Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database.

Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) which resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (ESADA) (n=4853, mean age ± SD 54.8±11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, IQR 3-13) . An ESS>10 occurred in 56% of patients at baseline, and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2190 patients (age: 55.1±12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, IQR 1-15). Sleep studies during CPAP use were obtained in 69% of these patients; EDS was reported by 54% of patients at baseline, and by 35.7% at follow-up. Residual OSA, defined as an apnea-hypopnea index (AHI)>10/h, and insufficient CPAP adherence, defined as nightly use 10 at the first follow-up visit was associated directly with ESS at baseline, and inversely with AHI at baseline, duration of follow-up, CPAP use, and subjective sleep duration at follow-up (R2 of the model: 0.402). EDS showed heterogeneity in different European countries both at baseline and at first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in about one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment, and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment