title: Predicting CPAP Use and Treatment Outcomes Using Composite Indices of Sleep Apnea Severity.
abstract: Measures of baseline sleep apnea disease burden (apnea-hypopnea index, Epworth Sleepiness Scale) predict continuous positive airway pressure (CPAP) adherence, but composite indices of sleep apnea severity (Sleep Apnea Severity Index, Modified Sleep Apnea Severity Index) may be more robust measures of disease burden. We tested the relative prognostic ability of each measure of sleep apnea disease burden to predict subsequent CPAP adherence and subjective sleep outcomes.
  
  
  
  Prospective cohort study at a tertiary academic sleep center. Patients (n = 323) underwent initial diagnostic polysomnography for suspected obstructive sleep apnea and 6 mo of subsequent CPAP therapy.
  
  
  
  Baseline apnea-hypopnea index and both composite indices predicted adherence to CPAP therapy at 6 mo in multivariate analyses (all p ≤ 0.001). Baseline Epworth Sleepiness Scale did not predict CPAP adherence (p = 0.22). Both composite indices were statistically stronger predictors of CPAP adherence at 6 mo than apnea-hypopnea index (p < 0.001). In multivariate analyses, baseline apnea-hypopnea index (p < 0.05) and both composite indices (both p < 0.04) predicted change in Pittsburgh Sleep Quality Index, whereas only the composite indices predicted changes in Sleep Apnea Quality of Life Index (both p < 0.001). Adjustment for treatment adherence did not affect the relationship of the composite indices with change in Sleep Apnea Quality of Life Index (both p ≤ 0.005).
  
  
  
  Composite indices of baseline sleep apnea severity better predict objective CPAP adherence and subjective treatment outcomes than baseline apnea-hypopnea index and baseline Epworth Sleepiness Scale.
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN.
authors: Karthik
authors: K
authors: Balakrishnan
authors: Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, WA.|Comparative Effectiveness, Cost & Outcome Research Center, University of Washington and Harborview Medical Center, Seattle, WA.
authors: Kathryn T
authors: KT
authors: James
authors: Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, WA.|Comparative Effectiveness, Cost & Outcome Research Center, University of Washington and Harborview Medical Center, Seattle, WA.|Surgery Service, Department of Veterans Affairs Medical Center, Seattle, WA.|University of Washington Sleep Center, Harborview Medical Center, Seattle, WA.
authors: Edward M
authors: EM
authors: Weaver
mesh_terms: D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome
keywords: cohort studies; illness burden; obstructive sleep apnea; patient adherence; prospective studies