Elsevier

Sleep Medicine

Volume 2, Issue 6, November 2001, Pages 477-491
Sleep Medicine

Review
Quality of life in obstructive sleep apnea: a systematic review of the literature

https://doi.org/10.1016/S1389-9457(01)00072-7Get rights and content

Abstract

Objective: To review the literature on obstructive sleep apnea (OSA) and health-related quality of life (HRQOL).

Background: OSA affects nearly one in four men and one in ten women aged 30–60 years in the United States. Health consequences of OSA can include neuropsychiatric and cardiovascular sequela that disrupt professional, family, and social life and negatively impact HRQOL.

Methods: We conducted a comprehensive review of the literature on HRQOL and OSA, with special attention paid to instruments developed specifically for OSA.

Results: Generic instruments used to study HRQOL and OSA include: Medical Outcomes Study Short Form-36, Nottingham Health Profile, Sickness Impact Profile, Functional Limitations Profile, EuroQol, and Munich Life Quality Dimension List. Specific instruments include: Calgary Sleep Apnea Quality of Life Instrument, Functional Outcomes of Sleep Questionnaire, OSA Patient Oriented Severity Index, the OSA-18, and Cohen's pediatric OSA surgery quality of life questionnaire.

Conclusions: OSA patients have impaired HRQOL when compared with healthy age- and gender-matched controls. Treatment with continuous positive airway pressure appears to improve HRQOL. Other treatment modalities have not been rigorously studied. In addition, more data are needed from preference-based measures that allow conversion to utility scores, which can be used to calculate quality-adjusted life years and cost-effectiveness ratios.

Section snippets

Obstructive sleep apnea: assessment of effects

The breathing pattern that defines obstructive sleep apnea (OSA) affects nearly one in four men and one in ten women between the ages of 30 and 60 years in the United States; 4% of men and 2% of women have OSA with excessive daytime sleepiness, which is only one of several possible symptoms [1]. Other primary health consequences that may result from chronic sleep disruption or recurrent hypoxemia include neuropsychiatric and cardiovascular sequela. Neuropsychiatric effects may include

Introduction to health-related quality of life

According to Schipper and colleagues, “Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient” [19]. They proposed four primary domains for HRQOL measurement: physical and occupational function, psychological function, social interaction, and somatic sensation. Although HRQOL researchers have agreed to include certain specific domains in HRQOL assessment, no consensus has emerged over other

The process of measuring HRQOL

Prior to undertaking a study of HRQOL, researchers should answer the following questions. (1) What is the purpose of HRQOL assessment in this study? (2) What level of HRQOL is of interest? (3) Which instrument is most appropriate?

Instrument selection

The HRQOL instruments are grouped into two basic categories: generic and specific instruments. Generic instruments include single indicators (such as global assessments) and instruments designed for use among a variety of people with different types of illness. They also include health profiles and preference-based (utility) measures [23]. Specific instruments have been developed and validated to measure a narrow topic of interest, such as the effects of treatment on obstructive sleep apnea.

Methods

To review the literature on HRQOL and OSA, we used Ovid MEDLINE (National Library of Medicine, 1966–2000) and performed a systematic search of English-language journals and other electronic databases. We used major MeSH headings and text words ‘sleep’, ‘sleep apnea’, ‘obstructive sleep apnea’, and ‘quality of life’. In addition, we evaluated selected references cited in articles for pertinence and applicability, and we scanned recent sleep and otolaryngology journals to avoid omission of

Measuring HRQOL in patients with obstructive sleep apnea (Tables 2 and 3)

Researchers have used dozens of different instruments to measure HRQOL in patients with OSA. The generic instruments used include, but are not limited to: the Medical Outcome Survey Short Form-36 (SF-36), the Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), the Functional Limitations Profile (FLP), the EuroQol (EQ-5D), and the Munich Life Quality Dimension List (MLDL). The specific instruments include: the Calgary Sleep Apnea Quality of Life Instrument (SAQLI), The Functional

Medical Outcome Study Short Form-36 (SF-36)

One of the most frequently used generic instruments is the Medical Outcome Study's Short Form survey (SF-36, Table 2) [4], [7], [11], [13], [15], [16], [25], [32], [33], [34]. Ware recommends use of the SF-36 as a ‘generic core’ of HRQOL assessment to be augmented with specific instruments or specific questions that address the research hypothesis more directly. Researchers can then compare results across studies and measure HRQOL issues specific to the disease or population of interest.

Calgary Sleep Apnea Quality of Life Instrument (SAQLI)

The Calgary Sleep Apnea Quality of Life Instrument (SAQLI) (Table 2) [36], [43] is one of the few HRQOL instruments specifically geared toward patients with OSA. It has shown evidence of good internal consistency, face validity as judged by content experts and patients, and construct validity as shown by its positive correlations with the SF-36 among patients who underwent CPAP. It has also demonstrated responsiveness among patients successfully completing 4-week trials of CPAP [43].

Flemons and

Discussion

This review illustrates the variety of instruments used to study HRQOL and OSA. The choice of HRQOL instruments should be based on the purpose of the evaluation, the level of assessment to be performed, and instrument attributes and psychometric properties. For clinical purposes, instruments should be used in settings that resemble, as closely as possible, those for which data on validity and reliability have been published. In research, use of at least one OSA-specific instrument and one

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