Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Psychometric aspects of obstructive sleep apnea syndrome
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder consisting of episodes with impaired breathing due to obstruction of the upper airways. Treatment with Continuous Positive Airway Pressure (CPAP) is a potentially effective treatment, but adherence is low. Several potential factors affecting adherence, e.g., subjective sleepiness and personality, are only quantifiable through questionnaires. Better knowledge about psychometric properties of such questionnaires might improve future research on CPAP adherence and thus lead to better treatment options.

Aim: Study I: To describe the devlopment and initial testing of the Side Effects of CPAP treatment Inventory (SECI) questionnaire. Study II: To describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. Study III: To study whether any of the items in the Epworth Sleepiness Scale (ESS) exhibit differential item functioning and, if so, to which degree. Study IV: To examine the evolution of CPAP side effects over time; and prospectively assess correlations between early CPAP side effects and treatment adherence.

Patients and Methods: In study I, SECI items were based on a literature review, an expert panel and interviews with patients. It was then mailed to 329 CPAP-treated OSAS patients. Based on this, a principal component analysis was performed, and SECI results were compared between adherent and non-adherent patients. In study II, the population consisted of 247 OSAS patients with ongoing CPAP treatment. The DS14 was used to assess the prevalence of type D personality, and SECI and adherence data from medical records were used to correlate Type D personality to side effects and adherence. In study III, the population consisted of pooled data from 1,167 subjects who had completed the ESS in five other studies. Ordinal regression and Rasch analysis were used to assess the existence of differential item functioning for age and gender. The cutoff for age was 65 years in the Rasch analysis. In study IV, SECI was sent to 186 subjects with newly diagnosed OSAS three times during the first year on CPAP. SECI results were followed over time within subjects, and were correlated to treatment dropout during the first year and machine usage time after 6 months.

Results: SECI provides a valid and reliable instrument to measure side effects, and non-adherent patients have higher scores (i.e., were more bothered by side effects) than adherent patients (study I). Type D personality was prevalent in approximately 30 % of CPAP treated OSAS patients, and was associated to poorer objective and subjective adherence as well as more side effects (study II). Differential item functioning was present in items 3, 4 and 8 for age in both DIF analyses, and to gender in item 8 the Rasch analysis (study III). Dry mouth and increased number of awakenings were consistently associated to poorer adherence in CPAP treated patients. Side effects both emerged and resolved over time (study IV).

Conclusions: Differences in previous research regarding side effects and CPAP adherence might be explained by differences in how side effects and adherence are defined. While some side effects are related to adherence, others are not. Side effects are furthermore not stable over time, and might be related to personality. ESS scores are also related to CPAP adherence according to previous research, but might be affected by other factors than sleepiness, such as age and possibly gender.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. , 102 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1378
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-97475ISBN: 978-91-7519-528-5 (print)OAI: oai:DiVA.org:liu-97475DiVA: diva2:647949
Public defence
2013-10-04, Victoriasalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-09-13 Created: 2013-09-13 Last updated: 2013-09-13Bibliographically approved
List of papers
1. The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment
Open this publication in new window or tab >>The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment
Show others...
2010 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 4, 603-611 p.Article in journal (Refereed) Published
Abstract [en]

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach’s α = 0.74–0.86) and acceptable for the subscales (Cronbach’s α = 0.62–0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.

Place, publisher, year, edition, pages
John Wiley & Sons, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63451 (URN)10.1111/j.1365-2869.2010.00825.x (DOI)
Available from: 2010-12-20 Created: 2010-12-20 Last updated: 2017-12-11Bibliographically approved
2. Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS
Open this publication in new window or tab >>Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS
Show others...
2007 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, no 4, 439-447 p.Article in journal (Refereed) Published
Abstract [en]

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires, the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment. © 2007 European Sleep Research Society.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-41182 (URN)10.1111/j.1365-2869.2007.00620.x (DOI)55306 (Local ID)55306 (Archive number)55306 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-01-10Bibliographically approved
3. The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning
Open this publication in new window or tab >>The fairness of the Epworth Sleepiness Scale: two approaches to differential item functioning
Show others...
2013 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 17, no 1, 157-165 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

Differential item functioning (DIF) is said to exist in an item if a subject’s response to the item is affected by other aspects than that which the test is intended to assess. DIF might affect the validity of a test. The aim of this study was thus to examine whether any of the items in the Epworth Sleepiness Scale (ESS) exhibits DIF regarding age or gender, and if so, to which degree.

