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Fatigue and sleepiness determine respiratory quality of life among veterans evaluated for sleep apnea.

Fatigue and sleepiness determine respiratory quality of life among veterans evaluated for sleep apnea.
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Vinnikov D, Blanc PD, Alilin A, Zutler M, Holty JC,


Vinnikov D, Blanc PD, Alilin A, Zutler M, Holty JC, (click to view)

Vinnikov D, Blanc PD, Alilin A, Zutler M, Holty JC,

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Health and quality of life outcomes 2017 03 1415(1) 48 doi 10.1186/s12955-017-0624-x
Abstract
BACKGROUND
In those with symptoms indicative of obstructive sleep apnea (OSA), respiratory-specific health-related quality of life (HRQL) may be an important patient-centered outcome. The aim of this study was to assess the associations between sleepiness, fatigue, and impaired general and respiratory-specific HRQL among persons with suspected OSA.

METHODS
We evaluated military veterans consecutively referred for suspected OSA with sleep studies yielding apnea-hypopnea index (AHI) values. They also completed the sleepiness (Epworth Sleepiness Scale [ESS]), and fatigue (Fatigue Severity Scale [FSS]) questionnaires, as well as two HRQL instruments (the generic Short-Form SF-12v2 yielding the Physical Component Scale [PCS] and the respiratory-specific Airways Questionnaire [AQ]-20R). Multiple linear regression tested the associations between ESS and FSS (standardized as Z scores for scaling comparability) with AQ-20R, accounting for AHI, SF-12v2-PCS and comorbid respiratory conditions other than OSA.

RESULTS
We studied 1578 veterans (median age 61.1 [IQR 16.8] years; 93.9% males). Of these, 823 (52%) met AHI criteria for moderate to severe OSA (AHI ≥15/h). The majority reported excessive daytime sleepiness (53%; median ESS 11 [IQR 9]) or fatigue (61%; median FSS 42 [IQR 23]). The median AQ-20R was 4 [IQR 1-8]. Controlling for AHI, SF-12v2-PCS, respiratory co-morbid conditions, body mass index, and demographics, both ESS and FSS were significantly associated with poorer AQ-20R: for each; ESS, 1.6 points (95% CI 1.4-1.9), and for FSS, 2.5 points (95% CI, 2.3-2.7).

CONCLUSIONS
Greater daytime sleepiness and fatigue are associated with poorer respiratory-specific HRQL, over and above the effects of OSA, respiratory comorbidity, and generic physical HRQL.

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