Comparing Demographic and Clinical Features of Obstructive Sleep Apnea Patients With and Without Sleepiness: A Cross‐Sectional Study

BACKGROUND: Excessive daytime sleepiness (EDS) is a common but variable symptom in obstructive sleep apnea (OSA), with unclear associations with disease severity and clinical features. This study aimed to compare demographic and clinical characteristics of OSA patients with and without EDS in an Iranian population. METHODS: In this cross-sectional study, 117 patients aged 18-65 years with polysomnography-confirmed OSA were recruited at Rasoul Akram Hospital, Tehran, Iran, from April 2022 to March 2023. EDS was assessed using the Epworth Sleepiness Scale (ESS ≥ 10). Data on demographics, anthropometric measures, clinical variables (e.g., AHI), and medical history were collected. Statistical analyses included Spearman correlations, t-tests, Mann-Whitney U tests, and chi-square tests. RESULTS: Of 117 patients (63.2% male, mean age 38.18 ± 2.43 years), 42.7% had EDS. No significant correlation was found between AHI and ESS (ρ = 0.121, p = 0.194), nor differences in OSA severity (mild, moderate, severe) between sleepy and non-sleepy groups (p = 0.998). AHI correlated with age, weight, BMI, neck, and waist circumference (p < 0.05); ESS correlated with height, weight, and neck circumference (p < 0.05). Head/neck disease or injury was associated with the absence of EDS (p = 0.014), with a trend linking opioid use to EDS (p = 0.082). CONCLUSIONS: EDS in OSA patients is not strongly tied to AHI but is associated with specific anthropometric features. The novel head/neck disease finding suggests neurological influences on EDS. These results advocate for phenotype-specific OSA management in Middle Eastern populations.