Association of EDS, PAP, and Quality of Care With OSA

In this Q&A, Sairam Parthasarathy, MD, Professor of Medicine, Chief of the Division of Pulmonary Allergy Critical Care and Sleep Medicine, and Director, UAHS Center for Sleep & Circadian Sciences, discusses his research around the association of excessive daytime sleepiness, positive airway pressure adherence, and satisfaction with care related to obstructive sleep apnea.

His poster, “A real-world study assessing the relationship between positive airway pressure treatment, excessive daytime sleepiness, and patient satisfaction in obstructive sleep apnea” was recently presented in San Antonio, Texas, at Psych Congress.

Answer: We had previously done a qualitative study of individuals with OSA and found that the burden of sleepiness was high and that such sleepiness was associated with worse health-related quality of life and daytime functioning. Therefore, we set out to perform a quantitative study to better understand the prevalence and determinants of excessive daytime sleepiness in individuals with OSA in a real-world setting. In a prior study, we had demonstrated that poor adherence to CPAP therapy was associated with worse patient satisfaction and excessive daytime sleepiness; therefore, we decided to assess these associations of EDS with these determinants — CPAP adherence and patient satisfaction.

Q: Please briefly describe the study method.

A: US-resident adults (≥18 years) who self-reported a clinician diagnosis of OSA between January 1, 2015, and March 31, 2020, (N = 2289) completed an online survey via Evidation Health’s Achievement app. Self-reported EDS (measured by Epworth score), CPAP adherence (hours/night and nights/week of usage), and patient satisfaction on a 5-point Likert scale (ranging from very satisfied to very unsatisfied) was assessed.

Q: Please briefly describe your most significant findings.

A: In 2289 individuals, EDS was prevalent in all PAP adherence groups (nonuse, nonadherent, intermediate adherence, and highly adherent group) and ranged from 36% to 47% (mean of 43%) of individuals within each PAP adherence group. Individuals who suffered from excessive daytime sleepiness were 50% less likely to be satisfied with health care providers and 38% less likely to be satisfied with their overall OSA care.

A: Individuals who were adherent to CPAP therapy (usage >4 hours per night on >5 nights per week) were more likely to rate being satisfied with their health care provider (odds ratio [OR] 2.9; 95% CI 2.03, 4.17) and their overall OSA care (OR 2.37; 95% CI 1.64, 3.63) than individuals who were nonadherent (usage <4 hours per night on 5 nights per week).

Q: What are the practical applications of your findings for clinicians treating sleep disorders, and in particular, EDS?

A: EDS adversely affects a patients’ health-related quality of life and daytime functioning. We were surprised to see the rather high prevalence of EDS in patients with OSA (43%) and that even in individuals who were highly adherent with PAP therapy (>6 hours/night; 5 nights/week) the prevalence of EDS was high (36%). Such measures of sleepiness were associated with worse PAP adherence and worse patient satisfaction ratings. Patient satisfaction metrics and ratings are increasingly being used by providers and health care organizations for assessment of health care quality. We need to systematically assess the nature and extent of sleepiness in individuals undergoing treatment for OSA.

Q: What did the research show about why participants with EDS are less likely to be satisfied with health care providers and OSA care? How can this information help clinicians treating patients with EDS?

A: In general, patients’ satisfaction with health care delivery is based upon outcomes. If individuals with OSA sought medical attention for their EDS, and such EDS did not resolve, such patients are going to rate the quality of their health care delivery poorly. Clinicians should systematically assess the satisfaction ratings of their patients and address poor PAP adherence and EDS with interventions aimed at promoting PAP adherence and reducing EDS.

Q: Any concluding thoughts?

A: Health care payors and organizations are interested in value-based care. If patients and organizations do not see value, they may not support or cover the costs of OSA management. The sleep field needs to take this matter seriously.

Sairam Parthasarathy, MD, is Professor of Medicine, Chief, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Director for the UAHS Center of Sleep & Circadian Science, and Medical Director for the Center for Sleep Disorders at the University of Arizona. His current research is supported by the NIH/NHLBI, PCORI, American Academy of Sleep Medicine Foundation and industry funding. Dr Parthasarathy is the current President (2021–2023) of the Sleep Research Society Foundation and is currently serving as an Associate Editor for the Journal of Clinical Sleep Medicine, Sleep & Vigilance, and Frontiers of Neurology and as an editorial board member of the American Journal of Respiratory and Critical Care Medicine. His research focuses on sleep and breathing in both ambulatory patients with sleep disorders, critically ill patients, and survivors of critical illness. Specifically, his current PCORI-funded initiative is addressing peer-driven intervention for promotion of CPAP adherence. His NIH-funded research investigates the role of community engagement in to address COVID-related health disparities and a NIH-funded training program for underrepresented minorities in lung and sleep apnea research. He is committed to training and fostering young scientific investigators in the pursuit of sleep and circadian science