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 (PAP) therapy is the first-line treatment for moderate-to-severe OSA and has been shown to improve health outcomes.

Treatment of Obstructive Sleep Apnea with CPAP and Patient-Reported Outcomes

2019 – 2020

Sleep Disorders — CPAP

CPAP = continuous positive airway pressure, ESS = Epworth Sleepiness Scale, OSA = obstructive sleep apnea, PHQ-9 = Patient Health Questionnaire, PROMIS = Patient-Reported Outcomes Measurement Information System

Legend: For ESS, median duration of follow-up was 182 days (range, 4-527), and clinically meaningful change was defined as a total point change of 3, based on one-half the standard deviation. For PHQ-9, median duration of follow-up was 224 days (range, 5-547), and clinically meaningful change was defined as a total point change of 5. For PROMIS-10 Mental Health, median duration of follow-up was 273 days (range, 1-630), and clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation. For PROMIS-10 Physical Health, median duration of follow-up was 273 days (range, 1-630), and clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation. For Sleep Time, median duration of follow-up was 280 days (range, 1-651), and clinically meaningful change was defined as a 1 hour change, based on one-half the standard deviation. For PROMIS-10 Sleep Disturbance, median duration of follow-up was 201 days (range, 1-539), and clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation.

631 OSA patients treated with PAP had at least 2 visits from 2019–2020 with ESS data available for analysis. Among those patients whose baseline ESS score ≥ 10 (N = 197), 39.6% (N = 78) showed improvement, 51.8% (N = 102) remained stable, and 8.6% (N = 17) worsened.¹⁻²

1016 OSA patients treated with PAP had at least 2 visits from 2019–2020 with PHQ-9 data available for analysis. Among those patients whose baseline PHQ-9 score ≥ 10 (N = 290), 38.3% (N = 111) showed improvement, 55.2% (N = 160) remained stable, and 6.6% (N = 19) worsened.³⁻⁴

1309 OSA patients treated with PAP had at least 2 visits from 2019–2020 with PROMIS Mental Health data available for analysis. Among those patients whose baseline PROMIS Mental Health score ≤ 45 (N = 542), 24.2% (N = 131) showed improvement, 67.5% (N = 366) remained stable, and 8.3% (N = 45) worsened.⁵

1319 OSA patients treated with PAP had at least 2 visits from 2019–2020 with PROMIS Physical Health data available for analysis. Among those patients whose baseline PROMIS Physical Health score ≤ 45 (N = 716), 26.8% (N = 192) showed improvement, 60.5% (N = 433) remained stable, and 12.7% (N = 91) worsened.⁵

421 OSA patients treated with PAP had at least 2 visits from 2019–2020 with Sleep Time data available for analysis. Among those patients whose baseline Sleep Time ≤ 24 hours (N = 421), 29.7% (N = 125) showed improvement, 46.3% (N = 195) remained stable, and 24% (N = 101) worsened.

860 OSA patients treated with PAP had at least 2 visits from 2019–2020 with PROMIS Sleep Disturbance data available for analysis. Among those patients whose baseline PROMIS Sleep Disturbance score ≥ 55 (N = 342), 39.5% (N = 135) showed improvement, 49.1% (N = 168) remained stable, and 11.4% (N = 39) worsened.

References
  1. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991 Dec;14(6):540-545.
  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. 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.
  4. 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.
  5. 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.