Identiﬁcation of quality of life concerns of patients with obstructive sleep
apnoea at the time of initiation of continuous positive airway pressure:
A discourse analysis
D. Veale, G. Poussin, F. Benes, J.-L. Pepin & P. Levy
Sleep Laboratory, CHU Grenoble, Centre Pneumologique, Henri Bazire, France
Accepted in revised form 9 January 2002
Background: Obstructive sleep apnoea syndrome (OSAS) is a common condition with multiple symptoms
dominated by daytime somnolence. Thus many worries and concerns of patients remain hidden. Treatment
by nasal continuous positive airway pressure (CPAP) can be imposing for the individual. An analysis of the
freely expressed concerns of such patients is required. Objective: To seek an in-depth analysis of how patients
live with sleep apnoea by allowing them an open discourse and analysing the text of their statements. Design:
A trained psychologist conducted semi-directive interviews with patients attending a pulmonary rehabili-
tation and convalescent unit around the themes of sleep, health and treatment. An analysis of content and of
discourse was carried out by textual analysis and by propositional analysis of discourse (PAD) with the aid
of dedicated computer programs (Tropes, Sphinx Lexica). Results: Thirty patients with severe sleep apnoea
were interviewed of whom 15 were initiating treatment with CPAP. Patients spoke of abnormal fatigue (22
mentions) and somnolence (21 times). Many have problems with obesity (25 instances), snoring related
problems (12). There were 30 mentions of depression with a relationship to alcohol and anti-depressives.
Twenty six times the theme of nocturnal waking was raised. There were many instances of problems with
CPAP (nasal mask and noise problems raised 21 times). Patients have problems with relationships and sex
because of OSAS. Other concerns were loss of memory and fear of dying. Conclusion: In a non-directed
conversation OSAS patients express concerns not revealed in the standard medical paradigm and such
concerns should be addressed in assessing treatment or evaluating quality of life (QOL).
Key words: Interview, Symptoms, Sleep apnoea syndrome
Obstructive sleep apnoea syndrome (OSAS) aﬀects
4% of men and 2% of women between the ages of
30 and 60 . The overwhelmingly predominant
symptom is daytime somnolence, which over-
shadows many other problems  such as morning
headache, night-time sweats, agitated sleep, clini-
cal depression  and ultimately reduced health-
related quality of life (QOL) .
The most widely used and most eﬀective treat-
ment of OSAS consists of the application of con-
stant pressure (6–18 cm H
O) produced by a small
turbine blower transmitted through ﬂexible tubing
into a ﬁrmly ﬁtting mask on the patient’s nose .
Obviously such treatment used exclusively during
sleep is very constraining. While this continuous
positive airway pressure (CPAP) treatment is eﬀec-
tive in alleviating the symptoms of OSAS  it has
Funding Fonds de recherche CHU de Grenoble.
Quality of Life Research 11: 389–399, 2002.
2002 Kluwer Academic Publishers. Printed in the Netherlands.