Quality of life consequences of sleep-disordered breathing,☆☆,

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Abstract

Sleep-disordered breathing occurs in approximately 2% to 4% of the adult population and includes conditions in which patients stop breathing completely (apnea) or have marked reductions in airflow (hypopnea) during sleep. Typical symptoms of sleep apnea include snoring, restless sleep, excessive daytime somnolence, nocturnal enuresis, irritability, depression, memory deficits, inability to concentrate, and decreased alertness. The clinically relevant outcomes of these symptoms include impairment in work efficiency, increased automobile accident rates, and decrements in quality of life. Treatment of sleep apnea, primarily with continuous positive airway pressure, reduces sleepiness and improves mood disturbances, neurocognition, and performance. Traditional measurements of sleep apnea severity do not correlate well with current tests and scales that are used to quantify alterations in alertness, performance, quality of life, or sleepiness. A disease-specific quality of life scale has been developed following patient and physician interviews and literature reviews. The Calgary Sleep Apnea Quality of Life Index is expected to capture aspects of quality of life important to sleep apnea patients, such as cognitive function, performance, and mood, that could be improved with appropriate treatment of sleep-disordered breathing. (J Allergy Clin Immunol 1997;99:S750-6.)

Section snippets

Excessive daytime somnolence

SA has been implicated as a cause of numerous daytime symptoms, many of which are the result of chronic sleep disruption. The most common and pervasive symptom is excessive daytime somnolence (EDS). SA and narcolepsy are the two most common medical causes of moderate and severe EDS.25 EDS is a common problem in Western society, with a prevalence rate of up to 5%.26 It is disruptive to afflicted patients, since over half of severely hypersomnolent patients report loss of job or disruption of

Depression

SA has been shown to be associated with depressive symptoms in many studies, although this is not a universal finding. Most studies have been cross-sectional and have involved selected and, therefore, biased samples of patients to establish this association. Kales et al.42 observed depression in 56% of 50 patients with SA. However, these patients had severe SA, and tracheostomy was recommended for treatment. Therefore, they are not representative of the majority of patients with SA. Millman et

Neurocognitive dysfunction and performance impairment

Numerous studies have evaluated SA patients for neurocognitive dysfunction, each using a battery of neuropsychological tests. A clear pattern of deficits has not emerged.13, 14, 49, 50, 51, 52, 53, 54 By and large, investigators have used different methodologies, different control populations, and probably different recruitment strategies to obtain their study population. Consequently, findings often differ from study to study. A comprehensive review of these studies is beyond the scope of this

Quality of life

Daytime symptoms, including sleepiness, irritability, depressed mood, and various aspects of cognitive dysfunction would be expected to impact patients' quality of life (QOL). However, individual measurements or a collective measurement of these symptoms would not be expected to adequately capture the most important aspects of SA patients' QOL that are a result of their breathing disorder. Measurement of QOL is now expected as an outcome measure in clinical trials. QOL indices can be generic,

Conclusions

Sleep-disordered breathing is a common condition, afflicting between 2% and 4% of the adult population. These individuals experience symptoms of excessive daytime sleepiness to varying degrees, as well as other significant symptoms that have an adverse impact on their lives. There is an association between SA and depressive symptoms, cognitive functioning, alertness, and performance. However, traditional measures of SA severity do not correlate well with current measures of alertness,

Acknowledgements

Development of the Calgary SAQLI was made possible through grants from the Alberta Lung Association.

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    From the Department of Medicine, University of Calgary.

    ☆☆

    Reprint requests: Dr. W. Ward Flemons, Alberta Lung Association Sleep Disorders Centre, Foothills Hospital, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9.

    1/0/79131

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