Can digital tools help identify ongoing sleepiness in people with sleep apnoea?

Background

Many people with Obstructive Sleep Apnoea (OSA) are treated with CPAP (continuous positive airway pressure), a treatment that uses gentle air pressure during sleep to keep the airway open.  For most, this improves symptoms such as snoring and daytime sleepiness.

However, some people continue to feel very sleepy during the day, even when they are using CPAP correctly. This is called residual excessive daytime sleepiness (rEDS). Persistent sleepiness can affect daily life, increase the risk of accidents and may sometimes be linked to other health or lifestyle factors, such as medicines, pain or other sleep problems.

Sleep clinics are advised to check whether people with OSA still have daytime sleepiness after starting treatment. However, busy clinics can find it difficult to review every patient in a consistent way. Researchers in the UK tested whether a digital system could help improve this process.

What did the study look at?

Researchers developed a digital pathway that helps healthcare staff follow clear steps when reviewing patients. This is a type of computer programme known as a clinical decision support system (CDSS).

The pathway was used to review people with OSA who had been using CPAP treatment for at least six months.

The digital pathway worked in several steps:

1. Patients who were using CPAP regularly were invited to take part in a guided telephone consultation.
2. During the consultation, healthcare staff asked about daytime sleepiness, other symptoms and possible causes of sleep problems.
3. If rEDS was suspected, cases were discussed at a meeting of different healthcare specialists, which is known as a multidisciplinary team (MDT).
4. Patients could then be referred for a face-to-face consultant appointment and, if needed, further sleep tests.

What did the results show?

Between May and September 2024, 472 patients were reviewed using this pathway. 46 patients were found to have rEDS.

People with rEDS were more likely to report other health or lifestyle challenges, including:

• Difficulty sleeping at night
• Restless legs symptoms
• Digestive problems
• Nasal allergies or congestion
• Needing to pass urine more often during the night
• Smoking
• Using certain medicines that may cause drowsiness
• Not currently working

Following a team discussion and a consultant review, the researchers found:

• Some patients’ sleepiness was linked to medications, pain or life circumstances.
• A few had insufficient control of their OSA and required CPAP adjustments.
• A small number were identified as suitable for medicines that help people stay awake during the day, but do not treat sleep apnoea itself.
• Others improved with no additional treatment needed.

Importantly, before this pathway was used, none of these patients had been reviewed for, or found to have, rEDS.

Why is this important?

This study shows that structured digital pathways can help sleep services find and support patients who continue to feel sleepy despite treatment.

The pathway helps healthcare teams:

• Find patients who may need additional support
• Provide assessments from home, reducing the need for unnecessary clinic visits
• Make better use of staff time by focusing specialist appointments on patients who need them most

For patients, this approach may help improve safety, day-to-day living and quality of life by making sure ongoing sleepiness is properly investigated.

Future developments could include more advanced digital tools, including artificial intelligence (AI), to help predict which patients may benefit from specific treatments.

• Read the original research paper: The development of a digital pathway for the assessment of Residual Excessive Daytime Sleepiness in Obstructive Sleep Apnoea: A service evaluation
• Information hub: Sleep disordered breathing