Abstract
BackgroundIn those with symptoms indicative of obstructive sleep apnea (OSA), respiratory-specific health-related quality of life (HRQL) may be an important patient-centered outcome. The aim of this study was to assess the associations between sleepiness, fatigue, and impaired general and respiratory-specific HRQL among persons with suspected OSA.MethodsWe evaluated military veterans consecutively referred for suspected OSA with sleep studies yielding apnea-hypopnea index (AHI) values. They also completed the sleepiness (Epworth Sleepiness Scale [ESS]), and fatigue (Fatigue Severity Scale [FSS]) questionnaires, as well as two HRQL instruments (the generic Short-Form SF-12v2 yielding the Physical Component Scale [PCS] and the respiratory-specific Airways Questionnaire [AQ]-20R). Multiple linear regression tested the associations between ESS and FSS (standardized as Z scores for scaling comparability) with AQ-20R, accounting for AHI, SF-12v2-PCS and comorbid respiratory conditions other than OSA.ResultsWe studied 1578 veterans (median age 61.1 [IQR 16.8] years; 93.9% males). Of these, 823 (52%) met AHI criteria for moderate to severe OSA (AHI ≥15/h). The majority reported excessive daytime sleepiness (53%; median ESS 11 [IQR 9]) or fatigue (61%; median FSS 42 [IQR 23]). The median AQ-20R was 4 [IQR 1–8]. Controlling for AHI, SF-12v2-PCS, respiratory co-morbid conditions, body mass index, and demographics, both ESS and FSS were significantly associated with poorer AQ-20R: for each; ESS, 1.6 points (95% CI 1.4–1.9), and for FSS, 2.5 points (95% CI, 2.3–2.7).ConclusionsGreater daytime sleepiness and fatigue are associated with poorer respiratory-specific HRQL, over and above the effects of OSA, respiratory comorbidity, and generic physical HRQL.
Highlights
In those with symptoms indicative of obstructive sleep apnea (OSA), respiratory-specific health-related quality of life (HRQL) may be an important patient-centered outcome
Study subjects Study participants were referred for OSA assessment based on their symptoms according to routine clinical practice and the potential subject pool comprised all veterans referred to the Veterans Affairs (VA) Palo Alto Healthcare System’s Pulmonary-Sleep Section for evaluation of complaints of either disrupted sleep or snoring who completed formal sleep study testing
We further explored the associations of Epworth Sleepiness Scale (ESS) and Fatigue Severity Scale (FSS) with respiratory-specific HRQL, taking into account generic HRQL (SF-12v2 Physical Component Score (PCS)), OSA severity, comorbid chronic lung conditions, and the covariates included in the previous multivariate analyses (Table 3)
Summary
In those with symptoms indicative of obstructive sleep apnea (OSA), respiratory-specific health-related quality of life (HRQL) may be an important patient-centered outcome. The aim of this study was to assess the associations between sleepiness, fatigue, and impaired general and respiratory-specific HRQL among persons with suspected OSA. Health-related quality of life (HRQL) is a critical patientcentered outcome measuring generic or disease-specific health status. Disease-specific HRQL is relevant to chronic health conditions whose effects are manifested through discrete subjective symptoms and limitations. Respiratory disorders such as chronic obstructive pulmonary disease (COPD), independent of OSA, are associated with poor subjective and objective sleep quality [13, 14], sleepiness [2] and decreased general and respiratory specific HRQL [15]. Sleep disturbance is a major determinant of Vinnikov et al Health and Quality of Life Outcomes (2017) 15:48
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