support, mastery was more strongly associated with functional status. The indirect effects of sleep-related problems on functional status via mastery varied between 17.7% and 23.3%. CONCLUSIONS Supporting OSA patients' sense of mastery may significantly contribute to better disease management.
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Affiliation(s)
- Vladimira Timkova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia; Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Slovakia.
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Sijmen A Reijneveld
- University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, The Netherlands
| | - Ruzena Tkacova
- Department of Pneumology and Phtiseology, Faculty of Medicine, PJ Safarik University in Kosice, Kosice, Slovakia
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, PJ Safarik University in Kosice, Slovakia; University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, The Netherlands
| | - Ute Bültmann
- University of Groningen Department, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, The Netherlands
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Serrano Merino J, Pérula de Torres LÁ, Bardwell WA, Muñoz Gómez R, Roldán Villalobos A, Feu Collado N, Ruiz-Moral R, Jurado-Gámez B. Impact of Positive Pressure Treatment of the Airway on Health-Related Quality of Life in Elderly Patients With Obstructive Sleep Apnea. Biol Res Nurs 2018; 20:452-461. [DOI: 10.1177/1099800418774633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Obstructive sleep apnea (OSA) is a chronic illness that increases in prevalence with age. Treatment includes continuous positive airway pressure (CPAP) devices. Studies about the use of CPAP in the elderly are scarce. The main objective of this study is to determine whether CPAP contributes to improvement in health-related quality of life (HRQL) in elderly patients with OSA. Method: This was a prospective, pre-/postintervention assessment of a cohort of patients ≥65 years of age with OSA diagnosis by polysomnography who were being treated with CPAP and were physically independent and had good cognitive status. We determined HRQL before and after 3 months of CPAP treatment using the Short Form-36 Health Survey (SF-36, a 36-item, patient-reported survey) and Sleep Apnea Quality of Life Index (SAQLI). The effect of CPAP on daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Results: Of the 103 participants with a mean age of 71.5 ± 4.19 years, 66% were male. After 3 months of therapy, the mean CPAP usage was 6.3 ± 1.41 hr/day. The effectiveness of CPAP in controlling the OSA was demonstrated (mean difference pre- and posttherapy: 34.30 ± 18.52 events/hr, p < .001). Postintervention, the categories of the SF-36 improved meaningfully ( p < .001). Moreover, all categories of SAQLI improved ( p < .001) with the exception of “symptoms” ( p = .073). ESS scores also improved significantly (difference = 5.2 ± 4.47, p < .001) postintervention. Conclusion: Therapy with CPAP in elderly patients with OSA helps improve their HRQL and reduces daytime sleepiness.
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Affiliation(s)
- Jesús Serrano Merino
- Sleep Unit, Respiratory Department, University Hospital Reina Sofia, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Luis Ángel Pérula de Torres
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
- Unidad Docente de Medicina Familiar y Comunitaria, Health District of Córdoba and Guadalquivir, Córdoba, Spain
| | - Wayne A. Bardwell
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Ana Roldán Villalobos
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
- Unidad Docente de Medicina Familiar y Comunitaria, Health District of Córdoba and Guadalquivir, Córdoba, Spain
| | - Nuria Feu Collado
- Sleep Unit, Respiratory Department, University Hospital Reina Sofia, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Roger Ruiz-Moral
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
- Faculty of Medicine, University of Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Bernabé Jurado-Gámez
- Sleep Unit, Respiratory Department, University Hospital Reina Sofia, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
- Faculty of Medicine, University of Córdoba, Córdoba, Spain
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43
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Chen LT, Fan XL, Li HJ, Ye CL, Yu HH, Xin HZ, Gong HH, Peng DC, Yan LP. Aberrant brain functional connectome in patients with obstructive sleep apnea. Neuropsychiatr Dis Treat 2018; 14:1059-1070. [PMID: 29713176 PMCID: PMC5912371 DOI: 10.2147/ndt.s161085] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is accompanied by widespread abnormal spontaneous regional activity related to cognitive deficits. However, little is known about the topological properties of the functional brain connectome of patients with OSA. This study aimed to use the graph theory approaches to investigate the topological properties and functional connectivity (FC) of the functional connectome in patients with OSA, based on resting-state functional magnetic resonance imaging (rs-fMRI). METHODS Forty-five male patients with newly diagnosed untreated severe OSA and 45 male good sleepers (GSs) underwent a polysomnography (PSG), clinical evaluations, and rs-fMRI scans. The automated anatomical labeling (AAL) atlas was used to construct the functional brain connectome. The topological organization and FC of brain functional networks in patients with OSA were characterized using graph theory methods and investigated the relationship between functional network topology and clinical variables. RESULTS Both the patients with OSA and the GSs exhibited high-efficiency "small-world" network attributes. However, the patients with OSA exhibited decreased σ, γ, Eglob; increased Lp, λ; and abnormal nodal centralities in several default-mode network (DMN), salience network (SN), and central executive network (CEN) regions. However, the patients with OSA exhibited abnormal functional connections between the DMN, SN, and CEN. The disrupted FC was significantly positive correlations with the global network metrics γ and σ. The global network metrics were significantly correlated with the Epworth Sleepiness Scale (ESS) score, Montreal Cognitive Assessment (MoCA) score, and oxygen desaturation index. CONCLUSION The findings suggest that the functional connectome of patients with OSA exhibited disrupted functional integration and segregation, and functional disconnections of the DMN, SN, and CEN. The aberrant topological attributes may be associated with disrupted FC and cognitive functions. These topological abnormalities and disconnections might be potential biomarkers of cognitive impairments in patients with OSA.
