Psychometric aspects of obstructive sleep apnea syndrome

.................................................................................................................... 2 ABBREVIATIONS........................................................................................................... 3 INTRODUCTION ............................................................................................................. 4 DEFINING SLEEP RELATED OBSTRUCTIVE BREATHING DISORDERS.................. 5 Definitions of specific syndroms .................................................................................................................................5 Definitions of events .....................................................................................................................................................7 DIAGNOSTIC PROCEDURE .......................................................................................... 9 EPIDEMIOLOGY........................................................................................................... 11 Prevalence in various populations ............................................................................................................................11 Risk factors for obstructive sleep apnea...................................................................................................................15 Obesity ....................................................................................................................................................................15 Age ..........................................................................................................................................................................16 Gender .....................................................................................................................................................................17 Consequences of obstructive sleep apnea.................................................................................................................17 Mortality..................................................................................................................................................................17 Hypertension ...........................................................................................................................................................21 Other cardiovascular diseases .................................................................................................................................24 Diabetes mellitus .....................................................................................................................................................28 Sleepiness................................................................................................................................................................29 Cognitive deficits ........................................................................................................................................................30 Accidents.................................................................................................................................................................31 TREATMENT ................................................................................................................ 32 Surgery........................................................................................................................................................................32 Mandibular advancement devices ............................................................................................................................32 Continuous Positive Airway Pressure ......................................................................................................................33 Adherence to CPAP treatment ................................................................................................................................34 AIMS ............................................................................................................................. 38 PAPER I: DEVELOPMENT AND INITIAL TESTING OF SECI..................................... 39 Rationale for paper I..................................................................................................................................................39 Methods.......................................................................................................................................................................39 Item generation........................................................................................................................................................39 Data collection.........................................................................................................................................................40 Statistical processing and analysis...........................................................................................................................41 Results .........................................................................................................................................................................41 Study population .....................................................................................................................................................41 Validity and reliability of the SECI.........................................................................................................................42 PAPER II: TYPE D PERSONALITY.............................................................................. 43 Rationale for paper II ................................................................................................................................................43 Methods.......................................................................................................................................................................43 Data collection.........................................................................................................................................................43 Questionnaires.........................................................................................................................................................43 Statistical processing and analysis...........................................................................................................................44 Results .........................................................................................................................................................................44 Study population .....................................................................................................................................................44 Type D personality and side effects ........................................................................................................................45 Type D personality and adherence ..........................................................................................................................45 PAPER III: DIFFERENTIAL ITEM FUNCTIONING IN THE EPWORTH SLEEPINESS SCALE .......................................................................................................................... 47 Rationale for paper III ..............................................................................................................................................47 Methods.......................................................................................................................................................................47 Data collection.........................................................................................................................................................47 Statistical analysis ...................................................................................................................................................48 Results .........................................................................................................................................................................49 Study population .....................................................................................................................................................49 General psychometric properties of the ESS...........................................................................................................49 Differential item functioning...................................................................................................................................50 PAPER IV: CPAP SIDE EFFECTS – EVOLUTION OVER TIME AND ASSOCIATION TO ADHERENCE.......................................................................................................... 51 Rationale .....................................................................................................................................................................51 Method ........................................................................................................................................................................51 Data collection.........................................................................................................................................................51 Statistical analysis ...................................................................................................................................................51 Results .........................................................................................................................................................................52 Study population .....................................................................................................................................................52 Prevalence of side effects ........................................................................................................................................53 Evolution of side effects over time..........................................................................................................................53 Association between side effects and adherence.....................................................................................................54 ETHICAL CONSIDERATIONS...................................................................................... 56 DISCUSSION ................................................................................................................ 58 Defining side effects ...................................................................................................................................................58 Measuring side effects................................................................................................................................................59 Defining adherence ....................................................................................................................................................60 Measuring adherence.................................................................................................................................................62 Side effects and adherence: Why would they be related?.......................................................................................63 Type D personality .....................................................................................................................................................64 Definition and prevalence .......................................................................................................................................64 Relationship to other personality constructs............................................................................................................65 Putative mechanisms linking type D personality to adherence ...............................................................................66 Temporal evolution of side effects ............................................................................................................................67 Defining and measuring sleepiness ...........................................................................................................................69 Epworth Sleepiness Scale........................................................................................................................................69 Future research ..........................................................................................................................................................71 CONCLUSIONS ............................................................................................................ 73 POPULÄRVETENSKAPLIG SAMMANFATTNING ...................................................... 75 ACKNOWLEDGEMENTS ............................................................................................. 77 REFERENCES .............................................................................................................. 78