PMU101 Examining the IMPACT of Excessive Daytime Sleepiness on Utility Scores in Patients with Obstructive SLEEP Apnea and Narcolepsy in the EU5

Abstract

To examine the association between excessive daytime sleepiness (EDS) and EQ-5D in patients with obstructive sleep apnea (OSA) and/or narcolepsy to predict EQ-5D utility from EDS scores. Data were obtained from the EU5 2016 and 2017 National Health and Wellness Survey, an online, general population survey, using stratified random sampling based on age and sex for each country. Analyses included 2,348 patients self-reporting symptomatic and diagnosed OSA (n=2,277), narcolepsy (n=48), or both (n=23). The Epworth Sleepiness Scale (ESS), a patient-reported outcome, was used to determine EDS severity, with a score of ≤10 being ‘normal’, 11-12 mild, 13-15 moderate and 16+ severe. Piecewise linear regression was used to identify segments of ESS in predicting EQ-5D utility, while controlling for covariates. Model equation was validated following the National Institute for Health and Care Excellence Decision Support Unit guidelines for predictive modeling. Nominal P-values were reported. Utility decreased as EDS severity increased (normal: 0.711±0.251, mild: 0.685±0.261, moderate: 0.643±0.268, severe: 0.559±0.323). Patients with only OSA or narcolepsy did not differ in utility scores, but those with both conditions had lower scores (0.685±0.266 vs. 0.627±0.325 vs. 0.439±0.340, respectively, p<0.001). Piecewise linear regression identified a single breakpoint at ESS score 11.29 with a change of -0.0107 in slope (p=0.003). The final model, with a breakpoint at 11, yielded slopes of -0.0026 (p=0.11) and -0.0131 (p<0.001) for ESS scores 0-11 and 12-24, respectively. Results from the validation sample supported these findings. This study demonstrates the burden of sleepiness on quality of life (QoL) and its negative impact irrespective of sleep condition (OSA or narcolepsy). The breakpoint identified is relatively consistent with the established cutoff of scores ≤10 representing normal sleepiness and scores ≥11 representing pathological sleepiness. Increasing severity of sleepiness has a greater impact on QoL in the pathological range on the ESS.