Collateral damage: the effects of obstructive sleep apnea on bed partners.

nocturnal oxygen desaturation using pulse oximeter and apnomonitor in patients with chronic pulmonary disease. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular dis-eases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. W hile health-related problems have a definite and identifiable effect on patients, the patients' families are also very much affected. This may reach such a level of intensity that the patient will present to a physician because their family desires that they be evaluated and treated. Most clinicians would agree that sleep apnea is one of those conditions that stimulates familial assertion. The dynamics and repercussions of these encounters on the doctor-patient relationship and the doctor-family relationship may be staggering. The willingness and compliance of a patient with treatment may be a result of familial coercion. The effect of medical illness on families has been studied in a wide variety of diseases, varying from pediatric cancers to mental illness. Quality-of-life scales and indexes also have been developed but have focused mainly on the patients. Five different categories of measurement can be performed. Measures can be generic, disease-specific, population-specific, dimension-specific, or of utility. 1 One such generic scale is the short form-36 (SF-36). This 10-min general health survey looks at the patient's self-report of the physical and mental distress of having a specific medical illness. The physical component examines physical functioning, role-physical (accomplishment), bodily pain, and general health. The mental component examines vitality (energy), social functioning, role-emotional (accomplishment), and mental health. The reliability and validity of this scale for patients to compare the effect of interventions has been confirmed. 1,2 The benefit of using such a generic scale, is that the effect of an illness on a patient can be compared against the effect that other diseases have on patients and against national normative values. A population-specific scale that also can be used for patients with daytime sleepiness, including those with obstructive sleep apnea, is the Epworth sleep-iness scale. This is an eight-item questionnaire that asks patients to rank their drowsiness and likeliness to fall asleep in different routine situations (for example, while watching television). While the utility of this scale as a subjective assessment of daytime sleepiness has been established, it has not correlated well with objective measurements. 3,4 Our current objective measurements of sleepiness may, however, benefit from adjustment. 5 Finally, a disease-specific scale has been created to assess patients …