Development of a Sleep Apnea-Specific Health State Utility Algorithm.

TitleDevelopment of a Sleep Apnea-Specific Health State Utility Algorithm.
Publication TypeJournal Article
Year of Publication2020
AuthorsSkirko JR, James KT, Garrison LP, Weaver EM
JournalJAMA Otolaryngol Head Neck Surg
Date Published2020 03 01
KeywordsAdolescent, Adult, Aged, Aged, 80 and over, Algorithms, Continuous Positive Airway Pressure, Female, Humans, Male, Middle Aged, Polysomnography, Quality of Life, Reproducibility of Results, Sleep Apnea, Obstructive, Symptom Assessment, Young Adult

Importance: With the increasing emphasis on economic evaluations, there is a need for additional methods of measuring patient utility in the obstructive sleep apnea population.

Objective: To develop and validate a utility scoring algorithm for a sleep apnea-specific quality-of-life instrument.

Design, Setting, and Participants: Development and validation were conducted at 2 tertiary referral sleep centers and associated sleep clinics and included patients with newly diagnosed obstructive sleep apnea from a randomized clinical trial and an associated observational cohort study. Baseline participants were randomly divided into a model development group (60%) and a cross-validation group (40%).

Main Outcomes and Measures: Utility scoring of the Symptoms of Nocturnal Obstruction and Related Events (SNORE-25) was mapped from the SF-6D utility index through multiple linear regression in the development sample using the Akaike information criterion to determine the best model.

Results: A total of 500 participants (development, n = 300; validation, n = 200) were enrolled; the analyzed sample of 500 participants included 295 men (59%), and the mean (SD) age was 48.6 (12.8) years, with a range of 18 to 90 years. The mean (SD) SF-6D utility among participants with untreated sleep apnea was 0.61 (0.08; range, 0.40-0.85) with similar utility across sleep apnea severity groups. The best-fit model (the SNORE Utility Index) was the natural log conversion of the instrument subscales (r2 = 0.32 in the development sample). The SNORE Utility Index retained this association within the validation sample (r2 = 0.33).

Conclusions and Relevance: The SNORE Utility Index provides a validated, disease-specific, preference-weighted utility instrument that can be used in future studies of patients with obstructive sleep apnea.

Alternate JournalJAMA Otolaryngol Head Neck Surg
PubMed ID31999308
PubMed Central IDPMC7042933
Grant ListUL1 TR002319 / TR / NCATS NIH HHS / United States
K23 HL068849 / HL / NHLBI NIH HHS / United States
R01 HL084139 / HL / NHLBI NIH HHS / United States
R01 HL084139 / HL / NHLBI NIH HHS / United States
Faculty Reference: 
Jonathan Skirko, MD, MHPA, MPH