Prevalence of excessive daytime sleepiness (EDS) and its association with quality of life in patients with obstructive sleep apnea (OSA): data from a sleep-center in Shenzhen, a single-center cross-sectional study.

Background: Excessive daytime sleepiness (EDS) is considered to be one of the main clinical manifestations of obstructive sleep apnea (OSA) and is a treatment target for patients with OSA. The prevalence of EDS in patients with OSA remains unclear and there is a lack of studies on the associations of EDS with quality of life among patients with OSA in China. This study aimed to evaluate the prevalence of EDS and its association with quality of life in patients with OSA in Shenzhen, China.

Methods: The cross-sectional study included patients diagnosed with OSA [apnea-hypopnea index (AHI) ≥5] at Shenzhen People's Hospital in China between May 21, 2023 and November 30, 2023. Differences in demographics, comorbidities, treatment, functional outcomes, and quality of life (measured using electronic questionnaires) in patients with and without EDS [Epworth Sleepiness Scale (ESS) ≥ and <10] were evaluated, as well as the prevalence of EDS, and its correlation using correlation analysis and logistic regression models.

Results: A total of 334 patients with OSA were included, 84.7% were male, with an average age of 38.1 years, and 31.14% had EDS. Patients with EDS in OSA had worse functional status [Functional Outcomes of Sleep Questionnaire Short Version (FOSQ-10) (P<0.001)], more work impairment {World Health Organization Quality of Life-Brief (WHOQOL-BREF) [physical domain (P<0.001); psychological domain (P=0.01); social domain (P=0.009)]}, poor quality of life and general health {Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Questionnaire (WPAI:SHP) [absenteeism (P=0.001); presenteeism (P<0.001); work productivity impairment (P<0.001); activity impairment (P<0.001)]}, more severe anxiety and depression {Hospital Anxiety and Depression Scale (HADS) [anxiety (P=0.006); depression (P=0.004)]} and more driving impairment compared to OSA patients without EDS. Moreover, the impairments of quality of life were associated with EDS severity, just as severe EDS showed poor quality of life. Correlation analysis and Logistic regression model univariate analysis revealed that EDS was associated with poor mental and physical health {FOSQ-10 [odd ratio (OR): 0.90, P<0.001]; WHOQOL-BREF: physical domain (OR: 0.82, P<0.001); psychological domain (OR: 0.89, P=0.009); social domain (OR: 0.89, P=0.01). HADS: anxiety (OR: 1.11, P=0.006); depression (OR: 1.11, P=0.005)}, more work and activity impairment [WPAI:SHP: presenteeism (OR: 1.03, P<0.001); work productivity impairment (OR: 1.03, P<0.001); activity impairment (OR: 1.03, P<0.001)] and more driving impairment (all P≤0.01). The same results were shown after adjusting for demographics and comorbidities.

Conclusions: This single-center cross-sectional study is the first to examine the impact of OSA-related EDS on the quality of life in patients from a sleep center in Shenzhen. The results of this study showed a high prevalence of EDS among patients with OSA, and EDS, especially severe EDS, was correlated with a worse quality of life, worse functional status, and more severe driving impairment. This study will contribute to a better understanding of the impact of pathological sleepiness on health and well-being and provide a scientific basis for public health policymaking.