Abstract
Introduction
Health-related quality-of-life (HRQL) tests used in sleep apnea–hypopnea syndrome (SAHS) are time-consuming, complicating their application in clinical practice. The objective was to examine the validity and responsiveness of a simple visual analogical well-being scale (VAWS) for the clinical use.
Method
The subjects proceed from a cohort of SAHS patients treated with CPAP for 12 weeks. We correlated the VAWS with other HRQL tests, related clinical and polysomnographic measures to concurrent and construct validities. Responsiveness by: (1) comparison of HRQL tests between before and after treatment and effect size. (2) Association of the change with treatment between VAWS with other HRQL tests and between VAWS with clinical parameters.
Results
At baseline, VAWS correlated with all HRQL tests but better with functional outcomes in sleep questionnaires (FOSQ) and European quality-of-life questionnaire (EuroQol) thermometer. VAWS and FOSQ correlated better with clinical variables than other HRQL tests. VAWS captures the magnitude change with treatment similarly to FOSQ but better than other HRQL tests.
Conclusion
VAWS is a very simple test which measures HRQL in SAHS. It could be a useful tool in clinical practice, primarily for the responsiveness of treatment.
References
Young T, Palta M, Dempsey J (1993) The occurrence of sleep-disordered breathing among middle aged adults. N Engl J Med 328:1230–1235
Masa JF, Rubio M, Findley LJ, Cooperative Group (2000) Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Respir Crit Care Med 162:1407–1412
Terán J, Jiménez A, Cordero J (1999) The association between sleep apnea and the risk of traffic accidents. N Engl J Med 340:847–851
Peppard PE, Young T, Palta M (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384
Parra O, Arboix A, Bechich S (2000) Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 161(2):375–380
Masa JF, Rubio M, Pérez P (2006) Association between habitual naps and sleep apnea. Sleep 11:1463–1468
Marin JM, Carrizo SJ, Vivente E (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053
Ballester E, Badia JR, Hernández L (1999) Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Resp Crit Care Med 159:495–501
Masa JF, Jiménez A, Durán J, the Cooperative Group (2004) Alternative methods of titrating continuous positive airway pressure. Am J Respir Crit Care Med 170:1218–1224
Chakravorty I, Cayton RM, Szczepura A (2002) Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome. Eur Respir J 20:1233–1238
Jenkinson C, Davies RJO, Mullins R (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 353:2100–2105
Engleman HM, Kingshott RN, Wraith PK (1999) Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:461–467
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545
Lacasse Y, Godbout C, Series F (2002) Health-related quality of life in obstructive sleep apnea. Eur Respir J 19:499–503
EuroQol Group (1990) EuroQol—a new facility for measurement of health-related quality of life. Health Policy 16:199–208
Sanner BM, Klewer J, Trumm A (2000) Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome. Eur Respir J 16:118–122
Jenkinson C, Stradling J, Peterasen S (1998) How should we evaluate health status? A comparison of three methods in patients presenting with obstructive sleep apnoea. Qual Life Res 7:95–100
Schmidlin M, Fritsch K, Matthews F, Thurnheer R, Senn O, Bloch KE (2010) Utility indices in patients with the obstructive sleep apnea syndrome. Respiration 79(3):200–8, Epub May 27
Guyatt GH, Feeny DH, Patrick DL (1993) Measuring health-related quality of life. Ann Intern Med 118:622–629
Mara J, Rivero-Arias O, Durán-Cantolla J, Alonso-Álvarez ML, Gaminde I, De la Torre MG (2005) Efecto del tratamiento con presión positiva continua en la vía respiratoria durante la noche en la calidad de vida de los pacientes con apnea del sueño. Med Clin (Barc) 125(16):611–615
Lacasse Y, Godbout C, Series F (2002) Independent validation of the sleep apnoea quality of life index. Thorax 57:483–488
Weaver TE, Laizner AM, Evans LK (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843
Piccirillo JF, Gates GA, White DL (1998) Obstructive sleep apnea treatment outcomes pilot study. Otolaryngol Head Neck Surg 102:1855–1864
Lacasse Y, Bureau MP, Series F (2004) A new standardised and self-administered quality of life questionnaire specific to obstructive sleep apnoea. Thorax 59:494–499
Barbé F, Amilibia J, Capote F (1995) Diagnóstico del Síndrome de Apneas Obstructivas Durante el Sueño. Arch Bronconeumol 31:460–462
Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology and scoring system for sleep stages of human subjects. Brain Information Service/Brain Research Institute, University of California at Los Angeles
American Sleeep Disorders Association (1992) EEG arousals: scoring rules and examples. Sleep 15:174–183
Ware J, Sherbourne C (1992) The Mos 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
Liang MH, Larson MG, Cullen KE (1985) Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research. Arthitis Rheum 28:542–547
Diagnostic classification steering committee (1990) International classification of sleep disorders: diagnostic and coding manual. American Sleep Disorders Association, Rochester
American Thoracic Society (1987) Standardization of spirometry, 1987 update. Am Rev Respir Dis 136:1285–1298
Kramer MS, Fenstein AR (1981) Clinical biostatistics. LIV. The biostatistics of concordance. Clin Pharmacol Ther 29:111–123
Ferrer M, Vilagut G, Monasterio C (1999) Measurement of the perceived impact of sleep problems: the Spanish version of the functional outcomes sleep questionnaire and the Epworth Sleepiness Scale. Med Clin (Barc) 113(7):250–255
Acknowledgments
We are indebted to Verónica Rodríguez and Vanessa Iglesias for assistance in the translation of the manuscript and Asunción Martín and Carmen Lorenzana for technical assistance.
Conflict of interest statement
No authors have any conflicts of interest.
Supported by
ISCIII-RTIC-03-11, JUNTAEX-IPR00A064 and SEPAR.
There was no influence from promoters about design, data collection, analysis, results, paper writing, and journal choice for publication of the study.
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Appendices
Annex 1
Visual analogical well-being scale
The patient must choose one point on the line that corresponds to his or her health-related quality of life regarding the symptoms for the consultation; in this case suspected of sleep apnea–hypopnea syndrome.
Question
If the line below expresses the most favorable (on the right) and the least favorable (on the left) well-being status with respect to the symptoms which are motive of the consultation, the question to be answered is the following: whereabouts on this line do you think you are?
Annex 2
Reliability is an important measurement in health-related quality-of-life tests. In the “original” study this analysis was not performed.
As a consequence, at the end of the study the same sleep centers collected 81 new patients subsidiary of CPAP treatment after complete polysomnography with the same inclusion and exclusion criteria and protocol than in the previous study. At the inclusion time and 3 weeks later (previous to CPAP treatment) a visual analogical well-being scale (VAWS) was carried out.
Statistically, we firstly compared the new sample (81 patients) with the previous (315 patients) on clinical, anthropometric and polysomnographic variables using t test (normal distribution) or Mann–Whitney (non-normal distribution) for continuous and χ 2 for qualitative variables. Secondly, we analyzed the test–retest reliability between VAWS measurements by intraclass correlation coefficient (ICC).
The two samples (original and additional) were similar because only statistical differences between them were observed in non relevant variables such as alcohol intake, active smoker and FEV1 (Table 1). Good ICC (0.83) was detected between inclusion time and 3-weeks-later measurements of VAWS.
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Spanish Group of Breathing Sleep Disorders., Masa, J.F., Jiménez, A. et al. Visual analogical well-being scale for sleep apnea patients: validity and responsiveness. Sleep Breath 15, 549–559 (2011). https://doi.org/10.1007/s11325-010-0399-3
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DOI: https://doi.org/10.1007/s11325-010-0399-3