ReviewQuality of life in obstructive sleep apnea: a systematic review of the literature
Section snippets
Obstructive sleep apnea: assessment of effects
The breathing pattern that defines obstructive sleep apnea (OSA) affects nearly one in four men and one in ten women between the ages of 30 and 60 years in the United States; 4% of men and 2% of women have OSA with excessive daytime sleepiness, which is only one of several possible symptoms [1]. Other primary health consequences that may result from chronic sleep disruption or recurrent hypoxemia include neuropsychiatric and cardiovascular sequela. Neuropsychiatric effects may include
Introduction to health-related quality of life
According to Schipper and colleagues, “Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient” [19]. They proposed four primary domains for HRQOL measurement: physical and occupational function, psychological function, social interaction, and somatic sensation. Although HRQOL researchers have agreed to include certain specific domains in HRQOL assessment, no consensus has emerged over other
The process of measuring HRQOL
Prior to undertaking a study of HRQOL, researchers should answer the following questions. (1) What is the purpose of HRQOL assessment in this study? (2) What level of HRQOL is of interest? (3) Which instrument is most appropriate?
Instrument selection
The HRQOL instruments are grouped into two basic categories: generic and specific instruments. Generic instruments include single indicators (such as global assessments) and instruments designed for use among a variety of people with different types of illness. They also include health profiles and preference-based (utility) measures [23]. Specific instruments have been developed and validated to measure a narrow topic of interest, such as the effects of treatment on obstructive sleep apnea.
Methods
To review the literature on HRQOL and OSA, we used Ovid MEDLINE (National Library of Medicine, 1966–2000) and performed a systematic search of English-language journals and other electronic databases. We used major MeSH headings and text words ‘sleep’, ‘sleep apnea’, ‘obstructive sleep apnea’, and ‘quality of life’. In addition, we evaluated selected references cited in articles for pertinence and applicability, and we scanned recent sleep and otolaryngology journals to avoid omission of
Measuring HRQOL in patients with obstructive sleep apnea (Tables 2 and 3)
Researchers have used dozens of different instruments to measure HRQOL in patients with OSA. The generic instruments used include, but are not limited to: the Medical Outcome Survey Short Form-36 (SF-36), the Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), the Functional Limitations Profile (FLP), the EuroQol (EQ-5D), and the Munich Life Quality Dimension List (MLDL). The specific instruments include: the Calgary Sleep Apnea Quality of Life Instrument (SAQLI), The Functional
Medical Outcome Study Short Form-36 (SF-36)
One of the most frequently used generic instruments is the Medical Outcome Study's Short Form survey (SF-36, Table 2) [4], [7], [11], [13], [15], [16], [25], [32], [33], [34]. Ware recommends use of the SF-36 as a ‘generic core’ of HRQOL assessment to be augmented with specific instruments or specific questions that address the research hypothesis more directly. Researchers can then compare results across studies and measure HRQOL issues specific to the disease or population of interest.
Calgary Sleep Apnea Quality of Life Instrument (SAQLI)
The Calgary Sleep Apnea Quality of Life Instrument (SAQLI) (Table 2) [36], [43] is one of the few HRQOL instruments specifically geared toward patients with OSA. It has shown evidence of good internal consistency, face validity as judged by content experts and patients, and construct validity as shown by its positive correlations with the SF-36 among patients who underwent CPAP. It has also demonstrated responsiveness among patients successfully completing 4-week trials of CPAP [43].
Flemons and
Discussion
This review illustrates the variety of instruments used to study HRQOL and OSA. The choice of HRQOL instruments should be based on the purpose of the evaluation, the level of assessment to be performed, and instrument attributes and psychometric properties. For clinical purposes, instruments should be used in settings that resemble, as closely as possible, those for which data on validity and reliability have been published. In research, use of at least one OSA-specific instrument and one
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