Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients

Abstract

Study objectives: We hypothesized that patient reported outcomes (PROs) improve with positive airway pressure (PAP) in patients with sleep-disordered breathing (SDB) and hypertension (HTN).

Methods: Questionnaire-based PROs (sleepiness [Epworth Sleepiness Scale, (ESS)], depression [Patient Health Questionnaire-9 (PHQ-9)], and fatigue [Fatigue Severity Scale (FSS)]) were retrospectively examined in patients with SDB and HTN at baseline and within a year following PAP initiation. PRO changes were estimated using multivariable linear mixed-effect models adjusted for baseline age, sex, race, body mass index, resistant hypertension (RHTN) status, cardiac and diabetes history, and correlation between repeated measurements. Age and race by PAP interaction terms (mean change, 95% CI) were examined.

Results: 894 patients with HTN and SDB were examined. 130 (15%) had baseline RHTN (age 58 ± 12 y, 52.9 % male, BMI 36.2 ± 9.1 kg/m2). In multivariable models, a significant improvement in sleepiness ESS (-2.09, 95% CI: -2.37, -1.82), PHQ-9 (-1.91, 95% CI: -2.25, -1.56), and FSS scores (-4.06 95% CI: -4.89, -3.22) was observed. A significant race by PAP effect interaction was observed (p < 0.0001 for all PROs); Caucasians had greater improvements than non-Caucasians. The interaction term of effect of PAP and age was significant for ESS (p = 0.04) and PHQ-9 (p = 0.0003), indicating greater improvement in younger patients.

Conclusions: Consistent improvement of broad PRO domains in response to PAP in SDB was observed in this clinic-based hypertensive cohort; Caucasians and younger patients derived greater benefit.

Keywords: hypertension; patient reported outcomes; positive airway pressure.

© 2016 American Academy of Sleep Medicine

Figures

Figure 1. Changes in outcomes of ESS, PHQ-9 and FSS after institution of CPAP by race category (p

ESS, Epworth Sleepiness Scale; PHQ-9, Patient Health Questionnaire-9; FSS, Fatigue Severity Scale; CPAP, continuous positive airway pressure.

Figure 2. Changes in outcomes of ESS, PHQ-9 and FSS after institution of CPAP by age.

ESS (p = 0.04), PHQ-9 (p = 0.0003), FSS (p = 0.42). ESS, Epworth Sleepiness Scale; PHQ-9, Patient Health Questionnaire-9; FSS, Fatigue Severity Scale; CPAP, continuous positive airway pressure.