(1303) Association Between Baseline Quality of Life and Decisional Conflict Among Patients Considering Sleep Surgery

Introduction: Patients with obstructive sleep apnea (OSA) carry significant burden in terms of symptoms, quality of life (QOL), and function. These patients face decisional conflict when considering sleep surgery, due to the combination of past difficulty with non-surgical therapy and sleep apnea burden versus the invasiveness and variable outcomes of surgery. We hypothesized that lesser baseline OSA QOL burden would be associated with greater decisional conflict among patients considering sleep surgery. This study is a step toward understanding factors impacting decisional conflict.

Methods: This prospective cohort study enrolled adults with OSA after surgical consultation from a Sleep Surgery Center with two sleep surgeons. Patients completed the validated SNORE-25 (OSA-specific QOL measure, 25 items, score range 0-5, higher worse) and validated Decisional Conflict Scale (16 items, score range 0-100, higher worse) at the time of enrollment. Records were extracted for demographics and other OSA measures. Multivariate linear regression analysis tested the association after adjustment for age, sex, and apnea-hypopnea index.

Results: Characteristics of the cohort (N = 159) include: mean+/-standard deviation age 41+/-13 years, 62% males, baseline apnea-hypopnea index 25+/-22, and baseline Epworth Sleepiness Scale 11+/-6. In multivariate analysis, there was no significant independent association between decisional conflict and SNORE-25 scores (adjusted R square 0.08, 95% confidence interval -1.72-4.02, p = 0.4).

Conclusions: Among patients considering sleep surgery, baseline decisional conflict was not associated with OSA QOL burden as a sole factor, independent of OSA physiologic burden (apnea-hypopnea index). Many factors may impact decisional conflict beyond OSA QOL burden, such as other forms of OSA burden, predisposition toward surgery, variable advice on the role of surgery, invasiveness and risks of surgery, and alternative options.