Conference contribution 20. OCT 2022
Real-world impact of continuous positive airway pressure on sleepiness in patients with obstructive sleep apnoea in a National Registry. [Oral abstract]
Authors:
- Poul Jørgen Jennum
- Jakob Kjellberg
- G. Carls
- Rikke Ibsen
- S. Mettam
Objectives/Introduction: Excessive daytime sleepiness (EDS) persists in some patients with obstructive sleep apnoea (OSA) despite continuous positive airway pressure (CPAP) treatment. This study aimed to identify real-world impacts of CPAP on EDS in patients with OSA.
Methods: Data from the Danish National Patient Registry were analysed. Inclusion criteria were OSA diagnosis between 1994–2016, and Epworth Sleepiness Scale (ESS) scores and apnoea-hypopnoea index (AHI) recorded before beginning CPAP therapy (baseline) and following 1–13 months of CPAP therapy. Patients were excluded if CPAP adherence was unknown. Patients were categorised by ESS score as no EDS (≤10), mild EDS (11–12), moderate EDS (13–15), and severe EDS (≥16).
Results: Among 1174 eligible patients (mean ± SD age, 57 ± 12 years; 75.5% male), 692 had no EDS, 155 had mild EDS, 164 had moderate EDS, and 163 had severe EDS at baseline. Overall, 13% and 9.5% of patients used sedatives before and during CPAP treatment, respectively; few used stimulants. During CPAP treatment, 52.5% of patients were CPAP-adherent (use > 4 h/night) on ≥70% of nights. Mean ± SD AHI at baseline was 29.0 ± 24.4 overall; means ranged from 25.2 (no EDS) to 37.3 (severe EDS); after starting CPAP, mean AHI was ≤4.1 for all groups. Mean ± SD ESS score at baseline was 9.5 ± 5.2 overall, and 5.9 ± 3.0, 11.5 ± 0.5, 14.0 ± 0.8, and 18.2 ± 2.0 for the no-EDS, mild-EDS, moderate-EDS, and severe-EDS groups, respectively. At follow-up, mean ± SD changes in ESS score were –3.1 ± 5.1 overall, and –0.8 ± 3.7, –4.0 ± 4.1, –6.4 ± 4.0, and −8.8 ± 5.5 for the no-EDS, mild-EDS, moderate-EDS, and severe-EDS groups, respectively. Across all groups, mean ESS scores following CPAP treatment were in the normal range (≤10). 76% of patients in the mild-EDS group, 78% in the moderate-EDS group, and 60% in the severe-EDS group achieved ESS scores in the normal range. Furthermore, 17% of the severe-EDS group remained severely sleepy.
Conclusions: EDS before CPAP was common among this cohort of patients with OSA. For most patients, ESS scores normalised after CPAP therapy. Patients with severe EDS improved the most, but EDS persisted in a subgroup of patients.
Methods: Data from the Danish National Patient Registry were analysed. Inclusion criteria were OSA diagnosis between 1994–2016, and Epworth Sleepiness Scale (ESS) scores and apnoea-hypopnoea index (AHI) recorded before beginning CPAP therapy (baseline) and following 1–13 months of CPAP therapy. Patients were excluded if CPAP adherence was unknown. Patients were categorised by ESS score as no EDS (≤10), mild EDS (11–12), moderate EDS (13–15), and severe EDS (≥16).
Results: Among 1174 eligible patients (mean ± SD age, 57 ± 12 years; 75.5% male), 692 had no EDS, 155 had mild EDS, 164 had moderate EDS, and 163 had severe EDS at baseline. Overall, 13% and 9.5% of patients used sedatives before and during CPAP treatment, respectively; few used stimulants. During CPAP treatment, 52.5% of patients were CPAP-adherent (use > 4 h/night) on ≥70% of nights. Mean ± SD AHI at baseline was 29.0 ± 24.4 overall; means ranged from 25.2 (no EDS) to 37.3 (severe EDS); after starting CPAP, mean AHI was ≤4.1 for all groups. Mean ± SD ESS score at baseline was 9.5 ± 5.2 overall, and 5.9 ± 3.0, 11.5 ± 0.5, 14.0 ± 0.8, and 18.2 ± 2.0 for the no-EDS, mild-EDS, moderate-EDS, and severe-EDS groups, respectively. At follow-up, mean ± SD changes in ESS score were –3.1 ± 5.1 overall, and –0.8 ± 3.7, –4.0 ± 4.1, –6.4 ± 4.0, and −8.8 ± 5.5 for the no-EDS, mild-EDS, moderate-EDS, and severe-EDS groups, respectively. Across all groups, mean ESS scores following CPAP treatment were in the normal range (≤10). 76% of patients in the mild-EDS group, 78% in the moderate-EDS group, and 60% in the severe-EDS group achieved ESS scores in the normal range. Furthermore, 17% of the severe-EDS group remained severely sleepy.
Conclusions: EDS before CPAP was common among this cohort of patients with OSA. For most patients, ESS scores normalised after CPAP therapy. Patients with severe EDS improved the most, but EDS persisted in a subgroup of patients.
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Published in
Journal of Sleep Research
