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Visual analogical well-being scale for sleep apnea patients: validity and responsiveness

A test for clinical practice

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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.

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Fig. 1

References

  1. 1.

    Young T, Palta M, Dempsey J (1993) The occurrence of sleep-disordered breathing among middle aged adults. N Engl J Med 328:1230–1235

  2. 2.

    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

  3. 3.

    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

  4. 4.

    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

  5. 5.

    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

  6. 6.

    Masa JF, Rubio M, Pérez P (2006) Association between habitual naps and sleep apnea. Sleep 11:1463–1468

  7. 7.

    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

  8. 8.

    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

  9. 9.

    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

  10. 10.

    Chakravorty I, Cayton RM, Szczepura A (2002) Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome. Eur Respir J 20:1233–1238

  11. 11.

    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

  12. 12.

    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

  13. 13.

    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545

  14. 14.

    Lacasse Y, Godbout C, Series F (2002) Health-related quality of life in obstructive sleep apnea. Eur Respir J 19:499–503

  15. 15.

    EuroQol Group (1990) EuroQol—a new facility for measurement of health-related quality of life. Health Policy 16:199–208

  16. 16.

    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

  17. 17.

    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

  18. 18.

    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

  19. 19.

    Guyatt GH, Feeny DH, Patrick DL (1993) Measuring health-related quality of life. Ann Intern Med 118:622–629

  20. 20.

    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

  21. 21.

    Lacasse Y, Godbout C, Series F (2002) Independent validation of the sleep apnoea quality of life index. Thorax 57:483–488

  22. 22.

    Weaver TE, Laizner AM, Evans LK (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843

  23. 23.

    Piccirillo JF, Gates GA, White DL (1998) Obstructive sleep apnea treatment outcomes pilot study. Otolaryngol Head Neck Surg 102:1855–1864

  24. 24.

    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

  25. 25.

    Barbé F, Amilibia J, Capote F (1995) Diagnóstico del Síndrome de Apneas Obstructivas Durante el Sueño. Arch Bronconeumol 31:460–462

  26. 26.

    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

  27. 27.

    American Sleeep Disorders Association (1992) EEG arousals: scoring rules and examples. Sleep 15:174–183

  28. 28.

    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

  29. 29.

    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

  30. 30.

    Diagnostic classification steering committee (1990) International classification of sleep disorders: diagnostic and coding manual. American Sleep Disorders Association, Rochester

  31. 31.

    American Thoracic Society (1987) Standardization of spirometry, 1987 update. Am Rev Respir Dis 136:1285–1298

  32. 32.

    Kramer MS, Fenstein AR (1981) Clinical biostatistics. LIV. The biostatistics of concordance. Clin Pharmacol Ther 29:111–123

  33. 33.

    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

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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.

Author information

Correspondence to Juan F. Masa.

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?

figurea

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.

Table 7 Clinical, anthropometric and polysomnographic characteristics of patients from “original” and additional studies

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Masa, J.F., Jiménez, A., Durán, J. 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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Keywords

  • CPAP treatment
  • Sleep apnea syndrome
  • Quality of life