Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management

ABSTRACT

Excessive daytime sleepiness (EDS) affects approximately half of patients with obstructive sleep apnea (OSA) and can persist in some despite normalization of breathing, oxygenation, and sleep quality with primary OSA therapy, such as continuous positive airway pressure (CPAP). EDS is often overlooked and under discussed in the primary care setting and in the follow-up of CPAP-treated patients due to difficult assessment of such a multi-dimensional symptom. This review aims to provide suggestions for procedures that can be implemented into routine clinical practice to identify, evaluate, and manage EDS in patients treated for OSA, including how to appropriately use various self-report and objective assessments along the clinical pathway and options for pharmacotherapy. In addition, examples of when it is appropriate to refer a patient to a sleep specialist for evaluation are discussed.

KEYWORDS:

• Excessive daytime sleepiness
• assessment
• pharmacotherapy
• clinical practice
• sleep medicine

Transparency

Acknowledgments

Under the direction of the authors, Hannah K. Ritchie, PhD, Jeannette Fee, and Christopher Jaworski of Peloton Advantage, LLC, an OPEN Health company, provided medical writing and editorial support for this review article, which was funded by Jazz Pharmaceuticals.

Declaration of funding

This review was supported by Jazz Pharmaceuticals. Jazz Pharmaceuticals has worldwide development, manufacturing, and commercialization rights to solriamfetol, excluding certain jurisdictions in Asia. SK Biopharmaceuticals, the discoverer of the compound (also known as SKL-N05), maintains rights in 12 Asian markets, including Korea, China, and Japan.

Declaration of financial/other relationships

R Rosenberg has received consultancy fees from Eisai; honoraria from Merck; research funding from Jazz Pharmaceuticals, Merck, Actelion, Eisai, and Philips Respironics; and has served on the speakers’ bureau for Merck and as an advisory board member for Jazz Pharmaceuticals. PK Schweitzer has received consultancy fees from Jazz Pharmaceuticals, Her institution has received research funding from Jazz Pharmaceuticals, Apnimed, Balance Therapeutics, Avadel-Flamel, Harmony Biosciences, Inspire Medical Systems, and Suven Life Sciences. J Steier has received consultancy fees from Jazz Pharmaceuticals, Sanofi, travel support from Fisher Paykel, GSK, and research funding from ResMed, British Lung Foundation, Actelion, Phillips Respironics. J Steier’s contributions were partially supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. J-L Pepin has received lecture fees or conference traveling grants from Resmed, Perimetre, Philips, Fisher and Paykel, AstraZeneca, Jazz Pharmaceuticals, Agiradom, and Teva, and has received unrestricted research funding from ResMed, Philips, GlaxoSmithKline, Bioprojet, Foundation de la Recherche Medicale (Foundation for Medical Research), Direction de la Recherche Clinique du CHU de Grenoble (Research Branch Clinic CHU de Grenoble), and fond de dotation ‘Agir pour les Maladies Chroniques’ (endowment fund ‘Acting for Chronic Diseases’). Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Biographical notes

Russell P. Rosenberg, PhD, is currently the Chief Science Officer and CEO of NeuroTrials Research, Inc. and the Director of the Atlanta School of Sleep Medicine and Technology in Atlanta, GA. Paula K. Schweitzer, PhD, is director of research at St. Luke’s Sleep Medicine and Research Center in Chesterfield, MO. Professor Joerg Steier works as Consultant Respiratory Physician at the Lane Fox Unit, a tertiary service for weaning and noninvasive ventilation, and the British Sleep Society (BSS) accredited Sleep Disorders Centre at King’s Health Partners; he is an executive committee member and honorary secretary of the BSS, and a task force member of the European Respiratory Society. Jean-Louis Pepin, MD, PhD, is currently a Professor of Clinical Physiology at University of Grenoble-Alpes (UGA) (exceptional class), a member of the national council of universities (CNU, 44-02: Clinical Physiology), Vice-Dean of the Grenoble School of Medicine in charge of research, and Director of the HP2 Laboratory (Inserm U1300; Hypoxia Pathophysiology).