A real-world observational study assessing relationships between excessive daytime sleepiness and patient satisfaction in obstructive sleep apnea

Abstract

Objectives/background: To estimate prevalence and severity of excessive daytime sleepiness among patients with obstructive sleep apnea (OSA) who were prescribed treatment; assess perception and satisfaction of OSA-related care; describe relationships between excessive daytime sleepiness, treatment adherence, and patient satisfaction.

Patients/methods: A national population-based cross-sectional sample of US adults with clinician-diagnosed OSA was surveyed in January 2021 via Evidation Health's Achievement App. Patients completed the Epworth Sleepiness Scale, rated satisfaction with healthcare provider and overall OSA care, and reported treatment adherence. Covariates affecting excessive daytime sleepiness (average weekly sleep duration, treatment adherence, sleepiness-inducing medications, age, sex, body mass index, nasal congestion, smoking status, and comorbidities) were adjusted in multivariate regression models.

Results: In 2289 participants (50.3 % women; 44.8 ± 11.1 years), EDS was highly prevalent (42 %), and was experienced by 36 % of patients with high positive airway pressure (PAP) therapy adherence. Each additional hour of nightly PAP use was associated with improved sleepiness (a 0.28-point lower Epworth score; p < 0.001). Excessive daytime sleepiness was associated with lower patient satisfaction with healthcare providers and overall care (OR [95 % CI] 0.62 [0.48-0.80] and 0.50 [0.39-0.64], respectively; p < 0.0001), whereas PAP adherence was associated with higher patient satisfaction (OR [95 % CI] 2.37 [1.64-3.43] and 2.91 [2.03-4.17]; p < 0.0001), after adjusting for confounders.

Conclusions: In a real-world population-based study of patients with OSA, excessive daytime sleepiness was highly prevalent and associated with poor patient satisfaction ratings. Better patient-centered care among patients with OSA may require interventions aimed at addressing excessive daytime sleepiness and treatment adherence.

Keywords: Apnea; Excessive daytime sleepiness; Patient satisfaction; Treatment adherence.

Fig. 1.

PAP users with EDS were less satisfied with their overall OSA care and HCPs compared with PAP users without EDS. EDS, excessive daytime sleepiness; HCP, healthcare provider; OSA, obstructive sleep apnea; PAP, positive airway pressure. ^aTotal % of subgroups does not add to 100 due to rounding.

Fig. 2.

Frequency of EDS across PAP use subgroups. EDS, excessive daytime sleepiness; ESS, Epworth Sleepiness Scale; PAP, positive airway pressure. ^aIndividual % values may not add up to total % due to rounding.

Fig. 3.

Relationship between PAP use and EDS with patient satisfaction with HCPs, overall OSA care, and specific aspects of OSA care. CI, confidence interval; EDS, excessive daytime sleepiness; HCP, healthcare provider; OSA, obstructive sleep apnea; PAP, positive airway pressure. ^aPAP nonuse subgroup excluded. ^bControlled for age, sex, BMI, presence of congestion, smoking status, and presence of medical comorbidity in addition to the factors listed in the table. The satisfaction dependent variable was binary: “satisfied” (very satisfied, satisfied) and “not satisfied” (neither satisfied nor unsatisfied, unsatisfied, very unsatisfied). PAP adherence level was a binary variable: “adherent” (intermediate and highly adherent groups) and “nonadherent.”