More than 18 million adults suffer from OSA, and the condition’s chronic oxygen starvation, coupled with disturbed sleep, increases the risk of hypertension, heart disease, mood disorders, and metabolic problems. Most patients are treated with a continuous positive airway pressure (CPAP) device. Success is achieved when the apnea-hypopnea index (AHI) is reduced to less than five, or when AHI falls between five and 15 and symptoms have been resolved.
However, approximately one in 10 patients experiences significant daytime sleepiness despite CPAP use and a normalization of AHI, a disheartening outcome for patients with OSA. Pell Ann Wardrop, MD, medical director of the St. Joseph Sleep Wellness Center in Lexington, Ky., and ENTtoday editorial advisory board member, said otolaryngologists should do a better job of managing patient expectations. “We need to tell patients that we are going to improve physiological parameters, [and] we will make you feel better, but we may not completely resolve your sleepiness,” she added.
Kathleen Yaremchuk, MD, chair of the department of otolaryngology-head and neck surgery at Henry Ford Health System in Detroit, recommends administering the Epworth Sleepiness Scale (ESS), a validated questionnaire that evaluates level of daily sleepiness by asking patients to assess their likelihood of dozing in eight different situations (available at epworthsleepinessscale.com). A score of 10 or higher is considered abnormal. Dr. Yaremchuk said, “It is important to administer an ESS to see how much patients’ symptoms have improved over their pre-treatment sleepiness level. If they were a 14 before treatment and a 12 after, you need to look for another cause beyond OSA.”