Author(s): Engleman HM, Hirst WS, Douglas NJ
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Abstract Under reporting of symptoms by patients with sleep apnoea/hypopnoea syndrome (SAHS) has been reported anecdotally, but investigation of the prevalence or determinants of this is limited. To assess this, repeated ratings in 99 patients with sleep apnoea/hypopnoea syndrome of pre-treatment Epworth sleepiness score, unintended napping, driving impairment and mood were obtained, first at presentation and then after treatment with continuous positive airway pressure (CPAP) therapy of median 22 (range 2-70) weeks duration. Median Epworth score for pre-treatment sleepiness rose from 12 (range 0-24) initially to 14 (range 5-24) retrospectively (P<0.0001). More patients initially under-rated Epworth score (67\%) than over-rated (29\%; P<0.001). 'False negative' cases with an initially 'normal' (< or = 10) and retrospectively 'sleepy' (> or = 11) Epworth score comprised 24\% of all patients and 62\% of initially 'normal' scorers. Unintended napping behaviour also was rated as significantly more severe on retrospective assessment (P<0.001). Driving impairment due to sleepiness was initially reported by 23\% of all drivers and retrospectively by 37\% (P=0.01), with 25\% of initial deniers retrospectively admitting compromised driving ability before continuous positive airway pressure. No polysomnographic predictors of symptom under reporting were found (P>0.1). These results suggest a high prevalence of symptom minimization before treatment in patients with sleep apnoea/hypopnoea syndrome.
This article was published in J Sleep Res
and referenced in Journal of Ergonomics