A REAL-WORLD STUDY ASSESSING THE RELATIONSHIP BETWEEN POSITIVE AIRWAY PRESSURE TREATMENT, EXCESSIVE DAYTIME SLEEPINESS, AND PATIENT SATISFACTION IN OSA

Abstract

TOPIC: Sleep Disorders TYPE: Original Investigations PURPOSE: Excessive daytime sleepiness (EDS) persists in some positive airway pressure (PAP)-treated patients with obstructive sleep apnea (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 residents (aged ≥18 years, self-reported diagnosis of OSA [from 1/1/2015 to 3/31/2020]) completed a survey in Evidation Health’s Achievement app assessing the Epworth Sleepiness Scale (ESS), PAP usage, and satisfaction with healthcare providers (HCPs) and overall OSA care. Patients were categorized by self-reported PAP use (nonuse [no PAP use], 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]; PAP-adherent refers to the intermediate and highly adherent groups). ESS >10 defined EDS. A linear model assessed relationship between PAP use and ESS score; a logistic regression model assessed the impact of PAP use and EDS on satisfaction with HCPs and overall OSA care. P-values are uncontrolled for multiplicity (nominal). RESULTS: In total, 2289 participants completed the survey (50.3% female; 82.5% White; mean±standard deviation [SD] age, 44.8±11.1 years; body mass index, 35.4±8.7 kg/m2). PAP use was: nonuse (n=700), nonadherent (n=153), or adherent (n=1436; intermediate n=225, high n=1211). Overall, 42.5% had EDS (ESS>10); mean (95% confidence interval [CI]) ESS scores were 14.1 (13.9, 14.3) in those with EDS and 6.7 (6.5, 6.8) in those without. The proportion (95% CI) with EDS per group were: nonuse (47% [43.7, 51.1]), nonadherent (52% [44.4, 60.2]), intermediate (53% [46.4, 59.4]), and highly adherent (36% [33.7, 39.1]). In a linear model (PAP users; n=1589), an additional h/night of PAP use was associated with lower ESS scores (β=–0.28; 95% CI=–0.40, –0.16; P<0.001). Overall, 72% were satisfied with HCPs and 65% with OSA care. Logistic regression (PAP users; n=1589) identified a positive association between PAP adherence (nonadherence=0, adherence=1) and satisfaction with HCPs (adjusted odds ratio [adjOR]=2.37; 95% CI=1.64, 3.43; P<0.001) and satisfaction with overall OSA care (adjOR=2.91; 95% CI=2.03, 4.17; P<0.001). EDS was associated with lower satisfaction with HCPs (adjOR=0.62; 95% CI=0.48, 0.80; P<0.001) and overall OSA care (adjOR=0.50; 95% CI=0.39, 0.64; P<0.001). CONCLUSIONS: In this real-world study, ESS scores decreased as PAP use increased, but EDS remained highly prevalent even among highly adherent patients. 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. CLINICAL IMPLICATIONS: Strategies to improve patient satisfaction with OSA care should focus equally on PAP adherence and monitoring and resolution of residual EDS. DISCLOSURES: Employee relationship with Jazz Pharmaceuticals Please note: 2018-present Added 04/30/2021 by James Doherty, source=Web Response, value=Salary Consultant relationship with Evidation Health Please note: 08/2020-Present Added 05/03/2021 by Levon Eldemir, source=Web Response, value=Consulting fee Consultant relationship with Jazz Pharmaceuticals Please note: 08/2020 - Present Added 04/30/2021 by Benjamin Fox, source=Web Response, value=Consulting fee Employee relationship with Jazz Pharmaceuticals Please note: 2014 - current Added 04/13/2021 by Danielle Hyman, source=Web Response, value=Salary Stock Holder relationship with Jazz Pharmaceuticals Please note: 2014 - current Added 04/13/2021 by Danielle Hyman, source=Web Response, value=Ownership interest No relevant relationships by Nell Marshall, source=Web Response Employee relationship with Jazz Pharmaceuticals Please note: May 2018 to Present Added 05/05/2021 by Susan Morris, source=Web Response, value=Salary Employee relationship with Jazz Pharmaceuticals Please note: 4/2019-Present Added 04/13/2021 by Gregory Parks, source=Web Response, value=Salary Removed 04/13/2021 by Gregory Parks, source=Web Response Employee relationship with Jazz Pharmaceuticals Please note: 4/2019-Present Added 04/13/2021 by Gregory Parks, source=Web Response, value=Salary Employee relationship with Jazz Pharmaceuticals Please note: 4/2019-Present Added 04/13/2021 by Gregory Parks, source=Web Response, value=Ownership interest Employee relationship with Jazz Pharmaceuticals Please note: current Added 04/26/2021 by Gregory Parks, source=Web Response, value=Salary Employee relationship with Jazz Pharmaceuticals Please note: current Added 04/26/2021 by Gregory Parks, source=Web Response, value=stock options Consultant relationship with Jazz Pharmaceuticals, Inc. Please note: 2020-201 Added 04/29/2021 by Sairam Parthasarathy, source=Web Response, value=Consulting fee Employee relationship with Jazz Pharmaceuticals Please note: 11/1/2019 Added 05/02/2021 by Ragy Saad, source=Web Response, value=Stocks Consultant relationship with Jazz Pharmaceuticals Please note: 28 Aug 2020--Present Added 04/30/2021 by Jessica Schroeder, source=Web Response, value=Consulting fee Consultant relationship with Jazz Pharmaceuticals Please note: 08/2020 - Present Added 04/30/2021 by Mai Ka Ying Vang, source=Web Response, value=Consulting fee Removed 04/30/2021 by Mai Ka Ying Vang, source=Web Response Consultant relationship with Jazz Pharmaceuticals Please note: 08/2020 - Present Added 04/30/2021 by Mai Ka Ying Vang, source=Web Response, value=Consulting fee Employee relationship with Jazz Pharmaceuticals Please note: May 2020 Added 04/30/2021 by JERRY ZHANG, source=Web Response, value=Salary