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

2020 – 2021

Sleep Disorders — CPAP

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

306 OSA patients treated with PAP had at least 2 visits from 2020–2021 with ESS data available for analysis. Among those patients whose baseline ESS score ≥ 10 (N = 83), 45.8% (N = 38) showed improvement, 43.4% (N = 36) remained stable, and 10.8% (N = 9) worsened. Median duration of follow-up was 141 days (range, 12-583). Clinically meaningful change was defined as a total point change of 3, based on one-half the standard deviation.¹

477 OSA patients treated with PAP had at least 2 visits from 2020–2021 with PHQ-9 data available for analysis. Among those patients whose baseline PHQ-9 score ≥ 10 (N = 125), 34.4% (N = 43) showed improvement, 54.4% (N = 68) remained stable, and 11.2% (N = 14) worsened. Median duration of follow-up was 190 days (range, 30-675). Clinically meaningful change was defined as a total point change of 5.²

586 OSA patients treated with PAP had at least 2 visits from 2020–2021 with PROMIS Mental Health data available for analysis. Among those patients whose baseline PROMIS Mental Health score ≤ 45 (N = 270), 27.8% (N = 75) showed improvement, 64.4% (N = 174) remained stable, and 7.8% (N = 21) worsened. Median duration of follow-up was 262 days (range, 1-681). Clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation.¹

589 OSA patients treated with PAP had at least 2 visits from 2020–2021 with PROMIS Physical Health data available for analysis. Among those patients whose baseline PROMIS Physical Health score ≤ 45 (N = 308), 24.4% (N = 75) showed improvement, 60.7% (N = 187) remained stable, and 14.9% (N = 46) worsened. Median duration of follow-up was 280 days (range, 1-720). Clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation.¹

205 OSA patients treated with PAP had at least 2 visits from 2020–2021 with Sleep Time data available for analysis. Among those patients whose baseline Sleep Time ≤ 24 hours (N = 205), 33.2% (N = 68) showed improvement, 37.6% (N = 77) remained stable, and 29.3% (N = 60) worsened. Median duration of follow-up was 270 days (range, 1-614). Clinically meaningful change was defined as a 1 hour change, based on one-half the standard deviation.¹

382 OSA patients treated with PAP had at least 2 visits from 2020–2021 with PROMIS Sleep Disturbance data available for analysis. Among those patients whose baseline PROMIS Sleep Disturbance score ≥ 55 (N = 156), 48.1% (N = 75) showed improvement, 44.2% (N = 69) remained stable, and 7.7% (N = 12) worsened. Median duration of follow-up was 143 days (range, 1-675). Clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation.¹

References
  1. 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.
  2. 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.