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Sleep Disordered Breathing

Sleep disordered breathing (SDB) refers to a wide spectrum of sleep-related conditions including increased resistance to airflow through the upper airway, heavy snoring, marked reduction in airflow (hypopnea), and complete cessation of breathing (apnea). Increased resistance to airflow without frank apnea has been referred to as upper airway resistance syndrome; apneas and hypopneas are classified as central, obstructive, or mixed; Patients with sleep disordered breathing can experience daytime symptoms, such as sleepiness or excessive somnolence, depressed mood, irritability, and cognitive dysfunction, that can adversely effect health-related quality of life. The sequelae of SDB result both from apnea-associated oxygen desaturation and from sleep disturbance. Ultimately, this condition can lead to any number of medical problems, including increased automobile accidents, hypertension, cognitive impairment, impotence, and early death.

A variety of treatment options are available for patients with sleep disordered breathing. Interventions for obstructive sleep apnea, for example, include behavioral intervention, diet and exercise programs, medications, jaw repositioning or tongue retraining, continuous positive airway pressure (CPAP), or surgical procedures for removing or circumventing obstruction.

Several instruments, including generic and condition-specific quality of life measures, have been used to evaluate the impact of the condition and the outcomes of treatment in sleep-disordered breathing.

Generic Health-Related Quality of Life Instruments Used in Sleep Disordered Breathing

  • Chakravorty I, Cayton R, Szczepura A. Health utilities in evaluating intervention in the sleep apnoa/hypopnoa syndrome. Euro Respir J. 2002; 20:1233-1238.

Nottingham Health Profile

  • Ballester E, Badia JR, Hernandez L, Carrasco E, de Pablo J, Fornas C, Rodriguez-Roisin R, Montserrat JM. Evidence of the effectiveness of continuous airway pressure in the treament of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:495-501.
  • Engleman HM, Kingshott RN, Wraith PK, et al. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:461-467.
  • Engleman HM, Martin SE, Deary IJ, Douglas NJ. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet. 1994;343:572-5.
  • Jokic R, Klimaszewski A, Crossley M, Sridhar G, Fitzpatrick MF. Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. Chest. 1999;115(3):771-81.
  • Loth S, Petruson B, Wiren L, Wilhelmsen L. Better quality of life when nasal breathing of snoring men is improved at night. Arch Otolaryngol Head Neck Surg. 1999;125(1):64-7.
  • Meslier N, Lebrun T, Grillier-Lanoir V, Rolland N, Henderick C, Sailly JC, Racineux JL. 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(1):185-92.

Quality of Life Index

  • Flemons WW, Reimer MA. Measurement properties of the calgary sleep apnea quality of life index. Am J Respir Crit Care Med. 2002;165(2):159-164.

