@article{3105911,
    title = "Use of the Clinical Global Impression scale in sleep apnea patients – Results from the ESADA database",
    author = "Dieltjens, M. and Verbraecken, J.A. and Hedner, J. and Vanderveken, O.M. and Steiropoulos, P. and Kvamme, J.A. and Saaresranta, T. and Tkacova, R. and Marrone, O. and Dogas, Z. and Schiza, S. and Grote, L. and Steiropoulos, P. and Verbraecken, J. and Petiet, E. and Trakada, G. and Montserrat, J.M. and Fietze, I. and Penzel, T. and Ludka, O. and Rodenstein, D. and Masa, J.F. and Bouloukaki, I. and Schiza, S. and Kent, B. and McNicholas, W.T. and Ryan, S. and Riha, R.L. and Kvamme, J.A. and Schulz, R. and Grote, L. and Hedner, J. and Zou, D. and Pépin, J.L. and Levy, P. and Bailly, S. and Lavie, L. and Lavie, P. and Hein, H. and Basoglu, O.K. and Tasbakan, M.S. and Varoneckas, G. and Joppa, P. and Tkacova, R. and Staats, R. and Barbé, F. and Lombardi, C. and Parati, G. and Drummond, M. and van Zeller, M. and Bonsignore, M.R. and Marrone, O. and Escourrou, P. and Roisman, G. and Pretl, M. and Vitols, A. and Dogas, Z. and Galic, T. and Pataka, A. and Anttalainen, U. and Saaresranta, T. and Sliwinski, P. and Plywaczewski, R. and Bielicki, P. and Zielinski, J. and ESADA collaborators",
    journal = "Sleep Medicine",
    year = "2019",
    volume = "59",
    pages = "56-65",
    publisher = "Elsevier B.V.",
    issn = "1389-9457",
    doi = "10.1016/j.sleep.2018.10.028",
    keywords = "adult;  aged;  apnea hypopnea index;  Article;  body mass;  Clinical Global Impression scale;  controlled study;  daytime somnolence;  disease severity;  Epworth sleepiness scale;  female;  follow up;  human;  major clinical study;  male;  polysomnography;  positive end expiratory pressure;  priority journal;  scoring system;  sleep disordered breathing;  clinical trial;  comorbidity;  factual database;  middle aged;  multicenter study;  prospective study;  severity of illness index;  sleep disordered breathing, Adult;  Aged;  Comorbidity;  Databases, Factual;  Female;  Humans;  Male;  Middle Aged;  Polysomnography;  Prospective Studies;  Severity of Illness Index;  Sleep Apnea, Obstructive",
    abstract = "Objective/Background: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). Patients/Methods: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement). Results: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, ‘normal, not ill’ 24.2% vs 15.3%, p < 0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta = −0.406, p < 0.01) was superior to sleep apnea severity or ESS-score (Beta = 0.052 and −0.021, p = 0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up. Conclusions: CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease. © 2018 Elsevier B.V."
}