Objectives/Background: To estimate prevalence and severity of excessive daytime sleepiness among patients with obstructive sleep apnea (OSA) who were prescribed treatment; assess perception and satisfaction of OSA-related care; describe relationships between excessive daytime sleepiness, treatment adherence, and patient satisfaction. Patients/methods: A national population-based cross-sectional sample of US adults with clinician-diagnosed OSA was surveyed in January 2021 via Evidation Health's Achievement App. Patients completed the Epworth Sleepiness Scale, rated satisfaction with healthcare provider and overall OSA care, and reported treatment adherence. Covariates affecting excessive daytime sleepiness (average weekly sleep duration, treatment adherence, sleepiness-inducing medications, age, sex, body mass index, nasal congestion, smoking status, and comorbidities) were adjusted in multivariate regression models. Results: In 2289 participants (50.3 % women; 44.8 +/- 11.1 years), EDS was highly prevalent (42 %), and was experienced by 36 % of patients with high positive airway pressure (PAP) therapy adherence. Each additional hour of nightly PAP use was associated with improved sleepiness (a 0.28-point lower Epworth score; p < 0.001). Excessive daytime sleepiness was associated with lower patient satisfaction with healthcare providers and overall care (OR [95 % CI] 0.62 [0.48-0.80] and 0.50 [0.39-0.64], respectively; p < 0.0001), whereas PAP adherence was associated with higher patient satisfaction (OR [95 % CI] 2.37 [1.64-3.43] and 2.91 [2.03-4.17]; p < 0.0001), after adjusting for confounders. Conclusions: In a real-world population-based study of patients with OSA, excessive daytime sleepiness was highly prevalent and associated with poor patient satisfaction ratings. Better patient-centered care among patients with OSA may require interventions aimed at addressing excessive daytime sleepiness and treatment adherence.

ABSTRACT Objectives This real-world study aimed to characterize the impact of illness of excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) who are adherent to continuous positive airway pressure (CPAP). Methods This cross-sectional study surveyed participants in Evidation Health’s Achievement app (November 2020–January 2021), a mobile consumer platform that encourages users to develop healthy habits and provides incentives to participate in research. Participants were US-resident adults who self-reported a physician diagnosis of OSA and adherence to CPAP (≥4 hours/night, ≥5 nights/week) for≥6 months. The survey included the Functional Outcomes of Sleep Questionnaire-Short Version (FOSQ-10), Epworth Sleepiness Scale (ESS), and questions regarding comorbidities, CPAP use, caffeine consumption, and physical activity. EDS was defined as ESS score >10. There were more female than male participants; therefore, data were reported separately for females/males. Results In total, 476 participants (female, n = 283 [59%]; mean [SD] age, 49.7 [10.8] years; obese, 74.4%) completed the survey; 209 had EDS (mean [SD] ESS, 13.8 [2.5]) and 267 did not (mean [SD] ESS, 6.3 [2.5]). Self-reported duration of CPAP use was consistent between the EDS/no EDS cohorts, with most participants using CPAP for 7 to 9 hours/night, 7 nights/week. Participants with EDS commonly reported anxiety ([EDS/no EDS] males: 31.5%/20.0%; females: 53.7%/39.5%), depression (males: 35.6%/24.2%; females: 55.9%/44.9%), and insomnia (males: 19.2%/6.7%; females: 25.7%/12.9%) and showed impairment on the FOSQ-10 ([EDS/no EDS] males: 80.8%/35.0%; females: 91.9%/53.1%). Participants with EDS reported that sleepiness ‘very often’ prevented physical activity and influenced dietary choices. Conclusion EDS influences choices related to physical activity, caffeine consumption, and diet in patients who are adherent with CPAP. More research is needed to understand the association between EDS and choices of CPAP-adherent patients. Future research should explore the health-related consequences of residual EDS associated with OSA and whether they can be mitigated by improving EDS. Plain Language Summary Approximately 1 billion people worldwide have a sleep disorder called obstructive sleep apnea (OSA). People with OSA experience a blockage in their upper airway during sleep, which can lead to snoring, gasping for air, difficulty breathing, and disturbed sleep. As a result, 50%–80% of people with OSA experience excessive daytime sleepiness (EDS) – the irresistible need to sleep during the daytime. Many people (9%–22%) who are treated for OSA using continuous positive airway pressure (CPAP) still experience EDS. Previous studies have described the negative impact EDS has on people, such as decreased work productivity and increased risk of motor vehicle accidents. However, it is unclear if EDS impacts health, behavioral choices, and lifestyle in the real world. This study surveyed people with OSA and collected their Fitbit data using Evidation’s Achievement app. People with OSA and EDS reported having anxiety, depression, insomnia, and other health problems more often than people with OSA without EDS. Also, people with OSA and EDS reported having more impairments in daytime functioning than people with OSA without EDS. Furthermore, people with OSA and EDS reported that sleepiness ‘very often’ prevented them from engaging in physical activity. Women with OSA and EDS said that sleepiness ‘very often’ influenced their food choices. People with OSA and EDS also used caffeine and ‘sometimes’ used physical activity to stay awake during the daytime. Findings from this study show people with OSA alter their lifestyle and behavioral choices because of EDS.

