Comorbidities and Presenting Symptoms in a Real-World Population With Obstructive Sleep Apnea

Abstract: Background: Obstructive sleep apnea (OSA) is a sleep disorder that is often comorbid with psychiatric disorders. Excessive daytime sleepiness (EDS) is common in both psychiatric disorders and OSA. In patients with OSA, EDS can persist despite use of positive airway pressure (PAP) therapy. This study aimed to describe EDS and its relationship with PAP use in participants with and without depression. Methods: US adult residents with OSA completed a survey in Evidation Health’s Achievement app assessing sleepiness (Epworth Sleepiness Scale [ESS]) and PAP usage. ESS score >10 defined EDS. A linear model assessed relationships between PAP use and ESS score. Results: 2289 participants completed the survey. Anxiety and depression were the most common comorbidities and were more common in participants with EDS (49% and 49%) than those without EDS (41% and 37%). EDS was more common among participants with comorbid depression (49%) than those without (38%), even among highly adherent PAP users (46% vs 30%). In a linear model, each 1 h/night of PAP use was associated with lower ESS scores in participants without depression (n=928; estimate [SE], −0.42 [0.09]; P < 0.05), but not in those with depression (n=661; estimate [SE], −0.15 [0.10]; P>0.05). Conclusions: In this real-world population of participants with OSA, those with EDS were more likely to have comorbid anxiety or depression. EDS was more common in participants with comorbid depression than those without, even with PAP use. PAP use was associated with lower ESS scores in participants without comorbid depression, but not in those with comorbid depression.Short Description: Obstructive sleep apnea (OSA) and Excessive Daytime Sleepiness (EDS) are often comorbid with psychiatric disorders. In patients with OSA, EDS can persist despite use of positive airway pressure (PAP) therapy. This study describes EDS and its relationship with PAP use in participants with and without depression. EDS was more common in participants with comorbid depression, even with PAP use. PAP use was associated with lower ESS scores only in participants without comorbid depression.Name of Sponsoring Organization(s): Axsome Therapeutics, Jazz Pharmaceuticals