Comorbidities and quality of life in Australian men and women with diagnosed and undiagnosed high risk obstructive sleep apnea

Sex-specific associations between sleep apnoea and lung cancer risk in patients with COPD: a nationwide prospective cohort study

Background

COPD is an established risk factor for lung cancer. Sleep apnoea is prevalent in COPD and the inflammation caused by intermittent hypoxaemia may increase this lung cancer risk. Females have more systemic inflammation for a similar apnoea-hypopnoea index than males. Therefore, this study aims to investigate sex-specific associations between sleep apnoea and lung cancer in COPD.

Methods

The sex-specific absolute and relative risk of sleep apnoea on newly diagnosed lung cancer was estimated in a nationwide observational study of Belgian patients with COPD (≥55 years), between 2017 and 2022, using an Aalan-Johanson estimator and a cause-specific Cox regression model adjusted for age, socioeconomic status, smoking status, alcoholism, frailty, comorbidities, and comedication.

Findings

The study consisted of 62,903 COPD patients (42·80% female), of whom 2898 (4·60%) developed lung cancer. We found a significant sex interaction of sleep apnoea on lung cancer hazard ( χ -squared: 13·239, P-interaction < 0·01). In females, sleep apnoea was associated with a higher lung cancer risk (cumulative incidence: 1545 vs 1350 per 100,000 PY; aHR: 1·31 (95% CI: 1·05-1·63)). For males, sleep apnoea patients had a lower lung cancer risk (cumulative incidence: 1632 and 2305 per 100,000 PY; aHR: 0·82 (95% CI: 0·70-0·95)). The impact of sleep apnoea on lung cancer development was especially strong in female COPD patients with hypoxia-related comorbidities e.g., with a history of emphysema (aHR: 2·65 (95% CI: 1·11-6·34)).

Interpretation

Sleep apnoea was associated with a higher risk of lung cancer in female COPD patients while, in males, there was a lower risk. Especially in female COPD patients with hypoxia, sleep apnoea is strongly associated with an increased lung cancer risk.

Funding

Emmanuel van der Schueren cancer research fellowship "Kom Op Tegen Kanker".

Quality of life among obstructive sleep apnoea patients: a systematic review and meta-analysis of EQ-5D studies

BACKGROUND

Obstructive Sleep Apnoea (OSA) is a chronic condition which is associated with extreme daytime sleepiness, cognitive impairment, and other comorbidities and, hence, decreased quality of life (QoL). EQ-5D is one of the most widely used preference-based measures of QoL in patients with different diseases worldwide. This study aims to review the EQ-5D utility value of OSA across primary studies and perform a meta-analysis to derive pooled utility scores for OSA.

METHODS

A systematic review and meta-analysis of the EQ-5D scores of OSA patients adhering to PRISMA guidelines was conducted. Studies reporting EQ-5D utility scores among adult OSA patients were systematically searched across PubMed-Medline, Scopus, and Embase. Selected studies were systematically reviewed and we have assessed the studies for their quality. Meta-analysis was performed using a random-effect model with subgroup analysis to explore heterogeneity.

RESULTS

The search yielded 9,121 articles, of which twenty-eight studies were included in the synthesis. The pooled mean EQ-5D utility score was 0.73 (0.69 to 0.78) with high heterogeneity (I2 = 99.6%). The pooled EQ-5D VAS score was 67.14 (63.97 to 70.32) with high heterogeneity (I2 = 87.04%). Subgroup analyses indicated significant variability in utility scores across different countries, age groups, and disease severities. The variation of utility values for OSA was influenced by the characteristics of patients, the living environment, and the EQ-5D value set.

CONCLUSION

The synthesis revealed that the QoL is significantly lower in OSA, and the aggregated quantitative estimates of EQ-5D utility scores are essential inputs for economic evaluations.

