Health-Related Burden of Illness Associated with Excessive Daytime Sleepiness in Patients with OSA Compliant with CPAP Treatment

Chest Journal

Gradner M., Stack C., Min J., Saad R., Leary E., Eldermir L., and Hyman D.

PURPOSE: Obstructive sleep apnea (OSA) can lead to excessive daytime sleepiness (EDS) despite continuous positive airway pressure (CPAP) use, and is associated with a range of cardiometabolic, psychiatric, and other comorbidities. Self-reported data were used to characterize the health-related burden of illness (BOI) of EDS in OSA.

METHODS: Eligible participants (adult US residents, self-reported physician diagnosis of OSA, self-reported adherent [≥4 hours/night, ≥5 nights/week] CPAP use ≥6 months, Fitbit use [≥10 hours/day, ≥4 days/week], and average total time in bed ≥6 hours/night) completed a survey in Evidation Health’s Achievement app. An Epworth Sleepiness Scale (ESS) score >10 defined EDS.
RESULTS: In total, 476 participants (n=193 male, n=283 female) completed the survey; 209 had EDS (n=73 male, n=136 female; mean±standard deviation [SD] ESS score=13.8±2.5) and 267 did not (n=120 male, n=147 female; mean±SD ESS score=6.3±2.5). Mean±SD age was 49.7±10.8 years; most were obese (74.4%), white (87.6%), and employed full-time (64.9%). Participants with EDS commonly reported anxiety ([EDS vs no EDS] males: 31.5% vs 20.0%; females: 53.7% vs 39.5%), depression (males: 35.6% vs 24.2%; females: 55.9% vs 44.9%), restless legs syndrome (males: 11.0% vs 5.8%; females: 19.9% vs 15.0%), and insomnia (males: 19.2% vs 6.7%; females: 25.7% vs 12.9%). The percentage of those with and without EDS with impairment on the Functional Outcomes of Sleep Questionnaire-10 was 80.8% and 35.0%, respectively (males), and 91.9% and 53.1%, respectively (females). Differences (EDS–no EDS) in proportions (95% confidence interval) showed that those with EDS more frequently reported that sleepiness very often prevented physical activity (males: 13% [0.5, 25.5]; females: 24% [13.2, 35.3]), and they sometimes used physical activity to stay awake (males: 12% [−0.7, 24.0]; females: 15% [5.0, 25.2]). More participants with EDS reported sleepiness very often influenced dietary choices (males: 9% [−2.4, 20.8]; females: 18% [7.6, 28.6]) as well as consuming caffeine mainly to stay awake throughout the day (males: 8% [−0.3, 17.3]; females: 14% [5.9, 21.2]) and to combat fatigue (males: 3% [−5.3, 11.7]; females: 6% [−0.3, 12.6]); fewer reported consuming caffeine due to the taste (males: −12% [−25.5, 1.6]; females: −7% [−18.3, 5.2]) or as part of their routine (males: −10% [−20.4, 1.3]; females: −11% [−19.6, −2.2]).

CONCLUSIONS: Participants with EDS had a higher health-related BOI vs those without EDS; their sleepiness often prevented physical activity and drove caffeine use to stay awake. Further research is needed to understand how improving EDS may improve health-related behaviors or outcomes in CPAP-treated patients with OSA.

CLINICAL IMPLICATIONS: EDS is common in OSA despite CPAP adherence and is associated with high comorbidity burden, behavioral impact, and functional impairment.