Among patients with obstructive sleep apnea (OSA), use of short- and long-term positive airway pressure (PAP) therapy was associated with an improvement in self-reported sleepiness, according to study findings published in Annals of the American Thoracic Society.
The real-world effectiveness of PAP is often questioned due to adherence issues. Researchers therefore conducted a study that monitored PAP therapy adherence via the myAir app (ResMed Inc) and assessed the relationship between adherence and patient-reported changes in sleepiness.
To be eligible for this study, participants needed to receive PAP therapy via an AirSense 10 device and register with the associated myAir app from November 2019 to April 2020; they also needed to provide self-reported daytime sleepiness levels, based on a 5-point scale, at baseline and on days 7, 14, 21, and 28 of the study. The primary outcome was the association between change in self-reported sleepiness over time and compliance at day 90 and adherence at day 360 to PAP therapy.
A total of 95,397 patients (mean [SD] age, 49.6 [13.0] years; 62% male; 42.2% with moderate to severe self-reported OSA) were included in the study. Daytime sleepiness was the most commonly reported reason for starting PAP therapy (by 57.1% of study participants).
PAP compliance, as defined by US Centers for Medicare and Medicaid Services (CMS) criteria, was achieved at 90 days by 80.2% of study participants. The median (IQR) sleepiness score at baseline was 2.0 (1.0, 3.0), which was reduced to 1.0 (1.0, 2.0) at 28 days (P <.001). Patients’ sleepiness score improved at day 28 by a median of 1.0 point (range, 0.0-1.0) in those with moderate baseline sleepiness, by 2.0 (range, 1.0-2.0) points in those who were very sleepy at baseline, and by 2.0 (range, 1.0-3.0) points in those who were extremely sleepy at baseline.
For each level of baseline sleepiness, PAP use was associated with a dose-dependent increase in the proportion of patients with improvement in sleepiness at day 28. The proportion of patients who had no self-reported sleepiness increased from 7.1% at baseline to 21.7% at day 28. The proportion of participants who were slightly sleepy increased from 20.7% at baseline to 40.4% at day 28, with corresponding decreases observed in patients who were moderately, very, or extremely sleepy during that same time period.
Adjusted models showed that patients who were less sleepy during the 28 days had higher odds of being CMS-compliant with PAP at 90 days (odds ratio [OR] 1.76; 95% CI, 1.73-1.80) and adherent to PAP at 360 days (OR 1.51; 95% CI, 1.49-1.54) vs patients with no change in their sleepiness. Participants who were more sleepy for 28 days had lower odds of being CMS-compliant with PAP at 90 days (OR 0.81; 95% CI, 0.78-0.83) and adherent to PAP at 360 days (OR 0.87; 95% CI, 0.85-0.89) compared with those whose sleepiness did not change.
Older age, male patients, higher 95th percentile pressure, and disturbing partner’s sleep were positively associated with higher odds of CMS compliance with PAP at 90 days and PAP adherence at 360 days.
Limitations include the small number of parameters with available information; the use of machine-recorded data with self-reported patient information; the use of a nonvalidated measure for patient-reported sleepiness; and the uncertain added effect of using the myAir app.
“The results demonstrated that self-reported improvement in sleepiness may be a better predictor of ongoing PAP adherence than the baseline sleepiness level. Our findings suggest that monitoring symptom change (or a lack thereof) may be clinically useful for identifying patients who require augmented management to further optimize treatment,” the researchers concluded, adding that their study “demonstrates the feasibility of capturing patient-reported outcomes via a digital platform.”
Disclosure: This work was funded by ResMed. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Cistulli PA, Armitstead JP, Malhotra A, et al. Relationship between self-reported sleepiness and positive airway pressure treatment adherence in obstructive sleep apnea. Ann Am Thorac Soc. Published online May 1, 2023. doi:10.1513/AnnalsATS.202206-482OC