Impact of Sleep-Disordered Breathing Treatment on Quality of Life Measures in a Large Clinic-Based Cohort

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 sleepdisordered 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. Keywords: age, quality of life, sleep-disordered breathing, socioeconomic status Citation: 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.

Breathing Synchronised Hypoglossal Nerve Stimulation with Inspire for Untreated Severe Obstructive Sleep Apnoea/Hypopnoea Syndrome: A Simulated Cost-Utility Analysis from a National Health Service Perspective

“…Finally, the expected lifetime QALYs are largely dependent on the choice of utility value used for the OSAHS health states. In our base-case, due to a lack of directly elicited utility values from HNS clinical trials, we have used a utility score based on the pre-CPAP and post-CPAP EQ-5D score of US OSAHS patients adherent to CPAP therapy [44]; however, it is not certain that this population is fully representative of the potential utility improvements that might be made with HNS therapy. The study population had relatively low (< 10) ESS scores at baseline, therefore it is conceivable that more symptomatic patients would experience greater improvement.…”

“…Outcomes are reported in QALYs to capture improved morbidity and mortality associated with effective treatment of OSAHS; we calculated these using published utility estimates (Table 3). Utility values for mild and severe OSAHS were sourced from a US study [44] examining QoL in a clinical sleep disordered breathing (SDB) population assessed using the European Quality of Life-5D (EQ-5D) scale before and after CPAP treatment retrospectively; an assumption is made that treatment with CPAP delivers a utility benefit similar to that expected in a patient who experiences disease improvement from severe to mild. A difference in utility of 0.05 (pre-treatment score 0.765, post-treatment score 0.815) was reported among adherent patients, when patients who reported a QoL measure of 1 before starting CPAP were removed.…”

Beyond heart health: Consequences of obstructive sleep apnea

“…A study of 2,027 patients with OSA evaluated therapy adherence relative to mean Functional Outcomes of Sleep Questionnaire and European Quality of Life-5D scores. 4 In patients with the most impaired quality of life, those adherent to positive airway pressure (PAP) therapy had improved quality of life as measured by these scores.…”

The Effect of Sleeping Environment and Sleeping Location Change on Positive Airway Pressure Adherence

“…2 Currently, the most effective form of therapy for OSA is positive airway pressure (PAP), which has been shown to improve quality of life, reduce daytime sleepiness, and may reduce cardiovascular disease risk among adherent users. [3][4][5][6][7] However, poor patient adherence undermines the efficacy of symptomatic relief and numerous health benefits of PAP. 8 The determinants of PAP acceptance and adherence are certainly multifactorial, and dozens of individual contributing factors…”