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.

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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 mobile app. An Epworth Sleepiness Scale (ESS) score >10 defined EDS.
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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]).
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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.
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CLINICAL IMPLICATIONS: EDS is common in OSA despite CPAP adherence and is associated with high comorbidity burden, behavioral impact, and functional impairment.

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