Quality of Life in Obstructive Sleep Apnea-hypopnea Syndrome

Quality of Life in Obstructive Sleep Apnea-hypopnea Syndrome

Calidad de vida con el síndrome de apnea-hipopnea del sueño

Gina Lizeth Castellanos Caro, Tatiana Lorena Matiz Ibarra, Alirio Rodrigo Bastidas Goyes, María Angélica Bazurto, Juan Gabriel García Manrique

Quality of Life in Obstructive Sleep Apnea-hypopnea Syndrome

Universitas Médica, vol. 59, no. 2, 2018

Pontificia Universidad Javeriana

Gina Lizeth Castellanos Caro

Universidad de La Sabana, Colombia

Tatiana Lorena Matiz Ibarra a

Universidad de La Sabana, Colombia

Alirio Rodrigo Bastidas Goyes

Universidad de La Sabana, Colombia

María Angélica Bazurto

Universidad de La Sabana, Colombia

Fundación Neumológica Colombiana, Colombia

Juan Gabriel García Manrique

Universidad de La Sabana, Colombia

Date received: 31/10/2015

Date accepted: 11/12/2017

Abstract: Obstructive Sleep Apnea/hypopnea Syndrome (OSAHS) has as its fundamental mechanism the failure of tonic dilatation of the pharyngeal muscles during sleep. Its prevalence has been fixed between 2-4% in women and 4-8% in men. This pathology elevates blood pressure, increases the risk of cardiovascular and cerebrovascular disease, causes excessive drowsiness and decreases the quality of life of patients who suffer it. Approximately 5% of the general population is affected in their daily lives due to this disorder. Therefore, it is pertinent to have instruments that effectively measure every aspect involved in OSAHS. In Colombia, there is currently no validated scale that evaluates the quality of life in OSAHS; however, worldwide, there are several instruments useful in this topic; one of these is the Sleep Apnea Quality of Life Index (SAQLI), which is validated in four languages, including Spanish, but has not yet been validated in our country, which probably involves a language and cultural barrier at the time of application.

Keywords sleep apnea, quality of life, validation studies, Colombia.

Resumen: El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) tiene como mecanismo fundamental el fallo de la dilatación tónica de los músculos faríngeos durante el sueño. Su prevalencia se ha fijado entre el 2% y el 4% en mujeres y entre el 4% y el 8% en hombres. Esta patología, a su vez, eleva la presión arterial, aumenta el riesgo de enfermedad cardiovascular y cerebrovascular, causa somnolencia excesiva y disminuye la calidad de vida de los pacientes que la sufren. Aproximadamente, el 5% de la población general se ve afectada en su vida cotidiana por sufrir este trastorno. Por ello, es pertinente contar con instrumentos que midan de manera eficaz todos los aspectos involucrados en el SAHOS. En Colombia, no existe ninguna escala validada que evalúe la calidad de vida con el SAHOS; sin embargo, existen varios instrumentos con este fin, uno de los cuales es la Sleep Apnea Quality of LifeIndex (SAQLI), validada en cuatro idiomas, incluido el español, pero aún no se ha hecho este proceso en el país, lo que probablemente implica una barrera lingüística y cultural a la hora de aplicarla.

Palabras clave: apnea del sueño, calidad de vida, estudios de validación, Colombia.


Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS) is characterized by recurrent episodes of partial or total collapse (hypopnea or apnea) of the upper airway during sleep, which causes hypoxemia, hypercapnia and repeated fragmentation (1,2,3). Clinically, these physiopathological changes are reflected in permanent daytime fatigue, headache, depression, poor work performance and lack of concentration. All this deteriorates the quality of life of patients who have the syndrome (4,5). The prevalence of this syndrome has increased in recent years (6,7,8,9,10), which has made it a public health problem (2,11). In addition, OSAHS is associated with multiple cardiovascular, metabolic and psychosocial complications that affect the quality of life (12,13).

For the preparation of this article, a search of scientific literature was made in the following databases: ClinicalKey, Ovid, ProQuest, PubMed, ScienceDirect y SciELO.

Obstructive Sleep Apnea-hypopnea Syndrome and Quality of Life

The most common manifestations of the patient with OSAHS are daytime sleepiness, nocturnal roncopathy and awakenings related to shortness of breath or respiratory effort (14), although irritability, difficulty concentrating, impaired memory, low energy for daily activities, chronic headache and depressive symptoms are also frequent (15). In addition, in patients with OSAHS there is a short-term increase in occupational and car accidents (16). All these conditions are directly related to the patient’s quality of life, and not only to cardiovascular and metabolic alterations (7,17).

All these symptoms are added to problems in the relationship with the partner, and an increased risk of car accidents and related comorbidities. This has made this a disease with high costs and a high impact on health and on the quality of life (5), which is defined as the representation of the functional effect of a disease and its treatment in the patient’s perception (18).

The degree to which the quality of life is affected is not directly proportional to the severity of the apnea (19); this highlights the importance of quantifying the impact of the disease on the quality of life, without severity being the determining marker. However, the treatment is related to the impact in the patient’s daily life; due to this, it is necessary to measure the impact that both the disease and the therapeutic measures have on the patient’s quality of life (18,20).

Quality of Life Measurement Scales with the Syndrome

Quality of life is one of the basic points when evaluating health care, as it is important to know the way it is affected and to develop the necessary instruments to measure it objectively.

Tools or scales are used to measure a complex phenomenon not directly observable; to perform the measurement, the phenomenon is broken down into groups of systems or manifestations that are constant, called domains, and through items a strategy is developed to measure them (20).

There are two different groups of scales to measure the quality of life of people with OSAHS: the first includes generic scales, used for other diseases. Their usefulness lies in the fact that several types of pathologies can be compared; however, when evaluating a specific disease such as OSAHS, sensitivity is lost (4,18). Among these scales, the SF36, a 36-item questionnaire that assesses physical functioning, body pain, vitality, social functioning and mental illness has been used. It has the advantage that, together with its abbreviated version, the SF12, have been validated for more than a decade (21,22). This questionnaire is the one most used in studies to validate specific scales of quality of life. There are other types of generic scales, such as the Nottingham Health Profile, Sickness Impact Profile (SIP), the Functional Limitations Profile (FLP) and EuroQol (EQ-5D), which evaluate items similar to the aforementioned scale , but with yes or no dichotomous answers, in which information can be lost (4,15,18).

The second group of instruments to assess the quality of life in OSAHS are the specific ones, among which is the Functional Outcomes of Sleep Questionnaire (FOSQ). This is a self-administered questionnaire, whose purpose is to measure the impact of drowsiness in daily activities: eating, cleaning the house, performing simple calculations, concentrating on an activity, driving, remembering information, carrying out recreational activities, productivity, social interaction and sexual relations; however, although it has a good validity, the fact that it focuses on inquiring about a symptom in all activities limits its use (4,6,18).

The Obstructive Sleep Apnea Patient-Oriented Severity Index (OSAPOSI) is a questionnaire based on a semi-structured interview that seeks to identify the physical, functional and emotional consequences of OSAHS and its treatment. It consists of 32 questions that are rated from 0 to 5, depending on the magnitude of the problem; however, its reproducibility and internal consistency have not been documented (23).

The Calgary Sleep Apnea Quality of Life Index (SAQLI) is also a specific questionnaire for OSAHS that measures domains such as daily functioning, social and emotional interactions and symptoms; the last domain of this questionnaire deals with possible adverse events to the treatment, which are evaluated by means of Likert-type scales of 7 points, being 1 the maximum deficiency, and 7, the one without deficiency. This makes SAQLI more objective in the evaluation of patients with OSAHS. These findings were confirmed by the World Health Organization (24,25,26).

The aspects deemed necessary to evaluate OSAHS can be summarized in six domains (5):

Daily activities. Within the component of daytime functioning or daytime symptoms is the greatest number of coincidences within the scales developed to measure health-related quality of life in patients with OSAHS (9). The hypersomnia generated by the disease has an important impact on patients’ lives. All studies agree that the following aspects significantly affect patients: non-restorative sleep, excessive fatigue, difficulty to stay awake, difficulties with memory and with keeping attention, falling asleep suddenly, malaise upon awakening and lack of concentration (14,16,27). This domain also seeks to identify the participation in activities and the limitation in these. It is evident that patients suffering from OSAHS face several problems in terms of mobility and work, or in engaging in recreational activities such as exercise and other relaxing activities (28).

Social relationships. The perception of individuals of their cultural context or the relations they maintain with society in terms of their projects and expectations are definitive markers of well-being (14). The following aspects limit the social life of patients with OSAHS: the constant struggle against the urge to sleep, the need to nap, the difficulty to stay awake while reading, social activities, driving a vehicle, the feeling of having to make a greater effort to develop activities, as well as greater limitations in school and work performance (23).

State of mind. It refers to the feeling of impatience, always feeling unable to regain strength, anxiety or depression, and a constant concern about their health (4,29). In addition to the discomfort that the patient feels to affect the sleep of his/her partner, the reluctance to spend the night with friends due to snoring, the lack of interest in leaving and the concern for bothering others cause isolation, as well as social and emotional limitation (10).

