0548 EPWORTH SLEEPINESS SCALE SCORE CHANGES IN RESPONSE TO SLEEP DISORDERED BREATHING TREATMENT WITH POSITIVE AIRWAY PRESSURE IN A LARGE CLINIC BASED COHORT

Abstract

Excessive Daytime Sleepiness (EDS) in Sleep Disordered Breathing (SDB) represents a clinically relevant, specific phenotype which modifies the relationship of clinically important outcomes. We leverage a well-phenotype large clinical cohort to address the hypothesis that Positive Airway Pressure (PAP) reduces propensity of dozing in moderate to severe SDB more so than mild SDB. Questionnaire-based Epworth Sleepiness Scale (ESS) scores of 2,211 patients with SDB who initiated PAP (1/1/2010–12/31/2014) were retrospectively analyzed. Paired and two sample t tests were used to evaluate ESS changes with PAP stratified on PAP adherence (≥ 4 hours nightly ≥ 70% of the time). Post-PAP ESS scores were estimated using multi-variable linear regression models adjusted for pre-PAP score, age, gender, race, socioeconomic status, smoking, BMI, sleep duration, anti-depressants, co-morbidities (cardiac risk factors, cardiac disease, cancer chronic renal failure, depression and stroke). Statistical interactions of Patient Health Questionnaire-9 (PHQ-9), BMI and ESS were examined. Mean age was 56.2 ± 13.2 years, 45.7% females, and 76.0% Caucasian. Overall, ESS scores improved after PAP (2.4 (4.3), p < 0.01). Patients with baseline ESS score ≥ 10 had ESS improvement compared to < 10 (4.3 versus 0.7, p < 0.001). Patients with severe SDB had significant improvement in unadjusted ESS scores (2.7 versus 2.1, p=0.025). ESS improved by 2.7 (4.2) in those with meeting objective adherence criteria versus 1.9 (4.0) in the non-adherent group. Model adjusted ESS improved by 0.48 points (p=0.023) in patients with severe SDB versus mild SDB. Among patients with severe depressive symptoms, higher BMI was associated with higher post-PAP ESS score. PAP therapy is associated with improved EDS in this large clinic-based cohort with findings most pronounced in those with more severe SDB, with baseline hypersomnia and adherent to PAP. Higher depressive symptoms burden and obesity were associated with resistance to PAP hypersomnia responsiveness. We acknowledge the Knowledge Program Data Registry of Cleveland Clinic, Cleveland, OH for providing the data used in this retrospective analysis. We further acknowledge the Neurological Institute Center for outcome Research and Evaluation (NICORE) Cleveland Clinic, Cleveland, OH for providing bio-statistical support for this study.