Sleep Goal Index (SGI) – New Outcome Measures, Beyond Apnea Hypopnea Index
Main Article Content
Abstract
Snoring affects not only the bed-partner’s sleep quality, but may also cause the break down in the marriage and relationship. Sleepiness, poor concentration and irritability affects quality of life, work and productivity. Successful treatment of an OSA patient would imply reversing debilitating symptoms faced by the patient, including the metabolic and oxidative stress that accompanies the disease load/burden. There is widespread evidence showing significant discordance between AHI used to denote outcomes of therapy and real-world clinical outcomes such as QOL, patient perception of disease, cardiovascular measures, disease burden and/or survival. It is widely accepted that AHI can vary from night to night, from laboratory to laboratory, from various nasal thermistor to pressure transducers. Different definitions of hypopnea used in different laboratories and software affect AHI values. The reliance on AHI as the only outcome measure assessed in clinical research is not in line with many other aspects of medicine that are becoming patient-centered as opposed to test-centered. Outcome measures of OSA should be based on end-organs effects rather than only one highly variable parameter, AHI. Too much weightage has been given to this single parameter (AHI) that is well known for its variability. Patients are concerned and affected by “real tangible” issues like loud snoring, daytime sleepiness, uncontrolled hypertension, obesity, high glucose levels; these are the effects of OSA as a systemic disease affecting end-organs, manifesting as these patient related symptoms or complaints. An example of more comprehensive outcome parameters would include end-organ effects like the Blood Pressure, Gross Weight (BMI), Oxygen Time Spent below 90% (T90), and AHI; these were collectively introduced as the Sleep Goal Index. This review article will highlight the short-comings of the AHI and illustrate holistic outcome measures that better reflect the oxidative stress that affect the OSA patient.
Keywords:
Sleep Apnea, Sleep Goal Index, Outcome Measures, AHI
Article Details
How to Cite
PANG, Kenny P. et al.
Sleep Goal Index (SGI) – New Outcome Measures, Beyond Apnea Hypopnea Index.
Medical Research Archives, [S.l.], v. 13, n. 6, june 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6601>. Date accessed: 17 july 2025.
doi: https://doi.org/10.18103/mra.v13i6.6601.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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3. Shakar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Critical Care Med 2001; 163(1): 19-25.
4. Bradley TD. Right and Left ventricular functional impairment and sleep apnea. Clin Chest Med. 1992; 13(3): 459-79.
5. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996; 19(2): 156-77.
6. Baldwin CM, Griffith KA, Nieto FJ, O'Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 2001; 24(1): 96-105
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8. Chediak AD, Acevedo-Crespo JC, Seiden DJ, Kim HH, Kiel MH. Nightly variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms. Sleep. 1996;19:589–592
9. Le Bon O, Hoffmann G, Tecco J, Staner L, Noseda A, Pelc I, Linkowski P. Mild to moderate sleep respiratory events: one negative night may not be enough. Chest. 2000; 118:353–359.
10. Levendowski D, Zack N, Rao SM. Assessment of the test-retest reliability of laboratory polysomnography. Sleep Breath. 2008.
11. Stepnowsky CJ Jr1, Orr WC, Davidson TM. Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngol Head Neck Surg. 2004 Dec;131(6):837-43.
12. Pordzik J, Seifen C, Ludwig K, Ruckes C, Huppertz T, Matthias C, Gouveris H. Waiting for in-Lab Polysomnography May Unnecessarily Prolong Treatment Start in Patients with Moderate or Severe OSA at Home Sleep Apnea Testing. Nat Sci Sleep. 2024 Dec 5;16:1881-1889
13. Teixeira RCP, Cahali MB. In-Laboratory Polysomnography Worsens Obstructive Sleep Apnea by Changing Body Position Compared to Home Testing. Sensors (Basel). 2024 Apr 27;24(9):2803
14. Zafar S, Ayappa I, Norman R. Choice of oximeter affects apnea-hyponea index sleep staging reliability. Sleep. 2004;27:1171–1179.