Development and Validation of a Screening Equation for Obstructive Sleep Apnea

Background: The high prevalence of obstructive sleep apnea (OSA), about 30% of people worldwide over 30 years old, underscores the crucial need for early screening. This study aimed to identify key predictive factors for OSA; use these factors to develop a screening equation for a population at high risk for OSA; and prospectively validate this equation's application. Methods: The study included two phases: a retrospective phase examining anthropometric data, the Epworth sleepiness scale (ESS), and the home sleep apnea test (HSAT) from 200 patients referred to the Respiratory Sleep Disorder Center at Policlinico Umberto I, Rome, Italy (January 2020-January 2023) to create a predictive equation for OSA using multivariate analysis (with the most predictive data according to scientific literature). A prospective phase testing this equation on 53 patients from May 2023 to September 2024. Results: In the retrospective phase, the most predictive variables for the apnea-hypopnea index (AHI) identified were neck circumference (NC) and the Epworth sleepiness scale (ESS). The predictive equation derived from the multivariate analysis was as follows: AHIp = [-70.498 + (2.196 × NC) + (0.809 × ESS)]. In the prospective phase of the study, we compared the AHI predicted by the equation (AHIp) with the AHI measured via the HSAT (AHIm) in 53 patients recruited. The results showed that AHIp had a sensitivity of 95%, a specificity of 28%, a positive predictive value (PPV) of 46%, and a negative predictive value (NPV) of 90%. Conclusions: This study identified NC and ESS as key predictors of OSA, forming a predictive equation. This equation, showing high sensitivity and high NPV, may be useful as a screening method to rule out OSA.

A Deep Transfer Learning Approach for Sleep Stage Classification and Sleep Apnea Detection Using Wrist-Worn Consumer Sleep Technologies

Obstructive sleep apnea (OSA) is a common, underdiagnosed sleep-related breathing disorder with serious health implications Objective - We propose a deep transfer learning approach for sleep stage classification and sleep apnea (SA) detection using wrist-worn consumer sleep technologies (CST). Methods - Our model is based on a deep convolutional neural network (DNN) utilizing accelerometers and photo-plethysmography signals from nocturnal recordings. The DNN was trained and tested on internal datasets that include raw data from clinical and wrist-worn devices; external validation was performed on a hold-out test dataset containing raw data from a wrist-worn CST. Results - Training on clinical data improves performance significantly, and feature enrichment through a sleep stage stream gives only minor improvements. Raw data input outperforms feature-based input in CST datasets. The system generalizes well but performs slightly worse on wearable device data compared to clinical data. However, it excels in detecting events during REM sleep and is associated with arousal and oxygen desaturation. We found; cases that were significantly underestimated were characterized by fewer of such event associations. Conclusion - This study showcases the potential of using CSTs as alternate screening solution for undiagnosed cases of OSA. Significance - This work is significant for its development of a deep transfer learning approach using wrist-worn consumer sleep technologies, offering comprehensive validation for data utilization, and learning techniques, ultimately improving sleep apnea detection across diverse devices.

Impact of High Risk of Obstructive Sleep Apnea on Health-Related Quality of Life: The Korean National Health and Nutrition Survey 2019-2021

Background/Objectives: Obstructive sleep apnea (OSA) impairs quality of life (QoL). However, its disease burden in the general population remains unknown. We aimed to investigate the association between OSA and health-related QoL in the general Korean population. Methods: This study analyzed cross-sectional datasets of adults (≥40 years) in the Korean National Health and Nutrition Examination Survey 2019-2021. QoL was assessed using the 3-level EuroQoL 5-dimension component (EQ-5D-3L). The high risk of OSA was determined using the STOP-Bang questionnaire (score ≥ 3). Demographic and clinical factors were included in linear regression analyses to identify the factors associated with EQ-5D-3L. Results: Of the 8966 total participants, 6792 (75.8%) and 2174 (24.2%) were classified as having a low risk and high risk of OSA, respectively. The high risk OSA group showed significantly lower QoL scores when compared with the low risk OSA group (0.939 ± 0.003 vs. 0.951 ± 0.002, p < 0.001). However, the mean difference was within the minimal clinically important difference (MCID) of EQ-5D-3L. Only females exceeded the MCID for the EQ-5D-3L. Elderly females with a high risk of OSA showed the lowest QoL. The regression coefficient of high risk OSA in the multivariate model was -0.018 (95% CI: -0.025--0.01, p < 0.001). Patient demographics and comorbidities also showed significant associations with the EQ-5D-3L. Their regression coefficient was higher than that of high risk OSA. Conclusions: The impact of high risk OSA on QoL manifested differently according to age and sex. The impact of comorbidities on QoL was greater than that of high risk OSA, highlighting the important role of comorbidities and the need for their adjustment in the assessment of QoL.

