Quality of Life Improves for Bedpartners

Discussion

This study was designed to test the hypothesis that OSA affects not only persons with OSA but also their bed partners, resulting in decreased QOL and increased sleepiness for both that improves when patients receive CPAP therapy. We confirmed that patients with OSA have reduced QOL compared with the national norms established for the SF-36, a frequently used measure of QOL in disease states.

In our study, the baseline QOL for bed partners was not significantly different from national norms except in the domain of bodily pain. There is no clear explanation of why the bodily pain domain should be abnormal when the other domains are normal. However, after patients used CPAP, we observed significant increases in QOL scores for bed partners as well as for patients. After CPAP therapy, the patients as a group improved significantly in the domains of role-physical, vitality, social functioning, role-emotional, and mental health. However, their physical functioning, bodily pain, and general health did not change significantly. The bed partners improved significantly in the domains of role-physical, vitality, social functioning, and mental health. Physical functioning, general health, bodily pain, and role-emotional did not differ significantly from baseline in bed partners after the treatment of patients with CPAP. Hence, although baseline QOL was not low, at least in comparison with national norms, there was improvement for the bed partners after patients had received CPAP treatment. The improved QOL seemed to be in accordance with our clinical impression that not only patients but also bed partners improve when OSA is treated effectively.

Our study also showed that ESS scores of the OSA patient and the bed partner improved after effective treatment. Although the ESS is a subjective instrument, and studies[10 –12] have not found strong correlations between it and the multiple sleep latency test, it is a commonly used measure of sleepiness that correlated in at least one study[13] with subjective improvement after CPAP therapy. The high mean ESS scores of our patients at baseline decreased significantly after treatment with CPAP. Although the mean ESS scores of bed partners before treatment were within the upper range of normal, the mean ESS score decreased significantly after the patients were treated with CPAP.

We also used a QOL instrument that was specific for sleep disorders, the SAQLI. We found that the mean score on the SAQLI increased for both the patients and the patients' bed partners. Scores for all four domains increased for the patients, whereas scores for three of the four domains increased for the bed partners. Domain E is related to treatment effects and hence is not applicable because the bed partners did not receive treatment themselves.

One weakness of our study is the fairly high exclusion rate, despite vigorous efforts to obtain follow-up data. However, the baseline data for the group of nonresponders did not differ from the data for the group that finished the study. We believe that the group of nonresponders had more patients who did not comply with CPAP therapy or who could not tolerate CPAP and so "gave up" on the study. If such is the case, it would imply that our study is biased because it primarily included a group of patients who were more likely to comply with CPAP therapy and, thus, may not have been representative of the entire population of OSA patients. However, they would well represent patients who use CPAP regularly to treat OSA. Therefore, our data suggested that patients who use CPAP do indeed benefit from its use.

Other weaknesses of our study are that it is an observational study comparing baseline characteristics with posttreatment characteristics, and it was not randomized or placebo-controlled. Given that CPAP has been shown to be an effective therapy for OSA, we decided that an observational study conducted before treatment and after treatment would not result in a treatment delay for half the patients. In prospective, randomized, blinded studies, CPAP has been shown to be an effective treatment for OSA.[14,15]

Several investigators have shown that QOL is adversely affected in patients with OSA and that it improves with treatment.[16–20] Other studies have examined the effects of OSA on the QOL of bed partners. Beninati et al[4] have shown that a patient's snoring causes increased arousals from sleep in the bed partner that decrease in number when the patient is treated with CPAP. Using the ESS and a nine-item nonvalidated questionnaire about sleep quality, daytime alertness, mood, QOL, and personal relationship, Kiely and McNicholas[21] assessed bed partners' responses to patients' treatment for OSA after the partner began receiving CPAP therapy and found improvement in all the variables measured. McArdle et al[22] showed that a bed partner often reports subjectively poor sleep before the patient is treated with CPAP and that reported sleep quality improves after CPAP treatment, but that objective measures of sleep do not differ between CPAP-treated patients and placebo-treated patients.

Our study was a systematic examination of the generic QOL and the disease-specific QOL of patients with OSA and of their regular bed partners. As expected, we found that QOL, as assessed by the SF-36 and the SAQLI, was impaired in patients with OSA and that it improved with CPAP therapy. Our data also showed that although QOL does not appear to be impaired in the bed partners of patients with OSA, as measured by the SF-36 and the SAQLI, it nevertheless improves significantly when the patient receives CPAP therapy.

Acknowledgements

The authors thank Bernie W. Miller, RRT, Robin N. Cremer, PA-C, Lynda S. Facchiano, FNP, Carolyn J. Barbieri, Teresa E. Radam, and José L. Hernandez for their assistance with this project.
Reprint Address

Correspondence to: James M. Parish, MD, FCCP, Division of Pulmonary Medicine, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: permissions@chestnet.org).
Abbreviation Notes

CPAP = continuous positive airway pressure; ESS = Epworth sleepiness scale; OSA = obstructive sleep apnea; QOL = quality of life; SAQLI = Calgary sleep apnea quality of life index; SF-36 = 36-item short form health survey