Symptomatology. General symptoms and not only those directly related to the disease, such as roncopathy, excessive fatigue or drowsiness that affect the patient, are additional causes of deterioration, including chronic headache and gastroesophageal reflux, which increases with OSAHS (15,30).

Symptoms related to the treatment. It has been widely documented that less than 50% of patients with indication of continuous positive airway pressure use adhere adequately to the treatment. Its use is not optimal, due to the reluctance of the patients to this type of treatment, its time of use and its side effects (15,31,32). This point is fundamental, since in any pathology it is important to evaluate the possible side effects of the treatment, which limit treatment adherence or are harmful for the patient (33).

Impact of the treatment. After confirming the diagnosis and prescribing a specific treatment, it is important to quantify the impact on the patient with respect to the improvement in the symptoms and general well-being (11).

The most complete and widely used instrument in the world is the SAQLI scale, which individualizes and takes into account the direct aspects that affect patients with this disease; in addition, it includes a domain of response to treatment and its possible adverse effects, something that none of the other scales considers (6). The SAQLI scale is validated in several languages, including Lithuanian, Chinese and Spanish; however, the Spanish language used in the Iberian Peninsula may have words that are not known in our language, so it is necessary to verify their meaning in Latin American countries (7,17). In Colombia we do not have any validated tool adapted to our language, which allows measuring how the quality of life of patients with OSAHS is affected, as well as the response to treatment.


The importance of measuring the quality of life derives from the fact that the definition of the concept of health is dynamic and multidimensional. It is based on a biopsychosocial projection of the individual, taking into account the positive and negative values that affect our life, social functionality and perception. Since OSAHS chronically affects sleep and produces multiple cardiovascular and neuropsychiatric alterations, such as depression and cognitive dysfunction, it is necessary to have tools to assess the quality of life in this type of patients.

Among the tools currently available, the SAQLI scale is the most appropriate for evaluating different quality of life items, in addition to measuring the impact that the treatment has on the quality of life.


1. Horacio G, Pallavidino C, Antinori M, Simonit MS, Gisela D, Rozas V. Sindrome de apnea/hipopnea obstructiva del sueño. Rev Posgrado la VIa Cátedra Med. 2008;180(1):12-20.

2. Jordan AS, McSharry DG. Adult obstructive sleep apnoea syndrome. J R Coll Physicians Lond. 2014;33(5):439-44.

3. Jorquera. J. Síndrome de apnea obstructiva del sueño. Boletín Esc Med UC, Pontif Univ Católica Chile. 2007;32(2):83-8.

4. Fundación Científica y Tecnológica (FUCYT). Apnea [Internet]. 2013;1:1-7. Disponible en: http://www.fucyt.cl.

5. Stucki A, Cieza A, Schuurmans MM, Ustun B, Stucki G, Gradinger F, et al. Content comparison of health-related quality of life instruments for obstructive sleep apnea. Sleep Med. 2008;9(2):199-206.

6. Williams C, Franic D. Pnd28 psychometric evaluation of obstructive sleep apnea specific health related quality of life instruments. Value Heal. 2007;10(3):A95.

7. Catalán P, Martínez A, Herrejón A, Martínez-García MÁ, Soler-Cataluña JJ, Román-Sánchez P, et al. Consistencia interna y validez de la versión española del cuestionario de calidad de vida específico para el síndrome de apnea del sueño: Sleep Apnoea Quality of Life Index. Arch Bronconeumol. 2012;48(12):431-42.

8. Sampaio RS, Pereira MG, Winck JC. Adaptation of the sleep apnea quality of life index (SAQLI) to Portuguese obstructive sleep apnea syndrome patients. Rev Port Pneumol. 2012;18(4):166-74. doi: http://dx.doi.org/10.1016/j.rppnen.2012.02.003.

9. Saddki N, Mohamad H, Mohd Yusof NI, Mohamad D, Mokhtar N, Wan Bakar WZ. Validity and reliability of the Malay version of sleep apnea quality of life index -- preliminary results. Health Qual Life Outcomes [Internet]. 2013;11(1):100. Disponible en: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3710083&tool=pmcentrez&rendertype=abstract.

10. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6. doi: http://dx.doi.org/10.1016/j.sleep.2009.10.005.

11. Gutierrez C, Brady P. Obstructive sleep apnea: a diagnostic and treatment guide. J Fam Pract [Internet]. 2013;62(10):565-72. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/24143347.

12. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Position paper on the management of patients with obstructive sleep apnea and hypertension. J Hypertens. 2012;30(4):633-46.

13. Loke YK, Brown JWL, Kwok CS, Niruban A, Myint PK. Association of obstructive sleep apnea with risk of serious cardiovascular events: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5(5):720-8.

