Cerner Enviza, Malvern, PA, USA.
Jazz Pharmaceuticals, Oxford, UK.
BMC Neurol. 2022 Aug 25;22(1):317. doi: 10.1186/s12883-022-02827-7.
Excessive daytime sleepiness (EDS) is a cardinal symptom of narcolepsy and affects many patients with obstructive sleep apnoea (OSA). EDS is associated with reduced quality of life, increased accident risk, and poor workplace performance. Given the impact of EDS, the ability to predict health-related utility from sleepiness is valuable for examining the cost effectiveness of novel treatments. The aim of this study was to examine the association between EDS and EQ-5D in patients with OSA and/or narcolepsy by modelling EQ-5D utility scores from Epworth Sleepiness Scale (ESS) scores.
Data were obtained from the Europe 2016/2017 National Health and Wellness Survey, an online, general population survey, designed to represent the age and gender composition of each country's adult population. Analyses included 2,348 patients self-reporting symptomatic and diagnosed OSA (n = 2,277), narcolepsy (n = 48), or both (n = 23). Multivariable models were used to examine ESS as a predictor of EQ-5D utility while adjusting for covariates of interest. Results were validated following the National Institute for Health and Care Excellence Decision Support Unit guidelines for predictive modelling.
Utility decreased as EDS severity increased (no EDS: 0.711 ± 0.251, mild: 0.685 ± 0.261, moderate: 0.643 ± 0.268, severe: 0.559 ± 0.323). Whereas participants with only OSA or only narcolepsy did not differ in utility, those with both conditions had lower scores (0.685 ± 0.266 and 0.627 ± 0.325 vs. 0.439 ± 0.340, respectively). Piecewise linear regression identified a single breakpoint at ESS score of 11.29. In the final model, for each point increase in ESS score, the corresponding decrease in EQ-5D utility was larger among patients with ESS scores ≥ 12 compared to patients with ESS scores ≤ 11 (model slopes: -0.0131 vs. -0.0026, respectively). Findings from the validation sample confirmed these results.
This study demonstrates the impact of sleepiness on quality of life (QoL) and its negative impact irrespective of sleep condition (OSA or narcolepsy). The breakpoint identified is relatively consistent with the established ESS cutoff score ≥ 11, which demarcates pathological sleepiness. Furthermore, as EDS severity worsens (increases) on the ESS, the impact on QoL is greater.
日间嗜睡（EDS）是嗜睡症的主要症状，影响许多阻塞性睡眠呼吸暂停（OSA）患者。EDS 会降低生活质量、增加事故风险和影响工作场所的表现。鉴于 EDS 的影响，从嗜睡预测健康相关效用的能力对于检查新型治疗方法的成本效益具有重要意义。本研究旨在通过从 Epworth 嗜睡量表（ESS）评分模型化 EQ-5D 效用评分，研究 OSA 和/或嗜睡症患者的 EDS 与 EQ-5D 之间的关联。
数据来自欧洲 2016/2017 年国家健康和健康调查，这是一项在线的、针对一般人群的调查，旨在代表每个国家成年人口的年龄和性别构成。分析包括 2348 名自我报告有症状和诊断为 OSA（n=2277）、嗜睡症（n=48）或两者兼有（n=23）的患者。多变量模型用于检查 ESS 作为 EQ-5D 效用的预测因子，同时调整了感兴趣的协变量。结果按照英国国家卫生与保健卓越研究所决策支持单位的预测模型指南进行了验证。
随着 EDS 严重程度的增加，效用值降低（无 EDS：0.711±0.251，轻度：0.685±0.261，中度：0.643±0.268，重度：0.559±0.323）。虽然仅患有 OSA 或仅患有嗜睡症的患者在效用方面没有差异，但同时患有两种疾病的患者得分更低（0.685±0.266 和 0.627±0.325 与 0.439±0.340 相比）。分段线性回归在 ESS 得分 11.29 处识别出一个单一的断点。在最终模型中，与 ESS 得分≤11 的患者相比，ESS 得分每增加 1 分，EQ-5D 效用的相应下降幅度在 ESS 得分≥12 的患者中更大（模型斜率：-0.0131 与-0.0026 相比）。验证样本的结果证实了这些结果。
本研究表明嗜睡对生活质量（QoL）的影响及其对睡眠状况（OSA 或嗜睡症）的负面影响。确定的断点与既定的 ESS 临界值≥11 相对一致，该临界值界定了病理性嗜睡。此外，随着 ESS 上的 EDS 严重程度恶化（增加），对 QoL 的影响更大。