15. Pevernagie DA, Gnidovec-Strazisar B, Grote L, Heinzer R, McNicholas WT, Penzel T, Randerath W, Schiza S, Verbraecken J, Arnardottir ES. On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal. J Sleep Res. 2020 Aug;29(4):e13066
16. Guilleminault C., Connolly S., Winkle R. Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique. The Lancet. 1984;1(8369):126–131
17. Rossi V. A., Stradling J. R., Kohler M. Effects of obstructive sleep apnoea on heart rhythm. European Respiratory Journal. 2013;41(6):1439–1451
18. Gami A. S., Olson E. J., Shen W. K., et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. Journal of the American College of Cardiology. 2013;62(7):610–616.
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21. Muiesan ML, Salvetti M, Rizzoni D, Paini A, Agabiti-Rosei C, Aggiusti C, et al. Resistant hypertension and target organ damage. Hypertens Res. 2013;36:485–491
22. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–817.
23. Milleron O, Pillière R, Foucher A, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J 2004;25:728-34
24. Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.
25. Weaver TE, Mancini C, Maislin G, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med 2012;186:677-83
26. Craig SE, Kohler M, Nicoll D, et al. Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial. Thorax 2012;67:1090-6
27. Bratton DJ, Stradling JR, Barbé F, et al. Effect of CPAP on blood pressure in patients with minimally symptomatic obstructive sleep apnoea: a meta-analysis using individual patient data from four randomised controlled trials. Thorax 2014;69:1128-35.
28. Lozano L, Tovar JL, Sampol G, et al. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 2010;28:2161-8
29. Martínez-García MA, Capote F, Campos-Rodríguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 2013;310:2407-15.
30. Pang KP, Woodson BT. The Pang-Woodson Protocol. Chapter 4. Advanced Surgical Techniques in Snoring and OSA. Chief Editor: Pang KP, Co-Editors: Rotenberg BR, Woodson BT. 1st Edition. Plural Publishing.
31. Thong JF, Pang KP. Clinical parameters in obstructive sleep apnea: are there any correlations? OHNS 2008 Dec;37(6):894-900.
32. Pang KP, Terris DJ, Podolsky R. Severity of obstructive sleep apnea: correlation with clinical examination and patient perception. Otolaryngol Head Neck Surg. 2006 Oct;135(4):555-60.
33. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 2002;127(1):13–21.
34. Nashi N, Kang S, Barkdull GC, Lucas J, Davidson TM. Lingual fat at autopsy. The Laryngoscope. 2007;117(8):1467–73.
35. Ahn SH, Kim J, Min HJ, Chung HJ, Hong JM, Lee JG, Kim CH, Cho HJ. Tongue Volume Influences Lowest Oxygen Saturation but Not Apnea-Hypopnea Index in Obstructive Sleep Apnea. PLoS One. 2015 Aug 17;10(8)
36. Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H, Torigian DA, Pack AI, Schwab RJ. Tongue fat and its relationship to obstructive sleep apnea. Sleep. 2014 Oct 1;37(10):1639-48.
37. Shelton KE, Woodson H, Gay S, Suratt PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993;148:462–6.
38. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–545
39. Baldwin CM, Griffith KA, Nieto FJ, O'Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep. 2001;24:96–105
40. D'Ambrosio C, Bowman T, Mohsenin V. Quality of life in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure--a prospective study. Chest. 1999;115:123–9
41. Jenkinson C, Stradling J, Petersen S. Comparison of three measures of quality-of-life outcome in the evaluation of continuous positive airways pressure therapy for sleep apnoea. J Sleep Res. 1997;6:199–204.
42. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213.
43. Jing J, Huang T, Cui W, Shen H. Effect on quality of life of continuous positive airway pressure in patients with obstructive sleep apnea syndrome: a meta-analysis. Lung. 2008;186:131–44
44. Weaver TE, Mancini C, Maislin G, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med. 2012;186:677–83. This article illustrates the results of CPAP on sleepiness.
45. Kuna ST, Gurubhagavatula I, Maislin G, et al. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:1238–44.
46. Phillips CL, Cistulli PA, Grunstein RR. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2013;187:8. Elegant study showing the comparisons.
47. Woodson BT, Steward DL, Weaver EM, Javaheri S. A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2003;128:848–61
48. Ware J, Kosinski M, Keller S. SF-36 physical and mental health summary scales: a user's manual. Health Assessment Lab. 1994
49. Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.
50. Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E. A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health. 1980;34:281–6.
51. EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208
52. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43
53. Weaver TE, Laizner AM, Evans LK, et al. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997;20:835–43
54. Flemons WW, Reimer MA. Measurement properties of the calgary sleep apnea quality of life index. Am J Respir Crit Care Med. 2002;165:159–64
55. Pang KP, Olszewska E, Braverman I, Yang CH, Alkan U, Chan YH, Vicinic C, Cammarato G, Bovolenta E, Cheng RCT, Unadkat S, Siow JK, Shocat I, Bahgat A, Carrasco-Llatas M, Kishore S, Chandra S, Chan YH, Baptista P, Casale M, Pang SB, Lim JW, Montevecchi F, Pang E, Pang CE, Moffa A, Rotenberg B. Sleep Goal Index: A new success criteria in 618 OSA patients. MJM. 2025. Submitted
2. Nieto JF, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of SDB, sleep apnea and hypertension in a large community-based study. JAMA 2000; 283(14): 1829-36.
3. Shakar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Critical Care Med 2001; 163(1): 19-25.
4. Bradley TD. Right and Left ventricular functional impairment and sleep apnea. Clin Chest Med. 1992; 13(3): 459-79.
5. Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996; 19(2): 156-77.
6. Baldwin CM, Griffith KA, Nieto FJ, O'Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 2001; 24(1): 96-105
7. Pang KP, Baptista PM, Olszewska E, Braverman I, Carrasco-Llatas M, Kishore S, Chandra S, Yang HC, Chan YH, Pang KA, Pang EB, Rotenberg B. SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients. Med J Malaysia. 2020 Mar;75(2):117-123.
8. Chediak AD, Acevedo-Crespo JC, Seiden DJ, Kim HH, Kiel MH. Nightly variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms. Sleep. 1996;19:589–592
9. Le Bon O, Hoffmann G, Tecco J, Staner L, Noseda A, Pelc I, Linkowski P. Mild to moderate sleep respiratory events: one negative night may not be enough. Chest. 2000; 118:353–359.
10. Levendowski D, Zack N, Rao SM. Assessment of the test-retest reliability of laboratory polysomnography. Sleep Breath. 2008.
11. Stepnowsky CJ Jr1, Orr WC, Davidson TM. Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngol Head Neck Surg. 2004 Dec;131(6):837-43.
12. Pordzik J, Seifen C, Ludwig K, Ruckes C, Huppertz T, Matthias C, Gouveris H. Waiting for in-Lab Polysomnography May Unnecessarily Prolong Treatment Start in Patients with Moderate or Severe OSA at Home Sleep Apnea Testing. Nat Sci Sleep. 2024 Dec 5;16:1881-1889
13. Teixeira RCP, Cahali MB. In-Laboratory Polysomnography Worsens Obstructive Sleep Apnea by Changing Body Position Compared to Home Testing. Sensors (Basel). 2024 Apr 27;24(9):2803
14. Zafar S, Ayappa I, Norman R. Choice of oximeter affects apnea-hyponea index sleep staging reliability. Sleep. 2004;27:1171–1179.
15. Pevernagie DA, Gnidovec-Strazisar B, Grote L, Heinzer R, McNicholas WT, Penzel T, Randerath W, Schiza S, Verbraecken J, Arnardottir ES. On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal. J Sleep Res. 2020 Aug;29(4):e13066
16. Guilleminault C., Connolly S., Winkle R. Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique. The Lancet. 1984;1(8369):126–131
17. Rossi V. A., Stradling J. R., Kohler M. Effects of obstructive sleep apnoea on heart rhythm. European Respiratory Journal. 2013;41(6):1439–1451
18. Gami A. S., Olson E. J., Shen W. K., et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. Journal of the American College of Cardiology. 2013;62(7):610–616.
19. Marin J. M., Carrizo S. J., Vicente E., Agusti A. G. N. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lancet. 2005;365(9464): 1046–1053
20. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117:e510–e526
21. Muiesan ML, Salvetti M, Rizzoni D, Paini A, Agabiti-Rosei C, Aggiusti C, et al. Resistant hypertension and target organ damage. Hypertens Res. 2013;36:485–491
22. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LK, Amaro AC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–817.
23. Milleron O, Pillière R, Foucher A, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J 2004;25:728-34
24. Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.