Dyspnea and Quality of Life Improvements with Management of Comorbid Obstructive Sleep Apnea in Chronic Lung Disease

Obstructive sleep apnea (OSA) has emerged as a significant and prevalent comorbidity associated with chronic lung diseases, including chronic obstructive pulmonary disease, asthma, and interstitial lung diseases. These overlap syndromes are associated with worse patient-reported outcomes (sleep quality, quality of life measures, mental health) than each condition independently. Observational studies suggest that patients with overlap syndrome who are adherent to positive airway pressure therapy report improved quality of life, sleep quality, depression, and daytime symptoms. Screening for and management of OSA in patients with overlap syndrome should emphasize the interconnected nature of these 2 conditions and the positive impact that OSA management can have on patients' well-being and overall health.

Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review

BACKGROUND

Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions.

OBJECTIVES

This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF).

METHODS

A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences.

RESULTS

Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression.

CONCLUSIONS

This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.

Multi-night measurement for diagnosis and simplified monitoring of obstructive sleep apnoea

Substantial night-to-night variability in obstructive sleep apnoea (OSA) severity has raised misdiagnosis and misdirected treatment concerns with the current prevailing single-night diagnostic approach. In-home, multi-night sleep monitoring technology may provide a feasible complimentary diagnostic pathway to improve both the speed and accuracy of OSA diagnosis and monitor treatment efficacy. This review describes the latest evidence on night-to-night variability in OSA severity, and its impact on OSA diagnostic misclassification. Emerging evidence for the potential impact of night-to-night variability in OSA severity to influence important health risk outcomes associated with OSA is considered. This review also characterises emerging diagnostic applications of wearable and non-wearable technologies that may provide an alternative, or complimentary, approach to traditional OSA diagnostic pathways. The required evidence to translate these devices into clinical care is also discussed. Appropriately sized randomised controlled trials are needed to determine the most appropriate and effective technologies for OSA diagnosis, as well as the optimal number of nights needed for accurate diagnosis and management. Potential risks versus benefits, patient perspectives, and cost-effectiveness of these novel approaches should be carefully considered in future trials.

Subjective HRQoL in Patients with Sleep Apnea Syndrome Who Underwent PAP Therapy in a Rehabilitation Setting: A Longitudinal Study

BACKGROUND

Obstructive sleep apnea (OSA) is often associated with decreased health-related quality of life (HRQoL). The aims of this study were to evaluate HRQoL, the clinical and psychological profile of suspected or verified OSA patients, and the impact of PAP therapy at 1-year follow-up.

METHODS

At T0, OSA-suspected subjects underwent clinical, HRQoL, and psychological assessment. At T1, OSA patients underwent PAP therapy in a multidisciplinary rehabilitation setting. At 1 year follow-up, OSA patients were evaluated for the second time.

RESULTS

At T0, OSA patients (n = 283) and suspected OSA subjects (n = 187) differed for AHI, BMI, and ESS. At T0, the PAP-treatment group (n = 101) showed moderate-severe anxious (18.7%) and depressive (11.9%) symptoms. At 1 year follow-up (n = 59), the sleep breathing pattern had normalized and there was a reduction of ESS scores and anxious symptoms. There was also an improvement in HRQoL (0.6 ± 0.4 vs. 0.7 ± 0.5, p = 0.032; 70.4 ± 19.0 vs. 79.2 ± 20.3, p = 0.001) and in satisfaction with sleep quantity (52.3 ± 31.7 vs. 71.4 ± 26.2, p = 0.001), sleep quality (48.1 ± 29.7 vs. 70.9 ± 27.1, p = 0.001), mood (58.5 ± 24.9 vs. 71.0 ± 25.6, p = 0.001), and physical resistance (61.6 ± 28.4 vs. 67.8 ± 27.4, p = 0.039).

CONCLUSION

Considering the impact of PAP treatment on patients' psychological and HRQoL evaluations that we observed, our data are valuable for unveiling different profiles characterizing this clinical population.