The development of a digital pathway for the assessment of residual excessive daytime sleepiness in obstructive sleep apnoea: a service evaluation.

BACKGROUND

In the United Kingdom, national guidelines for obstructive sleep apnoea (OSA) highlight the importance of assessing continuous positive airways pressure (CPAP) compliance in order to identify patient cohorts of clinical importance, e.g. residual excessive daytime sleepiness (rEDS). This service evaluation reports on the implementation of clinical decision support system (CDSS) software within a bespoke pathway focusing on assessment of rEDS.

METHODOLOGY: The CDSS is a National Health Service framework-listed digital ecosystem comprising multiple clinical guided consultations encompassing the entire OSA pathway. Patients commenced on CPAP for ≥6 months and deemed "CPAP compliant" were identified from remote monitoring and subsequently underwent review using a clinical guided consultation (CGC). Patients identified with rEDS following CGC review were then discussed in an interhospital multidisciplinary team meeting, listed for a sleep study on CPAP and booked for consultant physician outpatient review.

RESULTS

472 patients were identified as being CPAP compliant and underwent CGC review, with rEDS noted in 43 (9.7%) of them. rEDS was found to be significantly more common in those reporting chronic insomnia, symptoms of restless legs, dyspepsia, rhinitis and nocturia, as well as in current smokers, those prescribed key medications and in those not in current employment. The multidisciplinary team discussion and subsequent consultant review of the rEDS cohort was able to highlight specific factors requiring changes in patient management including those suitable for wake-promoting therapy.

CONCLUSION

The incorporation of CDSS technology within a bespoke clinical pathway in order to review patients post CPAP initiation ensures that sleep services are able to readily identify and manage rEDS.