Quality of life consequences of sleep-disordered breathing☆,☆☆,★
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.
References (76)
- et al.
Central sleep apnea
Clin Chest Med
(1992) - et al.
Pathogenesis of obstructive sleep apnoea/hypopnoea syndrome
Lancet
(1994) - et al.
Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia
Chest
(1986) - et al.
Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares
Lancet
(1981) - et al.
Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome
Lancet
(1994) - et al.
A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea
Chest
(1996) - et al.
Use of the Epworth sleepiness scale to demonstrate response to treatment with nasal continuous positive airway pressure in patients with obstructive sleep apnea
Respir Med
(1995) Daytime sleepiness, snoring, and obstructive sleep apnea: the Epworth Sleepiness Scale
Chest
(1993)- et al.
Excessive daytime sleepiness in man: multiple sleep latency measurement in narcoleptic and control subjects
Electroencephalogr Clin Neurophysiol
(1978) - et al.
Maintenance of wakefulness test: a polysomnographic technique for evaluating treatment in patients with excessive somnolence
Electroencephalogr Clin Neurophysiol
(1982)
Maintenance of wakefulness test and multiple sleep latency test: measurement of different abilities in patients with sleep disorders
Chest
Severe obstructive sleep apnea—II: Associated psychopathology and psychosocial consequences
J Chroni Dis
Vigilance and automobile accidents in patients with sleep apnea or narcolepsy
Chest
High incentive effects on vigilance performance during 72 hours of total sleep deprivation
Acta Psychol
The Nottingham Health Profile: subjective health status and medical consultations
Soc Sci Med
Extreme obesity associated with alveolar hypoventilation: a pickwickian syndrome
Am J Med
Snoring: Pathogenic, clinical and therapeutic aspects
Sleep apnea: a major public health problem
N Engl J Med
Sleep apnea and related sleep disorders
Physiological basis of therapy for sleep apnea
Am Rev Respir Dis
The sleep apnea syndromes
Annu Rev Med
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
Gas exchange and hemodynamics during sleep
Med Clin North Am
Hypoxemia alone does not explain blood pressure elevations after obstruction apneas
J Appl Physiol
Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome
Arch Intern Med
Nocturnal hypoxia and neuropsychological variables
J Clin Neuropsychol
Likelihood ratios for a sleep apnea clinical prediction rule
Am J Respir Crit Care Med
Recognition of obstructive sleep apnea
Am J Respir Crit Care Med
From obstructive sleep apnea syndrome to upper airway resistance syndrome: consistency of daytime sleepiness
Sleep
Clinical features and evaluation of obstructive sleep apnea
Neuropsychiatric manifestations of obstructive sleep apnea: a review
Int J Psychiatry Med
Management of obstructive sleep apnoea/hypopnoea syndrome
Lancet
Four-year follow up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome
Laryngoscope
Sleep apnea, sleepiness, and driving risk
Am J Respir Crit Care Med
Incidence of sleep disorders in medical practice: a physician survey
Sleep Res
Life effects of narcolepsy in 180 patients from North America, Asia and Europe compared to matched controls
Can J Neurol Sci
Sleep apnea patients have more automobile accidents
Lancet
Automobile accidents involving patients with obstructive sleep apnea
Am Rev Respir Dis
Cited by (206)
Impact of psychiatric disorders
2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second EditionPrevalence of mental illness in patients with obstructive sleep apnea – A cross-sectional study from Kashmir, India
2022, Annals of Medicine and SurgeryCitation Excerpt :The mental changes may be provoked by the biological or psychosocial consequences of OSA [10]. These mental disorders can have a harmful impact on the quality of life and their neurocognitive functioning in patients with OSA [29]. The findings of our study suggest that mental disorders are highly prevalent in OSA primary care settings.
Increased carotid intima-media thickness is independently associated with the occurrence of depressive disorders in patients with obstructive sleep apnea without cardiocerebrovascular disease
2022, Journal of Psychiatric ResearchCitation Excerpt :OSA episodes can cause wakefulness and sleep fragmentation, which is usually accompanied by blood oxygen desaturation. Common OSA symptoms include daytime sleepiness, fatigue, irritability, restless sleep, decreased memory, and decreased quality of life (Flemons and Tsai, 1997; Guilleminault et al., 1988). Recent epidemiological surveys have reported an association of untreated OSA with various mental illnesses, including depression and anxiety.
Obstructive sleep apnea, depression and cognitive impairment
2020, Sleep MedicineCitation Excerpt :In this group, the presence of OSA was not associated with depression or anxiety [61]. On the other hand, other studies have found that OSA may be associated with clinically significant depression [26,62] or increased severity of depressive symptoms [20,47,52,58,63–65]. That may be a direct consequence of sleep fragmentation or secondary to the social impact of this disease.
- ☆
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