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Affiliation(s)
- Li-Ting Chen
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiao-Le Fan
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hai-Jun Li
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Cheng-Long Ye
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hong-Hui Yu
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hui-Zhen Xin
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hong-Han Gong
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - De-Chang Peng
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Li-Ping Yan
- Department of Cardiology, People’s Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
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Walia HK, Thompson NR, Katzan I, Foldvary-Schaefer N, Moul DE, Mehra R. Impact of Sleep-Disordered Breathing Treatment on Quality of Life Measures in a Large Clinic-Based Cohort. J Clin Sleep Med 2017; 13:1255-1263. [PMID: 28992832 DOI: 10.5664/jcsm.6792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/22/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study aims to report the effect of positive airway pressure (PAP) therapy on quality of life (QoL) measures in the clinical sleep-disordered breathing (SDB) population. METHODS We examined general QoL measures assessed by European Quality of Life-5D (EQ-5D) and sleep-specific QoL by examining Functional Outcomes of Sleep Questionnaire (FOSQ) scores before and after PAP therapy retrospectively in a clinical SDB population using paired and two-sample t tests. Age and socioeconomic status (SES) effect modification on pre-PAP QoL measures were investigated utilizing the interaction terms. RESULTS A total of 2,027 patients with SDB initiated PAP therapy between January 1, 2010 and December 31, 2014. The mean age of the cohort was 56.2 years (standard deviation = 13.2), with 45.8% female and 76.9% Caucasians. EQ-5D change after exclusion of those with normal QoL was 0.042 (0.152) in all patients, 0.051 (0.150) in patients who were PAP adherent by self-report, and 0.050 (0.132) in patients who were objectively PAP adherent (n = 704 of 1,011 with available objective adherence data, 69.6%). Change in FOSQ after excluding those with normal FOSQ was 1.9 (2.9) in all patients, 2.2 (2.9) in patients who were PAP adherent by self-report, and 2.3 (2.9) in patients who were objectively PAP adherent. Those with (1) worse QoL at baseline and younger age and (2) worse QoL at baseline and residing in lower SES strata had worse outcomes after PAP therapy (P < .05). CONCLUSIONS We found consistent improvement in global and sleep-specific QoL measures after PAP therapy, hence providing evidence of PAP benefit in the clinical population and rationale for targeted efforts to optimize QoL in younger and lower SES subgroups.