14. Kyle SD, Morgan K, Espie CA. Insomnia and health-related quality of life. Sleep Med Rev. 2010;14(1):69-82.

15. Moroni L, Neri M, Lucioni AM, Filipponi L, Bertolotti G. A new means of assessing the quality of life of patients with obstructive sleep apnea: The MOSAS questionnaire. Sleep Med. 2011;12(10):959-65. doi: http://dx.doi.org/10.1016/j.sleep.2011.07.010.

16. Dutt N, Janmeja AK, Mohapatra PR, Singh AK. Quality of life impairment in patients of obstructive sleep apnea and its relation with the severity of disease. Lung India [Internet]. 2013;30(4):289-94. Disponible en: 10.4103/0970-2113.120603 http://ezproxy.umsl.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=92749014&site=ehost-live&scope=site.

17. Catalán P, Martínez A, Herrejón A, Chiner E, Martínez-García MÁ, Sancho-Chust JN, et al. Consistencia interna y validez de la versión española del cuestionario de calidad de vida específico para el síndrome de apneas-hipopneas del sueño Quebec Sleep Questionnaire. Arch Bronconeumol. 2012;48(4):107-13.

18. Moyer CA, Sonnad SS, Garetz SL, Helman JI, Chervin RD. Quality of life in obstructive sleep apnea: A systematic review of the literature. Sleep Med. 2001;2(6):477-91.

19. Marshall NS, Marshall NS, Wong KKH, Wong KKH, Liu PY, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep [Internet]. 2008;31(8):1079-85. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/18714779.

20. Sánchez R, Echeverry J. Validación de escalas de medición en salud. Rev Salud Pública. 2004;6(3):302-18.

21. Vera Villarroel P, Silva J, Celis-Atenas K, Pavez P. Evaluación del cuestionario SF-12: verificación de la utilidad de la escala salud mental. Red Med Chile. 2014;142(10):1275-83.

22. Ramírez-Vélez R, Agredo-Zúñiga RA, Jerez-Valderrama AM. Confiabilidad y valores normativos preliminares del cuestionario de salud SF-12 (Short Form 12 Health Survey) en adultos colombianos. Rev Salud Pública. 2011;12(5):807-19.

23. Lacasse Y, Godbout C, Series F. Health-related quality of life in obstructive sleep apnoea. Eur Respir J. 2002;19(3):499-503.

24. Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea. Am J Respir Crit Care Med. 1998;158(2):494-503.

25. Flemons WW, Reimer MA. Measurement properties of the Calgary sleep apnea quality of life index. Am J Respir Crit Care Med. 2002;165(2):159-64.

26. Flemons WW. The Calgary Sleep Apnea Quality of Life Index (SAQLI) Manual. 1999. 1-14.

27. Chica-Urzola HL, Escobar-Córdoba F, Eslava-Schmalbach J. Validación de la Escala de Somnolencia de Epworth. Rev Salud Pública. 2007;9(4):558-67.

28. Elso TMJ, Brockmann VP, Zenteno AD. Consecuencias del síndrome de apnea obstructiva del sueño. Rev Chil Pediatr. 2013;84(2):128-37.

29. Lomelí HA, Pérez-Olmos I, Talero-Gutiérrez C, Moreno CB, González-Reyes R, Palacios L, et al. Escalas y cuestionarios para evaluar el sueño: una revisión. Actas Españolas Psiquiatr. 2008;36(1):50-9.

30. Lloberes P, Durán-Cantolla J, Martínez-García MÁ, Marín JM, Ferrer A, Corral J, et al. Diagnóstico y tratamiento del síndrome de apneas-hipopneas del sueño. Arch Bronconeumol. 2011;47(3):143-56.

31. Ip S, D’Ambrosio C, Patel K, Obadan N, Kitsios GD, Chung M, et al. Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses. Syst Rev [Internet]. 2012;1(1):20. Disponible en: http://www.systematicreviewsjournal.com/content/1/1/20.

32. Bazurto MA, Herrera K, Vargas L, Dueñas E, González-García M. Factores subjetivos asociados a la no adherencia a la CPAP en pacientes con síndrome de apnea hipopnea de sueño. Acta Médica Colomb. 2013;38(2):71-5.

33. Smith I, Nadig V, Lasserson TJ. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2009;(2).

Author notes

a Correspondencia: tatyanamatiz@hotmail.com

Additional information

How to Cite: Castellanos Caro GL, Matiz Ibarra TL, Bastidas Goyes AR, Bazurto MA, García Manrique JG. Quality of Life in Obstructive Sleep Apnea-hypopnea Syndrome. Univ Med. 2019;59(2):1-10. doi: http://dx.doi.org/10.11144/Javeriana.umed59-2.apne


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