25. Weaver TE, Mancini C, Maislin G, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med 2012;186:677-83
26. Craig SE, Kohler M, Nicoll D, et al. Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial. Thorax 2012;67:1090-6
27. Bratton DJ, Stradling JR, Barbé F, et al. Effect of CPAP on blood pressure in patients with minimally symptomatic obstructive sleep apnoea: a meta-analysis using individual patient data from four randomised controlled trials. Thorax 2014;69:1128-35.
28. Lozano L, Tovar JL, Sampol G, et al. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 2010;28:2161-8
29. Martínez-García MA, Capote F, Campos-Rodríguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 2013;310:2407-15.
30. Pang KP, Woodson BT. The Pang-Woodson Protocol. Chapter 4. Advanced Surgical Techniques in Snoring and OSA. Chief Editor: Pang KP, Co-Editors: Rotenberg BR, Woodson BT. 1st Edition. Plural Publishing.
31. Thong JF, Pang KP. Clinical parameters in obstructive sleep apnea: are there any correlations? OHNS 2008 Dec;37(6):894-900.
32. Pang KP, Terris DJ, Podolsky R. Severity of obstructive sleep apnea: correlation with clinical examination and patient perception. Otolaryngol Head Neck Surg. 2006 Oct;135(4):555-60.
33. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 2002;127(1):13–21.
34. Nashi N, Kang S, Barkdull GC, Lucas J, Davidson TM. Lingual fat at autopsy. The Laryngoscope. 2007;117(8):1467–73.
35. Ahn SH, Kim J, Min HJ, Chung HJ, Hong JM, Lee JG, Kim CH, Cho HJ. Tongue Volume Influences Lowest Oxygen Saturation but Not Apnea-Hypopnea Index in Obstructive Sleep Apnea. PLoS One. 2015 Aug 17;10(8)
36. Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H, Torigian DA, Pack AI, Schwab RJ. Tongue fat and its relationship to obstructive sleep apnea. Sleep. 2014 Oct 1;37(10):1639-48.
37. Shelton KE, Woodson H, Gay S, Suratt PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993;148:462–6.
38. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–545
39. Baldwin CM, Griffith KA, Nieto FJ, O'Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep. 2001;24:96–105
40. D'Ambrosio C, Bowman T, Mohsenin V. Quality of life in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure--a prospective study. Chest. 1999;115:123–9
41. Jenkinson C, Stradling J, Petersen S. Comparison of three measures of quality-of-life outcome in the evaluation of continuous positive airways pressure therapy for sleep apnoea. J Sleep Res. 1997;6:199–204.
42. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213.
43. Jing J, Huang T, Cui W, Shen H. Effect on quality of life of continuous positive airway pressure in patients with obstructive sleep apnea syndrome: a meta-analysis. Lung. 2008;186:131–44
44. Weaver TE, Mancini C, Maislin G, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med. 2012;186:677–83. This article illustrates the results of CPAP on sleepiness.
45. Kuna ST, Gurubhagavatula I, Maislin G, et al. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:1238–44.
46. Phillips CL, Cistulli PA, Grunstein RR. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2013;187:8. Elegant study showing the comparisons.
47. Woodson BT, Steward DL, Weaver EM, Javaheri S. A randomized trial of temperature-controlled radiofrequency, continuous positive airway pressure, and placebo for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2003;128:848–61
48. Ware J, Kosinski M, Keller S. SF-36 physical and mental health summary scales: a user's manual. Health Assessment Lab. 1994
49. Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.
50. Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E. A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health. 1980;34:281–6.
51. EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208
52. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43
53. Weaver TE, Laizner AM, Evans LK, et al. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997;20:835–43
54. Flemons WW, Reimer MA. Measurement properties of the calgary sleep apnea quality of life index. Am J Respir Crit Care Med. 2002;165:159–64
55. Pang KP, Olszewska E, Braverman I, Yang CH, Alkan U, Chan YH, Vicinic C, Cammarato G, Bovolenta E, Cheng RCT, Unadkat S, Siow JK, Shocat I, Bahgat A, Carrasco-Llatas M, Kishore S, Chandra S, Chan YH, Baptista P, Casale M, Pang SB, Lim JW, Montevecchi F, Pang E, Pang CE, Moffa A, Rotenberg B. Sleep Goal Index: A new success criteria in 618 OSA patients. MJM. 2025. Submitted