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Affiliation(s)
- Harneet K Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Irene Katzan
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.,Neurological Institute Center of Research Outcomes, Cleveland Clinic, Cleveland, Ohio
| | | | - Douglas E Moul
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Sundman J, Friberg D, Bring J, Lowden A, Nagai R, Browaldh N. Sleep Quality After Modified Uvulopalatopharyngoplasty: Results From the SKUP3 Randomized Controlled Trial. Sleep 2017; 41:4584547. [DOI: 10.1093/sleep/zsx180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joar Sundman
- Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Sweden
| | - Danielle Friberg
- Department of Otorhinolaryngology, Institute of Surgical Science, Uppsala University, Sweden
| | | | - Arne Lowden
- Stress Research Institute, Stockholm University, Sweden
| | - Roberta Nagai
- Stress Research Institute, Stockholm University, Sweden
| | - Nanna Browaldh
- Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Sweden
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46
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Chen LT, Fan XL, Li HJ, Nie S, Gong HH, Zhang W, Zeng XJ, Long P, Peng DC. Disrupted small-world brain functional network topology in male patients with severe obstructive sleep apnea revealed by resting-state fMRI. Neuropsychiatr Dis Treat 2017; 13:1471-1482. [PMID: 28652747 PMCID: PMC5473494 DOI: 10.2147/ndt.s135426] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that can damage cognitive function. However, the functional network organization remains poorly understood. The aim of this study was to investigate the topological properties of OSA patients using a graph theoretical analysis. PATIENTS AND METHODS A total of 30 male patients with untreated severe OSA and 25 male education- and age-matched good sleepers (GSs) underwent functional magnetic resonance imaging (MRI) examinations. Clinical and cognitive evaluations were conducted by an experienced psychologist. GRETNA (a toolbox for topological analysis of imaging connectomics) was used to construct the brain functional network and calculate the small-world properties (γ, λ, σ, Eglob, and Eloc). Relationships between these small-world properties and clinical and neuropsychological assessments were investigated in OSA patients. RESULTS The networks of both OSA patients and GSs exhibited efficient small-world topology over the sparsity range of 0.05-0.40. Compared with GSs, the OSA group had significantly decreased γ, but significantly increased λ and σ. The OSA group's brain network showed significantly decreased Eglob (P<0.05) over the sparsity range of 0.09-0.15, but significantly increased Eloc over the sparsity range of 0.23-0.40. In OSA patients, γ was significantly negatively correlated with apnea-hypopnea index (AHI; r=-0.326, P=0.015) and Epworth Sleepiness Scale (ESS; r=-0.274, P=0.043), λ was significantly positively correlated with AHI (r=0.373, P=0.005) and ESS (r=0.269, P=0.047), and σ was significantly negatively correlated with AHI (r=-0.363, P=0.007) and ESS (r=-0.295, P=0.029). CONCLUSION Our results suggest that the high degree of local integration and integrity of the brain connections in OSA patients may be disrupted. The topological alterations of small-world properties may be the mechanism of cognitive impairment in OSA patients. In addition, σ, γ, and λ could be used as a quantitative physiological index for auxiliary clinical diagnoses.
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Affiliation(s)
| | | | | | | | | | | | | | - Ping Long
- Department of Otolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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47
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Iacono Isidoro S, Salvaggio A, Lo Bue A, Romano S, Marrone O, Insalaco G. Immediate effect of CPAP titration on perceived health related quality of life: a prospective observational study. BMC Pulm Med 2016; 16:172. [PMID: 27905903 PMCID: PMC5133738 DOI: 10.1186/s12890-016-0336-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perceived Health Related Quality of Life (HRQoL) is impaired in obstructive sleep apnea (OSA). This study examines changes in HRQoL aspects occurring immediately after CPAP titration. Furthermore, we analyzed variations in each gender and in patients undergoing home or laboratory-based CPAP titration pathways. METHODS Twohundredfive outpatients (151 M) (56.7 ± 10.3 years) were evaluated, before first visit and nocturnal diagnostic examination (T0), and the morning after CPAP titration (T1). Two self-reported HRQoL questionnaires were administered: Psychological General Well-Being Index (PGWBI), composed by six subscales, and 12-Item Short-Form Health Survey (SF-12), including Physical (PCS) and Mental Component Summaries (MCS). CPAP titration was performed using auto-adjusting CPAP units at patients' home or in the sleep laboratory. RESULTS PGWBI scores at T1 improved compared to T0 (p < 0.0001). A similar improvement was observed in SF-12 MCS (p = 0.0011), but not in SF-12 PCS. Changes were independent from anthropometric parameters, OSA severity and excessive daytime sleepiness. Gender comparisons showed better HRQoL in males at both times. At T0, patients who received home or laboratory CPAP titration pathways did not show any differences in PGWBI and SF-12 scores. At T1, PGWBI and SF-12 MCS improved in both home and laboratory groups. CONCLUSIONS This study gives evidence that first time CPAP application for titration can lead to a general increase in perceived well-being. Gender comparisons showed better perceived HRQoL with more subscales improvements in males after CPAP titration. The improvement was similar with both home and laboratory CPAP titration pathways.
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Affiliation(s)
- Serena Iacono Isidoro
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Adriana Salvaggio
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy.