Medical Outcomes Study SF-36

  • Akashiba T, Kawahara S. et al Relationship between quality of life and mood or depression in patients with severe obstructive sleep apnea syndrome. Chest. 2002; 122: 861-865.
  • Bardwell WA, Moore P, Ancoli-Israel S, Dimsdale JE. Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry. 2003;160(2):350-5.
  • Barnes M, Houston D, et al A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Res Crit Med. 2002; 165:773-780.
  • Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ, Kay A, Trinder J, Saunders NA, Mcevoy RD, Pierce RJ. A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165(6):773-780.
  • Bennett LS, Barbour C, Langford B, et al. Health status in obstructive sleep apnea: Relationship with sleep fragmentation and daytime sleepiness, and effects of continuous positive airway pressure treatment. Am J Respir Crit Care Med. 1999;159:1884-1890.
  • Browne HA, Adams L, Simonds AK, Morrell MJ. Sleep apnoea and daytime function in the elderly--what is the impact of arousal frequency? Respir Med. 2003;97(10):1102-8.
  • D'Ambrosio C, Bowman T, Mohsenin V. Quality of life in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure--a prospective study. Chest. 1999;115(1):123-9.
  • Doherty LS, Kiely JL, Lawless G, McNicholas WT. Impact of nasal continuous positive airway pressure therapy on the quality of life of bed partners of patients with obstructive sleep apnea syndrome. Chest. 2003;124(6):2209-14.
  • Engleman HM, Kingshott RN, Wraith PK, et al. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:461-467.
  • Flemons WW, Reimer MA. Measurement properties of the calgary sleep apnea quality of life index. Am J Respir Crit Care Med. 2002;165(2):159-164.
  • Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionaire for sleep apnea. Am J Respir Crit Care Med. 1998;158:494-503.
  • Friedman M, Ibrahim H, Lowenthal S, Ramakrishnan V, Joseph NJ. Uvulopalatoplasty (UP2): a modified technique for selected patients. Laryngoscope. 2004; 114(3):441-9.
  • Gall R, Isaac L, Dryger M. Quality of life in mild obstructive sleep apnea. Sleep. 1993;16;16:S59-61.
  • Gliklich RE, Wang PC. Validation of the snore outcomes survey for patients with sleep- disordered breathing. Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):819-824.
  • Goncalves MA, Paiva T, Ramos E, Guilleminault C. Obstructive sleep apnea syndrome, sleepiness, and quality of life. Chest. 2004; 125(6):2091-6.
  • Goncalves MA, Paiva T, Ramos E, Guilleminault C. Obstructive sleep apnea syndrome, sleepiness, and quality of life. Chest. 2004; 125(6):2091-6.
  • Hida W. Quality of life in obesity hypoventilation syndrome. Sleep Breath. 2003;7(1):1-2.
  • Hong S, Dimsdale JE. Physical activity and perception of energy and fatigue in obstructive sleep apnea. Med Sci Sports Exerc. 2003;35(7):1088-92.
  • Javaheri S, Abraham WT, Brown C, Nishiyama H, Giesting R, Wagoner LE. Prevalence of obstructive sleep apnoea and periodic limb movement in 45 subjects with heart transplantation. Eur Heart J. 2004; 25(3):260-6.
  • Jenkinson C, Stradling J, Petersen S. How should we evaluate health status? A comparison of three methods in patients presenting with obstructive sleep apnoea. Qual Life Res. 1998;7:95-100.
  • Lacasse Y, Bureau MP, Series F. A new standardised and self-administered quality of life questionnaire specific to obstructive sleep apnoea. Thorax. 2004; 59(6):494-9.
  • Lacasse Y, Godbout C, Series F. Independent validation of the Sleep Apnoea Quality of Life Index. Thorax. 2002; 57(6):483-488.
  • Li HY, Chen NH , Shu YH, Wang PC. Changes in quality of life and respiratory disturbance after extended uvulopalatal flap surgery in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2004;130(2):195-200.
  • Manser R Naughton M et a. The Victorian CPAP program is there a need for additional education and support? Intern Med J. 2002; 32:526-532.
  • Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med. 2004; 169(3):361-6.
  • Massie CA, McArdle N, Hart RW, et al. Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med. 2003;167(1):20-3.
  • Meston N, Davies RJ, Mullins R, Jenkinson C, Wass JA, Stradling JR. Endocrine effects of nasal continuous positive airway pressure in male patients with obstructive sleep apnoea. J Intern Med. 2003;254(5):447-54.
  • Parish JM, Lyng PJ. Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure. Chest. 2003;124(3):942-7.
  • Piccirillo JF, Gates GA, White DL, Schectman KB. Obstructive sleep apnea treatment outcomes pilot study. Otolaryngology Head and Neck Surgery. 1998;118:833-44.
  • Profant J, Ancoli-Israel S, Dimsdale JE. A randomized, controlled trial of 1 week of continuous positive airway pressure treatment on quality of life. Heart Lung. 2003;32(1):52-8.
  • Riley RW, Powell NB, Li KK, Troell RJ, Guilleminault C. Surgery and obstructive sleep apnea: long-term clinical outcomes. Otolaryngol Head Neck Surg. 2000;122:415-21.
  • Sforza E, Janssens J, et al. Determinants of altered quality of life in patients with sleep-related breathing disorders. Euro Respir J. 2003;21:682-687.
  • Stavem K, Kjelsberg FN, Ruud EA. Reliability and validity of the Norwegian version of the Functional Outcomes of Sleep Questionnaire. Qual Life Res. 2004;13(2):541-9.
  • Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF. Instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997; 20(10):835-843.

Sickness Impact Profile

  • Gall R, Isaac L, Dryger M. Quality of life in mild obstructive sleep apnea. Sleep. 1993;16;16:S59-61.
  • Phillips BA, Berry DTR, Schmitt FA, Harbison L, Lipke-Molby T. Sleep-disordered breathing in healthy aged persons: two and three year follow-ups. Sleep. 1994;17(5):411-5.
  • Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF. Instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997;20(10):835-843.

