Sleep Disorders

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse and represents a common disorder afflicting millions of people, with an estimated prevalence of moderate-to-severe OSA in the middle-aged population of 13% in men and 6% in women representing a 10% to 50% increase in prevalence during the past 15 to 20 years. Untreated OSA is associated with a host of medical, neurologic, and psychiatric problems. Positive airway pressure therapy is the first-line treatment for moderate-to-severe OSA and has been shown to improve health outcomes.

Change in Sleep-Related Symptoms in Patients With OSA

2018 – 2019

ESS = Epworth Sleepiness Scale, FSS = Fatigue Severity Scale, OSA = obstructive sleep apnea, PHQ-9 = Patient Health Questionnaire, PROMIS = Patient-Reported Outcomes Measurement Information System

Among 951 patients with OSA evaluated using the Epworth Sleepiness Scale (ESS)¹ during at least 2 visits in 2018–2019, 415 had a baseline score ≥ 10 indicating presence of significant daytime sleepiness. At follow-up, 61.2% showed improvement, 33% remained stable, and 5.8% worsened. Clinically meaningful change was defined as a total point change of 3, based on one-half the standard deviation.² Median duration of follow-up was 143 days (range, 23-741).

Among 916 patients with OSA evaluated using the Fatigue Severity Scale (FSS)³ during at least 2 visits in 2018–2019, 597 had a baseline score ≥ 36 indicating significant fatigue. At follow-up, 37.4% showed improvement, 53.9% remained stable, and 8.7% worsened. Clinically meaningful change was defined as a total point change of 7, based on one-half the standard deviation.² Median duration of follow-up was 129 days (range, 7-434).

Among 693 patients with OSA evaluated using the Patient Health Questionnaire (PHQ-9)⁴ during at least 2 visits in 2018–2019, 221 had a baseline score ≥ 10 indicating presence of depressive symptoms. At follow-up, 52.9% showed improvement, 44.8% remained stable, and 2.3% worsened. Clinically meaningful change was defined as a total point change of 5.⁵ Median duration of follow-up was 140 days (range, 22-684).

Among 599 patients with OSA evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS)⁶⁻⁷ during at least 2 visits in 2018–2019, 230 had a baseline Mental Health score ≤ 45 indicating impairment in mental health. At follow-up, 23% showed improvement, 71.7% remained stable, and 5.2% worsened. Clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation.² Median duration of follow-up was 155 days (range, 7-671).

Among 606 patients with OSA evaluated using PROMIS during at least 2 visits in 2018–2019, 296 had a baseline Physical Health score ≤ 45 indicating impairment in physical health. At follow-up, 30.1% showed improvement, 61.8% remained stable, and 8.1% worsened. Clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation.² Median duration of follow-up was 152 days (range, 7-694).

References
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  2. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003 May;41(5):582-592.
  3. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale; application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989 Oct;46(10):1121-1123.
  4. Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997 Oct;20(10):835-843.
  5. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care. 2004 Dec;42(12):1194-1201.
  6. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-613.
  7. Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009 Sep;18(7):873-880.