| | - Anna Lo Bue
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Salvatore Romano
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Oreste Marrone
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
| | - Giuseppe Insalaco
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy
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Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches. Sleep Med Rev 2016; 35:113-123. [PMID: 27815038 DOI: 10.1016/j.smrv.2016.10.002] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/23/2016] [Accepted: 10/05/2016] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is a complex and heterogeneous disorder and the apnea hypopnea index alone can not capture the diverse spectrum of the condition. Enhanced phenotyping can improve prognostication, patient selection for clinical trials, understanding of mechanisms, and personalized treatments. In OSA, multiple condition characteristics have been termed "phenotypes." To help classify patients into relevant prognostic and therapeutic categories, an OSA phenotype can be operationally defined as: "A category of patients with OSA distinguished from others by a single or combination of disease features, in relation to clinically meaningful attributes (symptoms, response to therapy, health outcomes, quality of life)." We review approaches to clinical phenotyping in OSA, citing examples of increasing analytic complexity. Although clinical feature based OSA phenotypes with significant prognostic and treatment implications have been identified (e.g., excessive daytime sleepiness OSA), many current categorizations lack association with meaningful outcomes. Recent work focused on pathophysiologic risk factors for OSA (e.g., arousal threshold, craniofacial morphology, chemoreflex sensitivity) appears to capture heterogeneity in OSA, but requires clinical validation. Lastly, we discuss the use of machine learning as a promising phenotyping strategy that can integrate multiple types of data (genomic, molecular, cellular, clinical) to identify unique, meaningful OSA phenotypes.
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Abnormal Intrinsic Functional Hubs in Severe Male Obstructive Sleep Apnea: Evidence from a Voxel-Wise Degree Centrality Analysis. PLoS One 2016; 11:e0164031. [PMID: 27723821 PMCID: PMC5056709 DOI: 10.1371/journal.pone.0164031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/19/2016] [Indexed: 01/09/2023] Open
Abstract
Purpose Obstructive sleep apnea (OSA) has been associated with changes in brain structure and regional function in certain brain areas. However, the functional features of network organization in the whole brain remain largely uncertain. The purpose of this study was to identify the OSA-related spatial centrality distribution of the whole brain functional network and to investigate the potential altered intrinsic functional hubs. Methods Forty male patients with newly confirmed severe OSA on polysomnography, and well-matched good sleepers, participated in this study. All participants underwent a resting-state functional MRI scan and clinical and cognitive evaluation. Voxel-wise degree centrality (DC) was measured across the whole brain, and group difference in DC was compared. The relationship between the abnormal DC value and clinical variables was assessed using a linear correlation analysis. Results Remarkably similar spatial distributions of the functional hubs (high DC) were found in both groups. However, OSA patients exhibited a pattern of significantly reduced regional DC in the left middle occipital gyrus, posterior cingulate cortex, left superior frontal gyrus, and bilateral inferior parietal lobule, and DC was increased in the right orbital frontal cortex, bilateral cerebellum posterior lobes, and bilateral lentiform nucleus, including the putamen, extending to the hippocampus, and the inferior temporal gyrus, which overlapped with the functional hubs. Furthermore, a linear correlation analysis revealed that the DC value in the posterior cingulate cortex and left superior frontal gyrus were positively correlated with Montreal cognitive assessment scores, The DC value in the left middle occipital gyrus and bilateral inferior parietal lobule were negatively correlated with apnea-hypopnea index and arousal index in OSA patients. Conclusion Our findings suggest that OSA patients exhibited specific abnormal intrinsic functional hubs including relatively reduced and increased DC. This expands our understanding of the functional characteristics of OSA, which may provide new insights into understanding the dysfunction and pathophysiology of OSA patients.
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Quality of Life Assessment After Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea. J Oral Maxillofac Surg 2016; 74:1228-37. [PMID: 26917205 DOI: 10.1016/j.joms.2016.01.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Although maxillomandibular advancement (MMA) surgery is highly efficacious for the management of obstructive sleep apnea (OSA), little information exists regarding the subjective effect of this treatment modality. The present study was undertaken to investigate the effect of MMA on patient-perceived quality of life (QOL) in OSA. PATIENTS AND METHODS A retrospective cohort study of patients treated with MMA for OSA from May 2010 to April 2015 was performed. The primary outcome measure was a change in the QOL detected using the Ottawa Sleep Apnea Questionnaire (OSA-Q), which assesses the MMA-related changes in QOL with a 5-point Likert scale. The secondary outcome measure was a change in the apnea hypopnea index (AHI). RESULTS Twenty-two patients participated in the present study. The mean maxillary and mandibular advancement were 8.36 and 11.08 mm, respectively. The AHI decreased from 42.4 to 6.9 events per hour postoperatively (P < .001). The QOL improved significantly after MMA (OSA-Q score 3.98 ± 0.35; P < 001). The sleep quality (4.35 ± 0.63), daytime function (4.13 ± 0.46), physical health (4.19 ± 0.45), mental and emotional health (4.02 ± 0.55), and sexual health (3.78 ± 0.62) categories all improved postoperatively (P < .001). The MMA-related side effects did not adversely affect the QOL. CONCLUSIONS MMA for OSA significantly improves patient's subjective overall QOL, with few MMA-related side effects.
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