Methods

Using previously collected cross-sectional ESS data from 1,168 subjects with different clinical characteristics (61% males, mean age 67.8 year (SD 12.2 year)), ordinal regression as well as Rasch-based DIF analyses were performed.

Results

Concerning age, both DIF analyses showed DIF for age in items 3 (inactive in a public place), 4 (passenger in a car), and 8 (in a car that has stopped in traffic). The Rasch model also showed DIF for gender in item 3. The DIF magnitudes as judged by McFadden pseudo-R2 changes were, however, only minor.

Conclusions

ESS has small but reproducible DIF for age in items 3, 4, and 8. The detected DIF might be worth to consider in large-sample studies, although it probably has no effect on an individual basis.

Place, publisher, year, edition, pages
Springer, 2013
Keyword
Epworth Sleepiness Scale, Differential item functioning, Sleep, Daytime sleepiness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89964 (URN)10.1007/s11325-012-0664-8 (DOI)000315167200029 ()22367404 (PubMedID)
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2017-12-06
4. Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence
Open this publication in new window or tab >>Side effects of Continuous Positive Airway Pressure treatment for Obstructive Sleep Apnea: Changes over time and association to adherence
Show others...
2014 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 18, no 4, 799-807 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: Continuous Positive Airway Pressure is an effective treatment for obstructive sleep apnea, but adherence is often low and side effects are common. It is unclear from previous research whether side effects are significant causes of non-adherence. No study has examined if side effects vary within subjects over time. The aims were to 1) examine the evolution of CPAP side effects over time; and 2) prospectively assess correlations  between early CPAP side effects and treatment adherence. Methods: 186 obstructive sleep apnea patients from three sleep centres were prospectively enrolled. They completed the Side Effects to CPAP Inventory, where the respondent rates the frequency, magnitude and perceived impact on adherence from 15 side effects. Adherence was measured by treatment dropout and machine usage time. Results: The most common side effects were dry mouth, increased number of awakenings, blocked up nose, mask pressure and mask leaks. While some side effects were stable over time, others could both resolve and emerge within subjects. Dry mouth, mask leakage and blocked up nose emerged within one year in approximately 30% of patients who had not experienced them after two weeks. Increased number of awakenings and dry mouth after 1-2 weeks were significantly associated to treatment dropout during the first year and machine usage time after six months. Conclusions: While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.

Place, publisher, year, edition, pages
Springer, 2014
Keyword
Obstructive sleep apnea/adverse effects, Continuous positive airway pressure, Adherence, Side Effects to CPAP Inventory
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-97474 (URN)10.1007/s11325-014-0945-5 (DOI)000344784800018 ()24557772 (PubMedID)
Available from: 2013-09-13 Created: 2013-09-13 Last updated: 2017-12-06Bibliographically approved

Open Access in DiVA

Psychometric aspects of obstructive sleep apnea syndrome(365 kB)623 downloads
File information
File name FULLTEXT01.pdfFile size 365 kBChecksum SHA-512
2b9c3a255f8f833c4507ec6843c4d0b0fb95942799fad346268c3bc3a891b7c7c95158b5167223c07c7f300e8303c118a5e82478e6023500919171a52c380e6b
Type fulltextMimetype application/pdf
omslag(58 kB)25 downloads
File information
File name COVER01.pdfFile size 58 kBChecksum SHA-512
2614356998f446d6da747cb09eae0a01b77f0e737ff94db4d67efb1cbc5f749eb2337594847e670e988f6096df2691f4c992dfe1fe2599c8f5e13ac2185369c2
Type coverMimetype application/pdf

Search in DiVA

By author/editor
Ulander, Martin
By organisation
Division of NeuroscienceFaculty of Health SciencesDepartment of Clinical Neurophysiology
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 623 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 733 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf