31 March 2023

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OSA Wellness Scale: A new quality of life test in obstructive sleep apnea patients

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The OSA Well-being Scale (OWS) is a questionnaire created to quantify the state of the malaise of the apneic patient with a mathematical number. It is a quick and easy-to-understand tool aimed at all social classes for screening and final post-therapy control, to be combined with the Epworth scale, medical history, and polysomnography or cardio-respiratory monitoring to try to obtain a broader view of the impact of OSA pathology on the malaise of the apneic patient as this may present absence of symptoms ( OSA patient) or, conversely, be symptomatic (OSAS patient), regardless of the number of apneas and hypopneas (AHI) present, which however determine their clinical severity.

Obstructive sleep apnea (OSA) is a respiratory disease characterized by repeated episodes of upper airway collapse and obstruction during sleep associated with awakening from sleep, with or without oxygen desaturation. The obstruction can be complete (apnea) or partial (hypopnea) during sleep. The consequences of OSA are linked to two important aspects: the modification of the quality of sleep time and the alteration of respiratory gaseous exchanges.

Continuous nocturnal awakenings alter the physiological sleep cycle, modifying sleep quality, daytime life, and health-related quality of life. Nocturnal awakenings also generate unsettling and unrefreshing sleep, which causes daytime sleepiness, head and neck pain, loss of concentration, anxiety or depression, weakness, and nocturnal bruxism.

Untreated obstructive sleep apnea (OSA) requires medical intervention and is related to impaired work performance and workplace injuries. The economic burden associated with untreated OSA is highly significant. The economic impact of untreated OSA patients is related to the limitation of work performance, the increase in the number of occupational accidents, road accidents, and frequent hospitalizations for cardiovascular diseases (stroke and heart attack). OSA is comparable to other chronic diseases, and it is very difficult to describe its economic effects exactly, but patients with OSA are estimated to cause a substantial economic burden on society (see focus on Dentistry33).

OSAs are associated with general increased respiratory effort, the presence of intermittent hypoxia, increased systemic blood pressure, and sleep disturbances. Most affected individuals are undiagnosed. Factors that increase susceptibility to the disorder include age, male gender, menopause, obesity, craniofacial abnormalities, family history, and health behaviors such as cigarette smoking and use of l 'alcohol.

Patients with OSA can present with several typical symptoms, including chronic snoring (often destructive to the sleeping partner), feeling unrefreshed upon awakening, excessive daytime sleepiness (EDS), psychological disturbances, and cognitive and emotional disturbances which may also give rise to conflicts with family and social. Perceived health-related quality of life is impaired and disturbed by obstructed breathing that occurs during sleep.

Patients with OSA often report poor quality human resources in social, emotional, and physical terms. We can have overlapping symptoms such as fatigue, loss of interest, decreased libido, and poor concentration.

OSA represents a chronic inflammatory pathology; consequently, the patient, over time, tends to get used to the general malaise that this pathology entails. The patient himself struggles to identify it as the main cause of the malaise because it is a nocturnal pathology that allows sleep as a number of hours of sleep but does not allow rest as there is a continuous fragmentation of sleep itself associated with intermittent hypoxia. This leads to a profound malaise and discomfort that is difficult to explain to everyone, including the partner. The patient tends to blame other external causes, such as heavy dinner, seasons, age, worries, etc... The clinician will have to try to interpret, which is always not easy, whether the discomfort is caused by the OSA pathology or not, such as depression in postmenopausal women. It will be up to the Clinician to make an objective general diagnostic evaluation with the help and use of all the aforementioned tools; the OWS scale is one of them. 

The OSA Well-being Scale (OWS) questionnaire is an 8-item self-assessment questionnaire developed to assess the level of the general malaise of the OSA patient. The questionnaire takes into consideration various situations of daily life, and for each of them, the subject must establish a vote, the sum of which quantifies the degree of malaise of the issue himself. It is a self-administered test and returns the result on a numerical scale from 0 to 24: it is generally accepted that a score > 5 is indicative of the presence of a probable state of malaise. It was decided to apply the same number of questions and the same numerical scale of the Epworth Scale (a scale that is applied worldwide to quantify the level of daytime sleepiness present) in order to have a direct and immediate numerical comparison of the state of malaise and of excessive daytime sleepiness (EDS) on the same patient. 

This need is due to the fact that sleepiness is indeed a cardinal sign of OSA, but it is not present in all apneic patients. The heterogeneous team composed of Dentists and Otolaryngologists experts in Sleeping Medicine has made possible the recognition, verification, development, and procedures to be able to arrive at the international publication of the OSA Wellness Scale (OWS).