Condition-Specific Health-Related Quality of Life Instruments Used in Sleep Disordered Breathing

Calgary Sleep Apnea Quality of Life Index

  • Ferguson KA, Heighway K, Ruby RR. A randomized trial of laser-assisted uvulopalatoplasty in the treatment of mild obstructive sleep apnea. Am J Respir Crit Care Med. 2003;167(1):15-9.
  • Fitzpatrick MF, Alloway CE, Wakeford TM, MacLean AW, Munt PW, Day AG. Can patients with obstructive sleep apnea titrate their own continuous positive airway pressure? Am J Respir Crit Care Med. 2003;167(5):716-22.
  • Flemons WW, Reimer MA. Measurement properties of the calgary sleep apnea quality of life index. Am J Respir Crit Care Med. 2002;165(2):159-164.
  • Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea. Am J Respir Crit Care Med. 1998;158:494-503.
  • Flemons WW, Tsai W. Quality of life consequences of sleep-disordered breathing. J Allergy Clin Immunol. 1997;99:S750-6.
  • Lacasse Y, Godbout C, Series F. Independent validation of the Sleep Apnoea Quality of Life Index. Thorax. 2002; 57(6):483-488.
  • Manser R Naughton M et a. The Victorian CPAP program is there a need for additional education and support? Intern Med J. 2002; 32:526-532.
  • Parish JM, Lyng PJ. Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure. Chest. 2003;124(3):942-7.
  • Sforza E, Janssens J, et al. Determinants of altered quality of life in patients with sleep-related breathing disorders. Euro Respir J. 2003;21:682-687.

Child Health Questionnaire - Parent Form 50

  • Flanary VA. Long-term effect of adenotonsillectomy on quality of life in pediatric patients. Laryngoscope. 2003;113(10):1639-44.

Functional Outcomes of Sleep Questionnaire

  • Barnes M, Houston D, et al A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Res Crit Med. 2002; 165:773-780.
  • Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ, Kay A, Trinder J, Saunders NA, Mcevoy RD, Pierce RJ. A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165(6):773-780.
  • Dinges DF, Weaver TE. Effects of modafinil on sustained attention performance and quality of life in OSA patients with residual sleepiness while being treated with nCPAP. Sleep Med. 2003;4(5):393-402.
  • Massie CA, Hart RW. Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest. 2003;123(4):1112-8.
  • Stavem K, Kjelsberg FN, Ruud EA. Reliability and validity of the Norwegian version of the Functional Outcomes of Sleep Questionnaire. Qual Life Res. 2004; 13(2):541-9.
  • Steward DL, Weaver EM, Woodson BT. A comparison of radiofrequency treatment schemes for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2004; 130(5):579-85.
  • Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF. Instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997;20(10):835-843.
  • Woodson BT, Steward DL, Weaver EM, Javaheri S. A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2003;128(6):848-61.

Obstructive Sleep Apnea Patient-Oriented Severity Index

  • Piccirillo JF, Gates GA, White DL, Schectman KB. Obstructive sleep apnea treatment outcomes pilot study. Otolaryngol Head Neck Surg. 1998;118:833-44.
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Obstructive Sleep Apnea-18 Questionnaire

  • Flanary VA. Long-term effect of adenotonsillectomy on quality of life in pediatric patients. Laryngoscope. 2003;113(10):1639-44.
  • Goldstein N, Fatima M et al Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002; 128-770-775.
  • Mitchell RB, Kelly J, Call E, Yao N. Long-term changes in quality of life after surgery for pediatric obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2004; 130(4):409-12.
  • Mitchell RB, Kelly J, Call E, Yao N. Quality of life after adenotonsillectomy for obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg. 2004; 130(2):190-4.
  • Nelson LM. Temperature-controlled radiofrequency tonsil reduction in children. Arch Otolaryngol Head Neck Surg. 2003;129(5):533-7.
  • Sohn H, Rosenfeld RM. Evaluation of sleep-disordered breathing in children. Otolaryngol Head Neck Surg. 2003;128(3):344-52.

Symptoms of Nocturnal Obstruction and Related Events (SNORE 25, formally OSA Patient-Oriented Severity Index)

  • Chen N., Li H, et al Validation assessment of the Chinese version of the Snore Outcomes Survey. Qual Life Res. 2002; 1:601-607.
  • Li HY, Chen NH , Shu YH, Wang PC. Changes in quality of life and respiratory disturbance after extended uvulopalatal flap surgery in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2004; 130(2):195-200.
  • Steward DL, Weaver EM, Woodson BT. A comparison of radiofrequency treatment schemes for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2004; 130(5):579-85.
  • Woodson BT, Steward DL, Weaver EM, Javaheri S. A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2003;128(6):848-61.

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