Health-related quality of life in patients with obstructive sleep apnea – a systematic review update assessing the quality of measurement properties of patient-reported outcome measures

PURPOSE: The purpose of this systematic review update was to identify existing health-related quality of life (HRQOL) patient-reported outcome measures (PROMs) for obstructive sleep apnea (OSA). Building upon a 2016 systematic review, which recommended four PROMs with the highest evidence, this investigation was warranted to synthesize new evidence and evaluate new PROMs that have emerged since then via the Consensus based Standards for the Selection of Health Measurement Instruments (COSMIN). METHODS: We searched Medline via PubMed, Embase and the Cochrane Library for HRQOL PROM development and validation studies published in English or German. Studies focusing on cross-cultural validation, those in which PROMs were assessed as secondary outcomes, and studies limited to specific demographic subgroups or single HRQOL domains were excluded. For risk of bias and quality of measurement properties (MP) assessment, we used the COSMIN methodology to facilitate comparability with the previous review, as well as the GRADE approach for evidence level evaluation. RESULTS: We identified two new PROMs, the Patient-Reported Apnea Questionnaire (PRAQ) and the Symptoms, Tiredness, Alertness, Mood and Psychosocial instrument (STAMP), which were validated in two studies and a single study, respectively. Overall, the PRAQ displays an moderate risk of bias with excellent quality of MP and high evidence for content validity in particular, whereas the STAMP shows a higher risk of bias and low quality of MP. CONCLUSION: The PRAQ has demonstrated the strongest evidence among PROMs since 2016. In total, including the previous review, five PROMs are currently recommended for assessing HRQOL in individuals with OSA. REVIEW REGISTRATION: The review was registered with PROSPERO under the registration number CRD42024602020.