Combination of Positive Airway Pressure Compliance and Efficacy Improves Subjective Sleepiness Compared to Compliance Alone

INTRODUCTION: Purpose of this study was to evaluate whether high PAP compliance and PAP efficacy produces decreased subjective sleepiness compared to high compliance alone and compliance as measured by the Medicare standard. HYPOTHESIS: We hypothesized that (1) higher compliance will result in lower Epworth Sleepiness Scale (ESS) scores, (2) that higher PAP efficacy will also result in lower ESS scores, (3) that OSA patients with high PAP compliance but low PAP efficacy will exhibit higher ESS scores, and (4) OSA patients who exhibit very high PAP compliance and efficacy will have lower ESS scores than OSA patients who merely meet the Medicare threshold. METHODS: Patients were included if they had a diagnosis of OSA made by overnight polysomnography and in-lab PAP titration studies according to AASM criteria. In study 1, patients were arranged into quartiles of PAP compliance. In study 2, patients were arranged into tertiles of PAP effectiveness. In study 3, patients were arranged into two groups, one group with high compliance and low efficacy, and the other group with high compliance and high efficacy. In study 4, patients with high compliance compared with current Medicare standard. One-way ANOVA was used to test differences in study 1-2 and unpaired Student’s t-tests were used in study 3-4. RESULTS: In study 1, patients in the first and second quartile of compliance had higher subjective mean ESS (P CONCLUSIONS: We conclude that patients who are highly PAP compliant, but have relatively poor PAP effectiveness, are sleepier than patients who are highly compliant and effective with PAP treatment.