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Outcome measurements in obstructive sleep apnea: Beyond the apnea-hypopnea index

Authors

  • Samantha Tam MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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  • B. Tucker Woodson MD, FACS,

    1. and the Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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  • Brian Rotenberg MD, MPH

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
    • Send correspondence to Brian Rotenberg, MD, St. Joseph's Healthcare Centre, 268 Grosvenor St., London, Ontario, Canada N6A 4V2. E-mail: brian.rotenberg@sjhc.london.on.ca

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  • Presented as a podium presentation at the 116th Triological Society Annual Meeting at COSM, Orlando, Florida, U.S.A., April 13, 2013.This study was funded by a grant from the International Sleep Surgical Society.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

The apnea-hypopnea index (AHI) is overwhelmingly used as the main therapeutic metric in the assessment of obstructive sleep apnea (OSA) in surgical studies. However, using AHI as the sole measure is problematic. This study investigates the utility of other outcome measures for patients with OSA undergoing surgery.

Study Design

Systematic review of cohort and review studies.

Methods

A review was performed using the PubMed database. English articles focusing on outcome measures in adults with OSA were included. Studies in pediatric populations, those combining obstructing and central sleep apnea, and those without the use of outcome measures were excluded. Articles were categorized according to level of evidence. The Downs and Black scale and AMSTAR scale were used to assess quality.

Results

Of a total of 10,454 retrieved articles, 21 studies met inclusion and exclusion criteria. Most articles related to continuous positive airway pressure outcomes. Many categories of outcome measures were found: general quality of life, OSA-specific quality of life, measurements of sleepiness, performance, and physiological. Subjects with OSA scored differently in measurement tools in all categories compared to control populations or after treatment, and generally a poor correlation with AHI was seen.

Conclusions

The literature shows a range of tools based on symptoms and physiology of OSA that can assess effects of treatment. Assessment of surgical treatment for OSA should neither be limited to AHI as an outcome, nor should this be the only outcome stressed.

Level of Evidence

NA. Laryngoscope, 124:337–343, 2014

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