Quality of Life Research

, Volume 11, Issue 4, pp 389–399 | Cite as

Identification of quality of life concerns of patients with obstructive sleep apnoea at the time of initiation of continuous positive airway pressure: A discourse analysis

  • D. VealeEmail author
  • G. Poussin
  • F. Benes
  • J.-L. Pepin
  • P. Levy


Background: Obstructive sleep apnoea syndrome (OSAS) is a common condition with multiple symptoms dominated by daytime somnolence. Thus many worries and concerns of patients remain hidden. Treatment by nasal continuous positive airway pressure (CPAP) can be imposing for the individual. An analysis of the freely expressed concerns of such patients is required. Objective: To seek an in-depth analysis of how patients live with sleep apnoea by allowing them an open discourse and analysing the text of their statements. Design: A trained psychologist conducted semi-directive interviews with patients attending a pulmonary rehabilitation and convalescent unit around the themes of sleep, health and treatment. An analysis of content and of discourse was carried out by textual analysis and by propositional analysis of discourse (PAD) with the aid of dedicated computer programs (Tropes, Sphinx Lexica). Results: Thirty patients with severe sleep apnoea were interviewed of whom 15 were initiating treatment with CPAP. Patients spoke of abnormal fatigue (22 mentions) and somnolence (21 times). Many have problems with obesity (25 instances), snoring related problems (12). There were 30 mentions of depression with a relationship to alcohol and anti-depressives. Twenty six times the theme of nocturnal waking was raised. There were many instances of problems with CPAP (nasal mask and noise problems raised 21 times). Patients have problems with relationships and sex because of OSAS. Other concerns were loss of memory and fear of dying. Conclusion: In a non-directed conversation OSAS patients express concerns not revealed in the standard medical paradigm and such concerns should be addressed in assessing treatment or evaluating quality of life (QOL).

Interview Symptoms Sleep apnoea syndrome 


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  1. 1.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. Occurrence of sleep disordered breathing among middleaged adults. N Eng J Med 1993; 328: 1230–1235.Google Scholar
  2. 2.
    Whyte KF, Allen MB, Jeffrey AA, Gould GA, Douglas NJ. Clinical features of the sleep apnoea/hypopnoea syndrome. Q J Med 1989; 72: 659–666.Google Scholar
  3. 3.
    Reynolds CF, Kupfer DJ, McEachran AB, Taska LS, Sewitch DE, Coble PA. Depressive psychopathology in male sleep apnoea. J Clin Psychiat 1984; 45: 287–290.Google Scholar
  4. 4.
    Jenkinson C, Stradling J, Petersen S. Comparison of three measures of quality of life outcome in the evaluation of continuous positive airways pressure therapy for sleep apnoea. J Sleep Res 1997; 6: 199–204.Google Scholar
  5. 5.
    Sullivan CE, Berthon-Jones M, Issa FG, et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; i: 862–865.Google Scholar
  6. 6.
    Meslier N, Lebrun T, Grillier-Lanoir V, et al. A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: Benefits, tolerance, compliance and quality of life. Eur Respir J 1998; 12: 185–192.Google Scholar
  7. 7.
    Pepin JL, Leger P, Veale D, Langevin B, Robert D, Levy P. Side effects of nasal continuous positive airway pressure in sleep apnoea syndrome (study of 193 patients in two French sleep centres). Chest 1995; 107: 375–381.Google Scholar
  8. 8.
    Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomised prospective parallel trial. Lancet 1999; 353: 9170, 2100–2105.Google Scholar
  9. 9.
    Flemons W, Reimer MA. Development of a disease specific health related quality of life questionnaire for sleep apnoea. Am Jour Respir and Crit Care Med 1998; 158: 494–503.Google Scholar
  10. 10.
    Ghiglione R, Matalon B, Bacri N. Les dires analysés: l'analyse propositionelle de discourse Paris PUV.Google Scholar
  11. 11.
    Ghiglione R, Blanchet A. Analyse du contenu et contenus d'analyse, Paris, Dunod, 1991.Google Scholar
  12. 12.
    Ghiglione R, Kekenbosch C, Lender A. L'analyse cognitivo-discursive, Grenoble, P.U.F., 1991.Google Scholar
  13. 13.
    Ghiglione R, Landré A, Bromberg M, Molette P. L'analyse automatique des contenus, Paris, Dunod, 1998.Google Scholar
  14. 14.
    Bardin L. L'analyse de Contenu, PUF, Paris, 1989.Google Scholar
  15. 15.
    Poussin G, Bourrouillou N. Evaluation by different methods of discourse analysis of the effect of divorce on a child. Neuropsychiat Enfan 1997; 45: 139–147.Google Scholar
  16. 16.
    Chahraoui K, Besche C, Lacassagne MF. Alexithymie et traumatisme psychique-analyse du récit chez des sujets souffrant d'état de stress post-traumatique: une étude exploratoire. L'Encéphale 2001; 27: 15–21.Google Scholar
  17. 17.
    Jakobi ML, Masse L. Le regard dans le discours politique. Psychol Française. 1999; 44: 343–348.Google Scholar
  18. 18.
    Masse L, Blanchet A, Poitrenaud S. Construction des univers référentiles en psychothérapie. Psychol Française 1999; 44: 349–360.Google Scholar
  19. 19.
    Poussin G, Blatier C, Le Quang C, Monti R. Réponses à une questionnaire et discours du patient: Quelle distance? Psychol Française 1996; 41(4): 375–382.Google Scholar
  20. 20.
    Hunt SM, McEwen J, McKenna SP. Perceived health, age and sex comparisons in a community. J Epidemiol Commun Health 1984; 38: 156–160.Google Scholar
  21. 21.
    Nolen-Hoeksema S. Sex Differences in Depression. Stanford: Standford University Press, 1990.Google Scholar
  22. 22.
    Lupton D. Discourse analysis: A new methodology for understanding the ideologies of health and illness. Aust-J Public-Health 1992; 16(2): 145–150.Google Scholar
  23. 23.
    Engleman HM, Martin SE, Douglas NJ. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax 1994; 49: 263–266.Google Scholar
  24. 24.
    Elwyn G, Gwyn R. Narrative based medecine. Stories we hear and stories we tell: Analysing talk in clinical practice. Br Med J 1999; 318: 186–188.Google Scholar
  25. 25.
    Atkinson JM, Heritage J (eds). Structures of Social Action: Studies in Conversation Analysis. Cambridge, UK: Cambridge University Press, 1984.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • D. Veale
    • 1
    Email author
  • G. Poussin
    • 1
  • F. Benes
    • 1
  • J.-L. Pepin
    • 1
  • P. Levy
    • 1
  1. 1.Sleep LaboratoryCHU Grenoble, Centre PneumologiqueHenri BazireFrance

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