Introduction Excessive daytime sleepiness (EDS) persists in some positive airway pressure (PAP)-treated patients with obstructive sleep apnoea (OSA). This study examined prevalence and severity of EDS in a real-world population with OSA to understand how EDS, PAP adherence, and patient satisfaction with care relate.
Methods US-resident adults (self-reported clinician OSA diagnosis [1/1/2015-31/3/2020]) were surveyed (Epworth Sleepiness Scale [ESS], PAP usage, and patient satisfaction) in Evidation Health’s Achievement app. Self-reported PAP use was categorised: nonuse, nonadherent (<4 h/night or <5 d/wk), intermediate (4-6 h/night, ≥5 d/wk), or highly adherent (≥6 h/night, ≥5 d/wk). ESS>10 defined EDS. In PAP users, a linear model tested whether PAP use and ESS score relate; logistic regression models tested how PAP use (nonadherence=0, adherence=1) and EDS impact satisfaction with healthcare providers (HCPs) and overall OSA care. Due to no adjustments for multiplicity, P-values are nominal.
Results Of 2289 participants (50.3% female; mean±SD 44.8±11.1 years old; 42.5% ESS>10), 72% were satisfied with HCPs and 65% with OSA care. In the nonuse (n=700), nonadherent (n=153), intermediate (n=225), and highly adherent (n=1211) groups, 47%, 52%, 53%, and 36% had EDS, respectively. An additional h/night PAP use was associated with lower ESS scores (n=1589, β=–0.28; 95% confidence interval [CI]=–0.40, –0.16; P<0.001). In PAP users (n=1589), adherence associated with higher satisfaction with HCPs (adjusted odds ratio [adjOR]=2.37; 95% CI=1.64, 3.43; P<0.001) and OSA care (adjOR=2.91; 95% CI=2.03, 4.17; P<0.001), and EDS with less satisfaction with HCPs (adjOR=0.62; 95% CI=0.48, 0.80; P<0.001) and OSA care (adjOR=0.50; 95% CI=0.39, 0.64; P<0.001).
Discussion In this real-world study, EDS was prevalent among highly adherent PAP users. PAP adherence was associated with greater patient satisfaction with HCPs and overall care, whereas persistent EDS was associated with lower patient satisfaction with HCPs and overall OSA care.
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