Qualitative Comparison of the Patient Experience of Excessive Daytime Sleepiness in Idiopathic Hypersomnia, Obstructive Sleep Apnea, and Major Depressive Disorder

Introduction: Patient interviews were completed to obtain in-depth insights into excessive daytime sleepiness (EDS) experienced in idiopathic hypersomnia, obstructive sleep apnea (OSA), and major depressive disorder (MDD), with the aim of identifying unique features that may differentiate idiopathic hypersomnia.

Methods: Concept elicitation interviews were completed with 60 adults (20 with idiopathic hypersomnia, 20 with OSA currently experiencing EDS [ie, Epworth Sleepiness Scale score >10], and 20 with MDD currently experiencing EDS). Interviews included open-ended/probed questions on the signs/symptoms and impacts experienced in these conditions, including EDS.

Results: The distribution of gender, race, ethnicity, and education levels of participants generally was similar across conditions. EDS manifested as 3 interrelated concepts: chronic daytime sleepiness, napping/excessive napping, and unintentional falling asleep during the day. EDS concepts were described as symptoms in MDD and idiopathic hypersomnia, and as impacts in OSA, largely attributable to disrupted nighttime sleep. EDS varied in MDD and OSA; however, EDS was typically tied to mood states in MDD. In OSA, EDS experiences were variable but often included brief episodes of dozing. Specific to idiopathic hypersomnia, EDS included severe sleepiness and propensity for long, unrefreshing naps. Additionally, EDS was constant, with peaks of intensity and was reported to occur regardless of perceived nighttime sleep quality and quantity.

Conclusion: EDS is a common symptom in idiopathic hypersomnia, OSA, and MDD, which can co-occur. EDS experiences varied based on the underlying condition. Further research is needed to better characterize EDS in these conditions to inform diagnosis and treatment strategies.