Predictors of residual sleepiness in CPAP treated obstructive sleep apnea

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Background: Positive airway pressure (PAP) treatment usually improves sleepiness in obstructive sleep apnea (OSA), but in a subset of patients residual sleepiness is seen despite good PAP-adherence. Aims: We aimed to investigate associations between patient characteristics, comorbidities and PAP-adherence and risk of residual sleepiness in PAP-treated OSA. Methods: A longitudinal analysis of the national register-based Diseases in the Swedish CPAP Oxygen and Ventilator Registry (DISCOVERY) cohort with multi-register data on patients starting PAP-treatment for OSA 2010-2022, with excessive daytime sleepiness (Epworth sleepiness scale [ESS] >10p) at baseline and available data at one-year follow-up. Associations between patient characteristics and having residual sleepiness (ESS>10) at one-year follow-up was analyzed using logistic regression. Results: At baseline, 9,893 individuals (48.2%) had excessive daytime sleepiness and were included. Out of these 2,271 (23%) had residual sleepiness at follow-up. Predictors of residual sleepiness were higher ESS at base-line ([adjusted OR] 1.17; [95%CI] 1.15-1.19), depression (1.64; 1.44-1.87), previous stroke (1.99; 1.37-2.87), milder OSA (1.65; 1.41-1.94 and 1.45; 1.29-1.63 for AHI <15 and AHI 15-<30, respectively), lower BMI (1.41; 1.13-1.76, 1.30; 1.12-1.51 and 1.22; 1.06-1.40 for BMI <25, 25-<30 and 30-<35, respectively), and low adherence to PAP treatment (<4h/night) (2.27; 1.98-2.61). Conclusions: Patients with more severe daytime sleepiness, milder OSA, lower BMI and depression have an increased risk of residual sleepiness on PAP-treatment. In patients with residual sleepiness, adherence to treatment and comorbidities including depression should be investigated.

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