Sex differences in Epworth Sleepiness Scale normalization with continuous positive airway pressure

Study Objectives:

Continuous positive airway pressure (CPAP) improves sleepiness in patients with obstructive sleep apnea (OSA), but some patients remain sleepy. The objective of this study was to identify determinants that are associated with improvements in self-reported sleepiness in patients with OSA on CPAP therapy.

Methods:

A retrospective cohort study was performed in a clinic-based population to determine which variables contributed to the improvement in the Epworth Sleepiness Scale (ESS) in patients on CPAP therapy for OSA, stratified by baseline ESS score (<11 or ≥11). Variables associated with ESS scores normalizing with CPAP were also assessed.

Results:

Patients with a baseline high ESS score showed greater improvements in the ESS with CPAP. When looking at interactions between baseline ESS classification and changes in ESS, a higher apnea-hypopnea index (AHI) was only associated with improvement in the ESS among patients with a high baseline ESS. Other assessed factors or covariates were not significantly different. When looking at ESS normalization, female sex and lower BMI were associated with lower likelihood of ESS normalization. The difference in the rate of ESS normalization between females and males was higher with more days on CPAP.

Conclusions:

Of all the assessed factors and covariates, only AHI was associated with the change in the ESS differently in patients with a high or normal baseline ESS score. ESS normalization rates were lower in females than in males and this disparity was amplified by more days on CPAP.

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