Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients EDWARD M. WEAVER, MD, MPH, B. TUCKER WOODSON, MD, and DAVID L. STEWARD, MD, Seattle, Washington, Milwaukee, Wisconsin, and Cincinnati, Ohio OBJECTIVE: We tested whether polysomnography (PSG) indexes were associated with sleepiness, quality of life, or reaction times at baseline and as outcome measures following surgical or sham treatment for patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND METHODS: Mild–moderate OSAS subjects were measured before and 8 weeks after surgical or sham treatment in this prospective lon- gitudinal study. Measures included standard PSG indexes, sleepiness, quality of life, and reaction times. Associations were examined with Spearman correlations and multivariate linear regression. RESULTS: Correlations between baseline PSG and non-PSG measures ranged from 0.22 to 0.25 (n, 87 subjects; mean correlation, 0.00  0.11), with one positive association significant of 56 tested (arousal index and SF36 Mental Component Summary, r, 0.25; P  0.03). Correlations between change in PSG and non-PSG measures ranged from 0.37 to 0.35 (n, 54 subjects; mean correlation, 0.05  0.19), with no significant positive association of 56 tested. Regression analyses confirmed these results. CONCLUSIONS: PSG indexes are not consistently associated with sleepiness, quality of life, or reac- tion time, both at baseline and as outcome mea- sures in patients with mild–moderate OSAS. PSG in- dexes may not quantify some important aspects of OSAS disease burden or treatment outcome. Clini- cally important outcomes should be measured di- rectly. EBM rating: A. (Otolaryngol Head Neck Surg 2005;132:255-62.) P olysomnography (PSG) is considered the gold stan- dard for the diagnosis of obstructive sleep apnea syn- drome (OSAS), the estimation of its severity, and the measurement of treatment response. 1 Although OSAS includes both a PSG abnormality and symptoms, 2 its severity is often defined by the apnea-hypopnea index (AHI) alone. 2 Improvement of symptoms, quality of life, and function are important outcomes, especially for patients with milder OSAS where serious medical complications are less likely to occur. 3-6 Surgical treatments for OSAS have typically been judged on PSG outcomes. Anecdotally, however, pa- tients’ reports of improvement often are discordant with PSG outcomes. If true, then clinically important out- comes like symptoms, quality of life, and reaction times should be measured directly to evaluate surgical (and nonsurgical) treatment response. Previous reports indicate a poor association at base- line between standard PSG indexes and sleepiness, health status, and quality of life in different populations of OSAS patients. 7,8 We sought to determine whether PSG indexes are associated with sleepiness, quality of life, or reaction times at baseline and as outcomes after active or sham treatment, in a new sample of patients with mild to moderate OSAS. METHODS Study Design A subgroup analysis of data from a 2-institution randomized controlled trial 9 was performed to test the hypotheses that PSG indexes are not associated with sleepiness, quality of life, and reaction times before treatment or as outcomes 8 weeks after surgical or sham treatment for mild to moderate OSAS. Participants Eligible subjects were adults with (1) excessive day- time sleepiness, (2) mild or moderate OSAS on screen- ing sleep study, (3) no prior treatment for OSAS, and (4) no morbid obesity. Detailed inclusion and exclusion From the Department of Otolaryngology–Head and Neck Surgery (Dr Weaver), Sleep Disorders Center (Dr Weaver), and Center for Cost and Outcomes Research (Dr Weaver), University of Washington, Seattle, WA; the Department of Otolaryngology and Communication Sciences (Dr Woodson) and Sleep Disorders Program (Dr Woodson), Medical College of Wisconsin, Milwaukee, WI; and the Department of Otolaryngology–Head and Neck Surgery (Dr Steward), University of Cincinnati, Cincinnati, OH. Data collection was supported in part by a research grant from Gyrus-ENT. Dr. Weaver was supported by the Robert Wood Johnson Clinical Scholars Program during project development. Dr. Weaver is currently supported by a career development award (HL068849) from the National Heart, Lung, and Blood Institute, and by a career devel- opment scholars award from the American Geriatrics Society. Presented at the Annual Meeting of the American Academy of Otolaryngol- ogy–Head and Neck Surgery, Orlando, FL, Sept. 21-24, 2003. Reprint requests: Edward M. Weaver, 1660 S. Columbian Way (112-OTO), Seattle, WA 98108; e-mail, eweaver@u.washington.edu. 0194-5998/$30.00 Copyright © 2005 by the American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. doi:10.1016/j.otohns.2004.11.001 255