Health-related impact of illness associated with excessive daytime sleepiness in patients with obstructive sleep apnea

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.

KEYWORDS:

• Sleepiness
• lifestyle
• caffeine
• diet
• exercise

Acknowledgments

The authors thank Catherine B. Stack, PhD for her contributions to the manuscript.

Declaration of financial/other relationships

MA Grandner has received grants from Jazz Pharmaceuticals, Kemin Foods, and CereZ Technologies. He has served as a consultant for Fitbit, Natrol, Casper, Athleta, Smartypants, Merck, and Idorsia. R Saad is a former employee of Jazz Pharmaceuticals who, in the course of their employment, has received stock options exercisable for, and other stock awards of, ordinary shares of Jazz Pharmaceuticals plc. EB Leary is a former employee of Jazz Pharmaceuticals who, in the course of their employment, received stock options exercisable for, and other stock awards of, ordinary shares of Jazz Pharmaceuticals plc., is a current employee of Axsome, and is a Scientific Advisor for Proper. JS Min is a former employee of Evidation, a consulting firm that received research funding from Jazz Pharmaceuticals to conduct this study. D Hyman is a former employee of Jazz Pharmaceuticals who, in the course of their employment, received stock options exercisable for, and other stock awards of, ordinary shares of Jazz Pharmaceuticals plc. L Eldemir is a former employee of Evidation, a consulting firm that received research funding from Jazz Pharmaceuticals to conduct this study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

All relevant data are provided within the manuscript and supporting files. Additional data may be available upon reasonable request.

Abbreviations

BMI	=	body mass index
CI	=	confidence interval
CMS	=	Centers for Medicare and Medicaid Services
CPAP	=	continuous positive airway pressure
CVD	=	cardiovascular disease
EDS	=	excessive daytime sleepiness
ESS	=	Epworth Sleepiness Scale
FOSQ-10	=	Functional Outcomes of Sleep Questionnaire-short version
HTN	=	hypertension
OSA	=	obstructive sleep apnea
PHQ-8	=	Patient Health Questionnaire-8
RLS	=	restless legs syndrome
SD	=	standard deviation

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2023.2203623

Additional information

Funding

This study was supported by Jazz Pharmaceuticals. At the time the study was conducted, Jazz Pharmaceuticals had worldwide development, manufacturing, and commercialization rights to solriamfetol, excluding certain jurisdictions in Asia. Axsome Therapeutics, Inc. and its affiliates completed acquisition of the rights to Sunosi (solriamfetol) from Jazz Pharmaceuticals in the US on May 9, 2022 and ex-US on November 14, 2022. SK Biopharmaceuticals, the discoverer of the compound (also known as SKL-N05), maintains rights in 12 Asian markets, including Korea, China, and Japan. Under the direction of the authors, Hannah K. Ritchie, PhD, and Kim Chesky of Peloton Advantage, LLC, an OPEN Health company, provided medical writing and editorial support for this manuscript, which was funded by Axsome Therapeutics, Inc. and Jazz Pharmaceuticals.