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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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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.


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.


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.


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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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


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.


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.


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.

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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  • CPAP treatment
  • Sleep apnea syndrome
  • Quality of life