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15 A real-world study assessing the relationship between positive airway pressure treatment, excessive daytime sleepiness, and patient satisfaction in obstructive sleep apnoea
  1. Sairam Parthasarathy1,
  2. Danielle Hyman2,
  3. James Doherty3,
  4. Ragy Saad3,
  5. Jerry Zhang3,
  6. Susan Morris2,
  7. Lev Eldemir4,
  8. Benjamin Fox5,
  9. Mai Ka Ying Vang5,
  10. Jessica Schroeder5,
  11. Nell J Marshall5 and
  12. Gregory Parks3
  1. 1University of Arizona, Tucson, USA
  2. 2Formerly of Jazz Pharmaceuticals, Palo Alto, USA
  3. 3Jazz Pharmaceuticals, Palo Alto, USA
  4. 4Formerly of Evidation Health, San Mateo, USA
  5. 5Evidation Health, San Mateo, USA


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.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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