Experimental studies often measure an individual’s quality of life before and after an intervention, with the data organized into a square table and analyzed using matched pair modeling. However, it is not unusual to find missing data in either round (i.e., before and/or after) of such studies and the use of multiple imputations with matched-pair modeling remains relatively unreported in the applied statistics literature. In this paper we introduce an approach which maintains dependency of responses over time and makes a match between the imputer and the analyst. We use ‘before’ and ‘after’ quality-of-life data from a randomized controlled trial to demonstrate how multiple imputation and matched-pair modeling can be congenially combined, avoiding a possible mismatch of imputation and analyses, and to derive a properly consolidated analysis of the quality-of-life data. We illustrate this strategy with a real-life example of one item from a quality-of-life study that evaluates the effectiveness of patients’ self-management of anticoagulation versus standard care as part of a randomized controlled trial.

Background: Obstructive sleep apnea (OSA) is a common sleep disorder associated with several adverse health outcomes. Given the close association between OSA and obesity, lifestyle and dietary interventions are commonly recommended to patients, but the evidence for their impact on OSA has not been systematically examined. Objectives: To conduct a systematic review and meta-analysis to assess the impact of weight loss through diet and physical activity on measures of OSA: apnea-hypopnea index (AHI) and oxygen desaturation index of 4% (ODI4). Methods: A systematic search was performed to identify publications using Medline (1948-2011 week 40), EMBASE (from 1988-2011 week 40), and CINAHL (from 1982-2011 week 40). The inverse variance method was used to weight studies and the random effects model was used to analyze data. Results: Seven randomized controlled trials (519 participants) showed that weight reduction programs were associated with a decrease in AHI (-6.04 events/h [95% confidence interval -11.18, -0.90]) with substantial heterogeneity between studies (I-2 = 86%). Nine uncontrolled before-after studies (250 participants) showed a significant decrease in AHI (-12.26 events/h [95% confidence interval -18.51, -6.02]). Four uncontrolled before-after studies (97 participants) with ODI4 as outcome also showed a significant decrease in ODI4 (-18.91 episodes/h [95% confidence interval -23.40, -14.43]). Conclusions: Published evidence suggests that weight loss through lifestyle and dietary interventions results in improvements in obstructive sleep apnea parameters, but is insufficient to normalize them. The changes in obstructive sleep apnea parameters could, however, be clinically relevant in some patients by reducing obstructive sleep apnea severity. These promising preliminary results need confirmation through larger randomized studies including more intensive weight loss approaches.