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Understanding the burden of illness of excessive daytime sleepiness associated with obstructive sleep apnea: a qualitative studyBackground Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS), which may go undiagnosed and can significantly impair a patient's health-related quality of life (HRQOL). This qualitative research examined timing and reasons patients sought medical care for their EDS and OSA symptoms, and the impact of EDS on HRQOL. Methods Focus groups were conducted in 3 US cities with 42 participants currently experiencing EDS with OSA. Transcripts were coded and analyzed using an adapted grounded theory approach common to qualitative research. Results Over three-fifths of study participants (n=26, 62%) were currently using a positive airway pressure (PAP) or dental device; one-third (n=14, 33%) had previously used a positive airway pressure (PAP) or dental device, and the remainder had either used another treatment (n=1, 2%) or were treatment naive (n=1, 2%). Twenty-two participants (52%) reported experiencing OSA symptoms for >= 1 year, with an average duration of 11.4 (median 8.0, range 1-37) years before seeking medical attention. Several (n=7, 32%) considered their symptoms to be "normal," rather than signaling a serious medical condition. Thirty participants (71%) discussed their reasons for ultimately seeking medical attention, which included: input from spouse/partner, another family member, or friend (n=20, 67%); their own concern about particular symptoms (n=7, 23%); and/or falling asleep while driving (n=5, 17%). For all 42 participants, HRQOL domains impacted by EDS included: physical health and functioning (n=40, 95%); work productivity (n=38, 90%); daily life functioning (n=39, 93%); cognition (n=38, 90%); social life/relationships (n=37, 88%); and emotions (n=30, 71%). Conclusions Findings suggest that patients may be unaware that their symptoms could indicate OSA requiring evaluation and treatment. Even following diagnosis, EDS associated with OSA can continue to substantially affect HRQOL and daily functioning. Further research is needed to address diagnostic delays and unmet treatment needs for patients with EDS associated with OSA.