A80-1-06 Beyond AHI: Patient-reported Symptom Burden and Early Improvement After PAP Therapy in OSA

Abstract Introduction The apnea-hypopnea index (AHI) is the current standard for classifying obstructive sleep apnea (OSA) severity, yet it does not reflect the full burden of disease. Thus, we sought to understand the 1) breadth and severity of OSA-related symptoms by OSA severity and 2) the magnitude and timing of symptom improvement by OSA severity following initiation of positive airway pressure (PAP) therapy. Methods Adults (18+ years) residing in the United States and using PAP therapy (Resmed) for OSA management were invited to complete a cross-sectional e-survey about their OSA experience. OSA severity was determined by self-reported diagnostic AHI (mild 5-15, moderate 15-30, and severe 30), and pre- and post-therapy symptoms were evaluated across 5 domains: sleep and energy, physical health, cognition, emotional and mental wellness, and sexual health. Symptom severity was assessed with a Likert scale from 1 (not a problem) to 5 (severe problem). Descriptive statistics summarized pre-and post-therapy symptom burden, and time to symptom improvement by OSA severity. Post-therapy analyses were limited to those responses describing pre-therapy symptoms as moderate, significant, or severe. Results Responses from 1,381 surveys were assessed (mean age: 54.8 years, 54.4% female, with 27.4% mild, 28.4% moderate and 44.2% severe OSA). Prior to PAP initiation, rates of self-reported symptoms were similar across OSA severity, with no significant differences observed for emotional and mental well-being, cognition and sexual health domains (p 0.05). However, select sleep- and energy-related symptoms including snoring, total sleep time, restlessness, daytime sleepiness, and morning headaches, were more frequent in severe OSA than moderate or mild OSA (p 0.05) (Figure 1). Following PAP initiation, 85.3% of respondents with severe OSA reported a noticeable improvement in 1 of their moderate-to-severe symptoms (vs. 75.8% for moderate and 76.4% for mild OSA (p 0.001)). Within seven days of PAP initiation, 73.9% of respondents reported a noticeable improvement in 1 moderate-to-severe symptom, with more frequent improvement among those with severe (79.5%) than those with moderate (71.5%) or mild (67.3%) OSA (p 0.001). Conclusion Adults with mild or moderate OSA reported a comparable overall symptom burden to those with severe OSA, except for higher rates of select sleep- and energy-related symptoms in severe OSA. Following PAP initiation, self-reported symptoms improved across OSA severity categories, and within a relatively short time frame. Findings highlight the importance of integrating patient-reported outcomes with diagnostic metrics like AHI to better understand and characterize the burden of OSA. This abstract is funded by: Resmed Science Center