Health Preference Measures in Patients with Obstructive Sleep Apnea Syndrome Undergoing Continuous Positive Airway Pressure Therapy: Data from a Randomized Trial

Abstract

<b><i>Background:</i></b> In patients with obstructive sleep apnea syndrome (OSAS), the preference-based, health-related quality of life in terms of utility has not been extensively studied. <b><i>Objective:</i></b> To address this point, we compared the performance of different instruments assessing utility in patients with OSAS undergoing continuous positive airway pressure (CPAP) therapy. <b><i>Materials and Methods:</i></b> Data of 208 patients with OSAS (28 women, mean ± SE age 54.4 ± 0.7 years, apnea-hypopnea index (AHI) 51.9 ± 1.8/h, Epworth sleepiness score 13.4 ± 0.2) participating in a randomized trial of different CPAP modalities over 2 years were analyzed. Evaluations included sleep studies, Epworth sleepiness scale, and several utility instruments that measure subjective health preference on a scale ranging from 1 (most preferred and perfect health) to 0 (least preferred and very poor health). <b><i>Results:</i></b> After 2 years of CPAP therapy, the mean ± SE AHI was 6.7 ± 1.5/h and Epworth score 7.9 ± 0.4, both <i>p</i> < 0.001 versus baseline. Baseline utilities and changes (95% confidence interval) after 2 years of CPAP therapy were EuroQol 5-dimensions 0.79 ± 0.01, 0.02 (0.00–0.05, <i>p</i> = 0.064); short-form 6-dimension medical outcome questionnaire 0.72 ± 0.01, 0.06 (0.04–0.08, <i>p</i> < 0.001); Euro-thermometer visual analog scale 0.70 ± 0.01, 0.09 (0.07–0.12, <i>p</i> < 0.001); time trade-off 0.82 ± 0.01, 0.03 (0.01–0.06, <i>p</i> = 0.002); and standard gamble 0.82 ± 0.01, −0.01 (−0.03 to 0.02, <i>p</i> = 0.712). <b><i>Conclusion:</i></b> The short-form 6-dimensions questionnaire, the Euro-thermometer, and the time trade-off instruments reflected the major clinical improvements in OSAS, while the EuroQoL 5-dimensions and standard gamble tests were not sensitive to CPAP effects. These results indicate that the evaluation of utility of a treatment for OSAS depends critically on the instrument used, which is important from an individual and societal perspective.

Dynamics of Circulating CD14/CD16 Monocyte Subsets in Obstructive Sleep Apnea Syndrome Patients upon Hypoglossal Nerve Stimulation

“…Today’s standard treatment for OSAS is noninvasive continuous positive airway pressure (CPAP), which secures respiratory support. Usage time of 4 h per night is considered sufficient for successful therapy in terms of daytime sleepiness and the risk for cardiovascular disease [ 3 , 4 , 5 , 6 ]. Hypoglossal nerve stimulation (HNS) in patients with OSA and CPAP failure has been applied since the 1990s, mainly the STAR trial of 2014 [ 7 ] led to the increased clinical application and intensive scientific interest [ 8 ].…”

An empirical comparison of sleep-specific versus generic quality of life instruments among Australians with sleep disorders

“…Further, expanding the comparisons to include other generic and/or sleep-specific instruments should be considered because they may be more applicable in the assessment of sleep health interventions. For example the newly-developed SF-6Dv2 [65] has shown comparative validity to the EQ-5D-5L [66] but is more sensitive to clinical improvements in OSA patients [67], and a recently derived value set enables the calculation of QALYs for health technology assessment [68]. Other jurisdictions should extrapolate our results cautiously given they are based on a nationally representative sample of Australians who self-reported having a sleep disorder.…”

Use of the visual analogue scale for health state valuation: a scoping review

“…The VAS and SG were reported to have similar difficulty levels in usage [ 47 ]. Both measures were seen as insensitive to improvements in patients with breathing-related symptoms [ 42 ].…”