Prevalence and predictors of Residual Sleepiness (RS) in Obstructive Sleep Apnea (OSA) Patients Treated with Positive Airway Pressure (PAP)

Abstract

<b>Background:</b> RS is prevalent in some OSA patients despite effective PAP treatment. <b>Aims and Objectives:</b> To assess RS prevalence in PAP-treated OSA patients and identify predictors associated with it. <b>Methods:</b> 514 OSA patients under PAP treatment between 2012 and 2019 were included. Excessive daytime sleepiness (EDS) defined as an Epworth Sleepiness Scale score (ESS) &gt;10 was assessed at baseline and at the end of follow up (mean 5 years). Logistic regression was used to analyze the factors associated RS, including age, gender, body mass index, ESS, OSA severity indices and comorbidities, subjective sleep latency at baseline and follow up, along with sleep diaries, medications and hours of PAP use. <b>Results:</b> EDS prevalence was 55% at baseline and RS was 15% at follow-up. ESS score decreased (5 vs 11, p&lt;0.001) and this was correlated with baseline ESS (β=0.768,&nbsp;p&nbsp;&lt; 0.001), diabetes (β=3.205,&nbsp;p=0.019) and hours of PAP use (β=0.303,&nbsp;p=0.04). Compared with non-sleepy patients, those with RS were predominantly males (82 vs 67%), with higher cardiovascular disease prevalence (CVD) (47 vs 27%), lower PAP use (4 vs 6 hours/day) and were sleepier at baseline (ESS 13 vs 10). Furthermore, RS was associated with CVD [OR (95% CI) 7.859 (1.194–51.704), p=0.032], ESS at baseline [OR (95% CI) 1.356 (1.083–1.698), p=0.008] and inversely associated with PAP use [OR (95% CI) 0.732 (0.589–0.911), p=0.005]. <b>Conclusions:</b> RS prevalence in PAP-treated OSA was up to 15% with major predictive factors baseline EDS, hours of PAP use, and presence of CVD. Further studies are warranted to clarify predictive patient characteristics, in order to provide adequate therapeutic options.