University of Washington, Seattle, WA.
University of Pittsburgh, Pittsburgh, PA.
Chest. 2020 Mar;157(3):665-672. doi: 10.1016/j.chest.2019.11.011. Epub 2019 Nov 27.
The Patient-Reported Outcomes Measurement Information System (PROMIS) includes two instruments to quantify sleep symptoms (sleep disturbance [SDA] and sleep-related impairment [SRI]) in diverse populations across a wide symptom spectrum. However, the responsiveness of PROMIS measures to treatment of sleep disorders is unknown. We examined the responsiveness of the PROMIS sleep scales to the treatment of OSA.
We collected SDA, SRI, and Epworth Sleepiness Scale (ESS) before and after initiation of positive airway pressure (PAP) in patients with type 2 diabetes newly diagnosed with OSA. To compare responsiveness, we compared effect sizes and classifications of symptom improvement using both the reliable change method and thresholds of minimum important difference (MID).
A total of 103 patients completed assessments pre- and post-PAP. SDA, SRI, and ESS scores all declined significantly with PAP therapy. We observed the largest effect size for SDA (-0.64; 95% CI, -0.86 to -0.42), followed by SRI (-0.43; 95% CI, -0.63 to -0.23), and ESS (-0.28; 95% CI, -0.42 to -0.15). More patients experienced the reliable change category of symptom remission categorized by the PROMIS measures (SDA: 23.3%; SRI: 31.1%) relative to the ESS (5.8%) (P < .001 for both). Using the MID, SDA and SRI also classified more patients as improved (SDA: 54.4%; SRI: 49.5%) relative to the ESS (35.0%) (P < .001 for both pairwise comparisons).
PROMIS sleep measures were more likely than the ESS to detect an improvement with PAP therapy. Incorporating PROMIS measures into research and clinical care may provide a more sensitive assessment of symptomatic response to OSA treatment.
患者报告结局测量信息系统（PROMIS）包括两个工具，用于在广泛的症状谱内量化不同人群的睡眠症状（睡眠障碍[SDA]和睡眠相关损害[SRI]）。然而，PROMIS 测量对睡眠障碍治疗的反应性尚不清楚。我们研究了 PROMIS 睡眠量表对 OSA 治疗的反应性。
我们在新诊断为 OSA 的 2 型糖尿病患者开始接受正压通气（PAP）治疗前后，收集 SDA、SRI 和 Epworth 睡眠量表（ESS）。为了比较反应性，我们使用可靠变化法和最小重要差异（MID）阈值比较了症状改善的效应大小和分类。
共有 103 例患者完成了 PAP 治疗前后的评估。SDA、SRI 和 ESS 评分均随 PAP 治疗显著下降。我们观察到 SDA 的效应量最大（-0.64；95%CI，-0.86 至-0.42），其次是 SRI（-0.43；95%CI，-0.63 至-0.23），ESS（-0.28；95%CI，-0.42 至-0.15）。与 ESS（5.8%）相比，PROMIS 测量更能将更多患者归类为症状缓解的可靠变化类别（SDA：23.3%；SRI：31.1%）（均 P<0.001）。使用 MID，SDA 和 SRI 也将更多患者归类为改善（SDA：54.4%；SRI：49.5%），而 ESS（35.0%）（均 P<0.001）。
与 ESS 相比，PROMIS 睡眠测量更有可能检测到 PAP 治疗的改善。将 PROMIS 测量纳入研究和临床护理可能会更敏感地评估 OSA 治疗的症状反应。
