Daytime Sleepiness, PAP Adherence, and Satisfaction in OSA Patients

man on bed
man on bed
Sleep apnea research presented at CHEST 2021 examined links between PAP therapy adherence and the prevalence and severity of excessive daytime sleepiness.

The following article is a part of conference coverage from CHEST 2021, being held virtually from October 17 to October 20, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from CHEST 2021.


Excessive daytime sleepiness remains prevalent among patients with obstructive sleep apnea (OSA) who adhere to positive airway pressure (PAP) therapy. Nevertheless, PAP-adherent patients indicate greater satisfaction with their overall OSA care, according to real-world research presented at the CHEST 2021 Annual Meeting, held virtually October 17 to 20.

Researchers sought to determine the relationship between excessive daytime sleepiness, PAP adherence, and patient satisfaction in a real-world population with OSA. A survey administered via an app was completed by 2289 US residents with a self-diagnosis of OSA (50.3% women; 82.5% White; age 44.8±11.1 years). Based on patient self-reports of PAP usage, study participants were separated into 4 categories: 1) nonuse; 2) nonadherent (>4 hours a night; <5 days a week); 3) intermediate (4 to 6 hours a night, ≥5 days a week); and 4) highly adherent (≥6 hours a night; ≥5 days a week). A logistic regression model was used to assess the impact of PAP use and excessive daytime sleepiness on satisfaction with healthcare providers.

Among the 2289 study participants, the majority were adherent to PAP use (n=1436; 1211 highly adherent, 225 intermediate). Nonuse was reported by 700 participants and and nonadherence by 153 participants.

Excessive daytime sleepiness was assessed based on patient responses to survey questions derived from the Epworth Sleepiness Scale (ESS). More than 42% of patients were diagnosed with excessive daytime sleepiness (ESS >10), with mean ESS scores of 14.1 in those with excessive daytime sleepiness and 6.7 in those without. The proportion of patients with excessive daytime sleepiness in the 4 groups were: nonuse, 47%; nonadherent, 52%; intermediate, 53%; and highly adherent, 36%. Patients who increased PAP use by an hour each night were found to have lower ESS scores. Additionally, 72% of patients with increased PAP use were more satisfied with health care professionals (adjusted odds ratio [adjOR], 2.37; 95% CI, 1.64-3.43; P <.001) and 65% with OSA care (adjOR, 2.91; 95% CI, 2.03-4.17; P <.001).

The finding of a positive correlation between PAP adherence and overall care indicated ESS scores decreased as PAP use increased; however excessive daytime sleepiness continued to remain prevalent among highly adherent patients. Researchers concluded that the association between patient satisfaction with healthcare providers and overall care demonstrate that “strategies to improve patient satisfaction with OSA care should focus equally on PAP adherence and monitoring and resolution of residual [excessive daytime sleepiness].”


Parthasarathy S, Hyman D, Doherty J, et al. A real-world study assessing the relationship between positive airway pressure treatment, excessive daytime sleepiness, and patient satisfaction in osa. Presented at: CHEST 2021; October 17-20, 2021; Orlando, FL/Virtual. Abstract A2433-A2434.