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Volume 13 No. 08
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Accepted Papers

Scientific Investigations

Validated Measures of Insomnia, Function, Sleepiness, and Nasal Obstruction in a CPAP Alternatives Clinic Population

Austin S. Lam, BS1; Nancy A. Collop, MD2,3; Donald L. Bliwise, PhD2,4; Raj C. Dedhia, MD, MS2,5
1Emory University School of Medicine, Atlanta, Georgia; 2Emory Sleep Center, Emory University School of Medicine, Atlanta, Georgia; 3Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia; 4Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; 5Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia

Study Objectives:

Although efficacious in the treatment of obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) can be difficult to tolerate, with long-term adherence rates approaching 50%. CPAP alternatives clinics specialize in the evaluation and treatment of CPAP-intolerant patients; yet this population has not been studied in the literature. To better understand these patients, we sought to assess insomnia, sleep-related functional status, sleepiness, and nasal obstruction, utilizing data from validated instruments.


After approval from the Emory University Institutional Review Board, a retrospective chart review was performed from September 2015 to September 2016 of new patient visits at the Emory CPAP alternatives clinic. Patient demographics and responses were recorded from the Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), Epworth Sleepiness Scale, and Nasal Obstruction Symptom Evaluation questionnaires.


A total of 172 patients were included, with 81% having moderate-severe OSA. Most of the patients demonstrated moderate-severe clinical insomnia and at least moderate nasal obstruction. FOSQ-10 scores indicated sleep-related functional impairment in 88%. However, most patients did not demonstrate excessive daytime sleepiness.


This patient population demonstrates significant symptomatology and functional impairment. Because of the severity of their OSA, they are at increased risk of complications. In order to mitigate the detrimental effects of OSA, these significantly impacted patients should be identified and encouraged to seek CPAP alternatives clinics that specialize in the treatment of this population.


Lam AS, Collop NA, Bliwise DL, Dedhia RC. Validated measures of insomnia, function, sleepiness, and nasal obstruction in a CPAP alternatives clinic population. J Clin Sleep Med. 2017;13(8):949–957.

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