Sleep and Quality of Life in Sleep Apnea

Abstract

Health-related quality of life (HRQOL) is increasingly recognized as an important parameter in the assessment of the morbidity associated with obstructive sleep apnea (OSA). Generic and sleep disorder-specific instruments consistently demonstrate impairment in multiple domains of HRQOL in OSA, particularly in the domains of sleep, energy, fatigue, and vigilance. Sleep disorder-specific tools are potentially more sensitive than generic tools in describing HRQOL impairment in untreated OSA and treatment effects of continuous positive airway pressure (CPAP) and are increasingly being employed in clinical trials of OSA treatment. Severe OSA is generally associated with severe HRQOL impairment; however, studies do not consistently demonstrate a linear relationship between physiologic measures of OSA severity and measures of severity of HRQOL impairment. Excessive sleepiness, cognitive dysfunction, and psychological impairment are common measurable components of HRQOL impairment in OSA, particularly severe OSA, but the interactions among these and quality of life impairments measured by standard HRQOL instruments are not well studied. Therapeutic CPAP appears to broadly improve HRQOL domains in OSA, but substantial placebo effect has been demonstrated, suggesting that HRQOL impairment in OSA may be mediated by aspects of the disorder other than the physiologic effects of the OSA. Further randomized controlled trials should better elucidate the associations between physiologic impairment in OSA and HRQOL measures of interest to clinicians and researchers in this field.