Abstract Introduction Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), despite positive airway pressure (PAP) therapy. These analyses evaluated EDS prevalence and its relationship with satisfaction with care in participants with OSA receiving OSA care in a primary care setting. Methods US residents (aged ≥18 years, self-reported physician OSA diagnosis [1/1/2015–3/31/2020]) completed a survey in Evidation Health’s Achievement app assessing Epworth Sleepiness Scale (ESS), specialties of healthcare providers (HCPs) treating OSA, PAP usage, and satisfaction with HCPs and overall OSA care. Self-reported PAP use was categorized: nonuse, nonadherent (<4 h/night, <5 d/wk), intermediate (4–6 h/night, ≥5 d/wk), or highly-adherent (≥6 h/night, ≥5 d/wk) (PAP-adherent=intermediate+highly-adherent groups). Linear modeling assessed the relationship between PAP use and ESS score; logistic regression assessed impacts of PAP adherence and EDS on satisfaction with care. P-values are uncontrolled for multiplicity. Results Participants (N=2289) were 50.3% female; 82.5% White; 44.8±11.1 years old (mean±SD); with BMI 35.4±8.7 kg/m2; 42.5% had EDS (ESS>10). OSA was primarily managed by sleep specialists (43.5%), general practitioners (GPs) (42.5% [28.9% saw a GP only; 13.6% saw a GP and a specialist/pulmonologist]), and/or pulmonologists (18.0%). Among participants with OSA managed by a GP only (n=662), proportions (95% CI) with EDS were: PAP nonuse (49% [42.8–54.9]), nonadherent (47% [31.5–63.2]), intermediate (47% [33.4–60.8]), and highly-adherent (35% [29.3–39.9]). Linear modeling (PAP users; n=398) showed an additional h/night of PAP use was associated with lower ESS scores (estimate [SE], –0.26 [0.13]; P<0.05); logistic regression showed association between PAP adherence and higher satisfaction with HCPs (adjOR=2.26; 95% CI=1.09–4.70; P<0.05) and OSA care (adjOR=1.58; 95% CI=0.75–3.36; P>0.05). There was an association between presence of EDS and lower satisfaction with their HCPs (adjOR=0.62; 95% CI=0.39–0.99; P<0.05) and OSA care (adjOR=0.49; 95% CI=0.31–0.79; P<0.05). Conclusion In a real-world population of participants with OSA receiving OSA care from GPs, EDS was common, even among highly-adherent PAP users. ESS scores were generally lower with increasing PAP adherence. PAP adherence was associated with increased satisfaction with their HCPs; EDS was associated with lower satisfaction with HCPs and overall OSA care. Support (If Any) Jazz Pharmaceuticals

Abstract Introduction Excessive daytime sleepiness (EDS) is common in patients with obstructive sleep apnea (OSA) and can persist despite use of positive airway pressure (PAP) therapy. These analyses assessed relationships between EDS, PAP use, and patient satisfaction across several aspects of OSA care in a real-world population with OSA. Methods US residents (aged ≥18 years, self-reported physician OSA diagnosis [1/1/2015–3/31/2020]) completed a survey in Evidation Health’s Achievement app assessing Epworth Sleepiness Scale (ESS), PAP usage, and satisfaction with care. Self-reported PAP use was categorized as nonuse, nonadherent (<4 h/night; <5 d/wk), intermediate (4–6 h/night, ≥5 d/wk), or highly adherent (≥6 h/night, ≥5 d/wk) (PAP-adherent=intermediate and highly adherent groups). Logistic regression models assessed impacts of PAP adherence and EDS on satisfaction with care across 7 domains. P-values are uncontrolled for multiplicity (nominal). Results Among all participants (N=2289; 50.3% female, 82.5% White, 44.8±11.1 years old [mean±SD], 35.4±8.7 kg/m2 body mass index [mean±SD]), 42.5% had EDS (ESS>10). PAP use was: nonuse (n=700), nonadherent (n=153), or adherent (n=1436; intermediate n=225, high n=1211). Within these subgroups, the proportions (95% CI) with EDS 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]). Logistic regression (using data from PAP users) showed a positive association of PAP adherence with satisfaction with PAP (OR [95% CI]: 5.43 [3.73–7.90]); OSA treatment effectiveness (3.56 [2.48–5.12]); OSA symptom management (3.15 [2.17–4.57]); coordination of OSA care (2.60 [1.82–3.72]); and education from their healthcare provider on the impact of OSA on cardiovascular health (1.62 [1.13–2.35]), importance of using PAP (1.7 [1.15–2.52]), or availability of prescription drugs to treat OSA symptoms (1.55 [1.06–2.26]). The presence of EDS was associated with lower patient satisfaction in nearly all domains examined (ORs ranged from 0.44–0.62 across 6 of 7 domains). Conclusion EDS was common in this real-world population with OSA, even among participants who were highly adherent PAP users. PAP adherence was associated with higher patient satisfaction across all care domains; the presence of EDS was associated with lower patient satisfaction across 6 of 7 domains. Support (If Any) Jazz Pharmaceuticals