Health Preference Measures in Patients with Obstructive Sleep Apnea Syndrome Undergoing Continuous Positive Airway Pressure Therapy: Data from a Randomized Trial

Fabienne L Huber; Michael Furian; Malcolm Kohler; Tsogyal D Latshang; Yvonne Nussbaumer-Ochsner; Alexander Turk; Otto D Schoch; Irene Laube; Robert Thurnheer; Konrad E Bloch

doi:10.1159/000513306

Health Preference Measures in Patients with Obstructive Sleep Apnea Syndrome Undergoing Continuous Positive Airway Pressure Therapy: Data from a Randomized Trial

Respiration. 2021;100(4):328-338. doi: 10.1159/000513306. Epub 2021 Feb 4.

Authors

Affiliations

¹ Department of Respiratory Medicine, Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.
² Department of Respiratory Medicine, Sleep Disorders Center, Cantonal Hospital Chur, Chur, Switzerland.
³ Department of Internal Medicine, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.
⁴ Department of Internal Medicine, See-Spital, Horgen, Switzerland.
⁵ Department of Respiratory Medicine, Center for Sleep Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
⁶ Department of Respiratory Medicine, Sleep Disorders Center, Triemli Hospital, Zurich, Switzerland.
⁷ Department of Respiratory Medicine, Sleep Disorders Center, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland.
⁸ Department of Respiratory Medicine, Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland, konrad.bloch@usz.ch.

Abstract

Background: In patients with obstructive sleep apnea syndrome (OSAS), the preference-based, health-related quality of life in terms of utility has not been extensively studied.

Objective: To address this point, we compared the performance of different instruments assessing utility in patients with OSAS undergoing continuous positive airway pressure (CPAP) therapy.

Materials and methods: Data of 208 patients with OSAS (28 women, mean ± SE age 54.4 ± 0.7 years, apnea-hypopnea index (AHI) 51.9 ± 1.8/h, Epworth sleepiness score 13.4 ± 0.2) participating in a randomized trial of different CPAP modalities over 2 years were analyzed. Evaluations included sleep studies, Epworth sleepiness scale, and several utility instruments that measure subjective health preference on a scale ranging from 1 (most preferred and perfect health) to 0 (least preferred and very poor health).

Results: After 2 years of CPAP therapy, the mean ± SE AHI was 6.7 ± 1.5/h and Epworth score 7.9 ± 0.4, both p < 0.001 versus baseline. Baseline utilities and changes (95% confidence interval) after 2 years of CPAP therapy were EuroQol 5-dimensions 0.79 ± 0.01, 0.02 (0.00-0.05, p = 0.064); short-form 6-dimension medical outcome questionnaire 0.72 ± 0.01, 0.06 (0.04-0.08, p < 0.001); Euro-thermometer visual analog scale 0.70 ± 0.01, 0.09 (0.07-0.12, p < 0.001); time trade-off 0.82 ± 0.01, 0.03 (0.01-0.06, p = 0.002); and standard gamble 0.82 ± 0.01, -0.01 (-0.03 to 0.02, p = 0.712).

Conclusion: The short-form 6-dimensions questionnaire, the Euro-thermometer, and the time trade-off instruments reflected the major clinical improvements in OSAS, while the EuroQoL 5-dimensions and standard gamble tests were not sensitive to CPAP effects. These results indicate that the evaluation of utility of a treatment for OSAS depends critically on the instrument used, which is important from an individual and societal perspective.

Keywords: Cost-utility analysis; Health-related quality of life; Noninvasive ventilation; Sleep apnea.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Continuous Positive Airway Pressure / methods*
Cost-Benefit Analysis
Diagnostic Self Evaluation*
Female
Healthy Life Expectancy
Humans
Male
Middle Aged
Patient Outcome Assessment
Patient Preference
Quality of Life*
Quality-Adjusted Life Years
Sleep Apnea, Obstructive* / economics
Sleep Apnea, Obstructive* / psychology
Sleep Apnea, Obstructive* / therapy
Treatment Outcome
Visual Analog Scale