Eliciting the quality of life impact of OSA with residual EDS using a time trade-off methodology

Introduction: Excessive daytime sleepiness (EDS) is a common symptom of obstructive sleep apnoea (OSA). People with EDS typically experience impaired cognitive and social functioning, and an urge to sleep at inappropriate times. These factors can negatively impact work productivity, driving ability, and quality of life (QoL) of patients and their partners. Objectives: To elicit QoL values (utilities) from a societal perspective for patients, and partners of patients, with OSA-associated residual EDS of varying severity, using a novel time trade-off (TTO) approach, and to compare these utilities to published EQ-5D-based estimates. Methods: A TTO study was conducted via face-to-face interviews with a general public sample (N=110). This assessed changes in perceived QoL across different EDS severity health states where participants ‘trade-off’ time in a described state for a shorter period in full health to generate a QoL value (scale of 0-1) for each EDS severity state (no EDS, mild, moderate, severe). Results: Mean utility scores declined with increasing EDS severity: no EDS 0.926; mild 0.794; moderate 0.614; severe 0.546. Utility scores for severe EDS patients were lower than published estimates based on EQ-5D-3L (0.747) and EQ-5D-5L (0.551). Partner perspective health state utilities also declined with increasing severity (0.955 for no EDS to 0.670 for severe). Conclusion: Results show the adverse QoL impact of EDS in OSA from both the patient and partner perspective. TTO utility values from a general population sample are lower than EQ-5D utilities collected in patients for more severe EDS states, potentially due to limited sensitivity and applicability of the generic EQ-5D to EDS in OSA.