Under reporting of sleepiness and driving impairment in patients with sleep apnoea/hypopnoea syndrome

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Abstract
SUMMARY Under reporting of symptoms by patients with sleep apnoeal/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%; P0.001). ‘False negative’ cases with an initially ‘normal’ (≤ 10) and retrospectively ‘sleepy’ (≥ 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.