Prevalence, incidence, and characteristics of CPAP treated OSA patients with residual excessive daytime sleepiness, as indicated by health-related data – A population representative study

Purpose

Excessive daytime sleepiness (EDS) is a symptom experienced by patients with obstructive sleep apnea (OSA) that may persist despite primary CPAP therapy (residual EDS; rEDS). This study aimed to estimate the age- and gender-specific prevalence and incidence for CPAP-treated OSA patients that showed indicators of rEDS in health-related data.

Methods

This study used the InGef research database, an anonymized representative dataset of 4 million persons covered by statutory health insurance in Germany. OSA patients receiving CPAP therapy were analyzed and data indicators for rEDS, or with EDS not satisfactorily treated by primary OSA therapy, were identified using an expert-opinion based diagnostic scheme in two study cohorts: The objective of the first cohort was to estimate the 12-month prevalence and incidence of rEDS in OSA (study period: 2016). The second cohort investigates patient characteristics and health care utilization (study period: 2013–2018).

Results

1298 OSA patients with indicators of rEDS after initiation of CPAP therapy were identified, giving an overall prevalence estimate of 41.1 (95%-CI 38.9-43.4) per 100,000 persons in Germany. Of all CPAP-users, 6.4% were affected by rEDS. Annual incidence was estimated to be 6.4 (95%-CI 5.6-7.4) per 100,000 persons. In the year before CPAP treatment started, 46% received antidepressants, 45% were in psychotherapeutic treatment and 58% of employees were unable to work, on average for 71 days within one year.

Conclusion

Patients that were identified with indicators of residual EDS showed a high socioeconomic burden potentially leading to an increased demand of healthcare services and incapacity for work.