The DS-14 questionnaire: psychometric characteristics and utility in patients with obstructive sleep apnea

REM-predominant obstructive sleep apnea: an unmet clinical need

PURPOSE

Obstructive sleep apnea (OSA) and rapid eye movement (REM) sleep fragmentation are associated with increased fatigue, sleepiness, anxiety and depressive symptoms. However, the clinical significance of REM-predominant OSA (REM-OSA) remains less clear.

AIM

To determine any differences in symptom-burden between REM-OSA and non-REM (NREM) OSA.

METHODS

Patients diagnosed with OSA at a University Hospital in Brussels between 25-11-2019 and 19-09-2020 were eligible. REM-OSA was defined as an apnea hypopnea index REM/NREM ratio of at least 2 with a minimum REM-time of 30 min. Severe OSA was excluded due to the expectedly lower prevalence of REM-OSA in this group. All patients completed the Hospital Anxiety and Depression Scale, Big Five Inventory-2, DS-14 questionnaire, SF-36 Health Survey Questionnaire, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Fatigue Assessment Scale, Checklist Individual Strength, Epworth Sleepiness Scale and Stanford Sleepiness Scale at diagnosis.

RESULTS

209 patients with REM-OSA (112 mild and 97 moderate) and 132 with NREM-OSA (48 mild and 84 moderate) were included. Patients with mild REM-OSA were twice as likely to have a SSS score of 3 or more (defined as excessive daytime sleepiness) compared to NREM-OSA (odds ratio 2.1591, p-value 0.0359). There was no significant difference in anxiety, depression, personality traits, fatigue or sleep quality.

CONCLUSION

For mild OSA, a predominance of obstructive respiratory events during the REM phase results in a greater impact on excessive daytime sleepiness. To address this symptom, a lower treatment threshold to include symptomatic mild REM-OSA patients may be warranted.

Hypothyroidism and Type D Personality: Results From E-MPATHY, a Cross-sectional International Online Patient Survey

CONTEXT

Between 10% and 15% of people with hypothyroidism experience persistent symptoms, despite achieving biochemical euthyroidism. The underlying causes are unclear. Type D personality (a vulnerability factor for general psychological distress) is associated with poor health status and symptom burden but has not been studied in people with hypothyroidism.

OBJECTIVE

To investigate type D personality in hypothyroidism and explore associations with other characteristics and patient-reported outcomes.

DESIGN

Multinational, cross-sectional survey.

SETTING

Online.

PARTICIPANTS

Individuals with self-reported, treated hypothyroidism.

INTERVENTION

Questionnaire.

MAIN OUTCOME MEASURES

Type D personality and associations with baseline characteristics, control of the symptoms of hypothyroidism by medication, satisfaction with care and treatment of hypothyroidism, impact of hypothyroidism on everyday living.

RESULTS

A total of 3915 responses were received, 3523 of which were valid. The prevalence of type D personality was 54.2%. Statistically significant associations were found between type D personality and several respondent characteristics (age, marital status, ethnicity, household income, comorbidities, type of treatment for hypothyroidism, most recent TSH level), anxiety, depression, somatization, poor control of the symptoms of hypothyroidism by medication, dissatisfaction with care and treatment of hypothyroidism, and a negative impact of hypothyroidism on everyday living).

DISCUSSION

Our study found a high prevalence of type D personality among people with hypothyroidism who responded to the survey. Type D personality may be an important determinant of dissatisfaction with treatment and care among people with hypothyroidism. Our findings require independent confirmation. Close collaboration between the disciplines of thyroidology and psychology is likely to be key in progressing our understanding in this area.