Residual Excessive Daytime Sleepiness Research Articles

Residual excessive daytime sleepiness in patients with sleep apnea syndrome receiving continuous positive airway pressure in Japan: A single-center study

Excessive daytime sleepiness (EDS) is a symptom of sleep apnea syndrome (SAS). In some patients with SAS who undergo continuous positive airway pressure (CPAP) therapy, EDS persists (residual EDS). However, knowledge of residual EDS in Japan is limited. Therefore, we examined EDS as defined by the Japanese version of the Epworth Sleepiness Scale (a score of ≥11) before and after long-term (≥1 year) CPAP therapy in 490 patients with SAS. Good adherence to CPAP therapy was defined as its use for at least 4 h during 70% of the nights. The prevalence of residual EDS was 9.4%. Residual EDS was negatively associated with good adherence to CPAP therapy. Furthermore, the longer the CPAP therapy duration after initiation, the lower the prevalence of residual EDS. Therefore, the findings on the prevalence of residual EDS and its association with CPAP therapy in Japan are probably similar to those of other countries.

0533 Healthcare Utilization by Patients with Obstructive Sleep Apnea and Excessive Daytime Sleepiness After Airway Therapy in the UK

Abstract Introduction Obstructive Sleep Apnea (OSA) is a chronic condition characterized by repetitive episodes of upper airway collapse during sleep. Despite standard treatment with continuous positive airway pressure (CPAP), some patients continue to experience residual excessive daytime sleepiness (rEDS). Pharmacotherapy use for rEDS is low in Europe and some wake-promoting agents are no longer allowed as treatments by the European Medicines Agency. The objective of this study was to characterize the patient demographics, comorbidities, medications, and healthcare resource utilization (HCRU) in a population of OSA patients with and without rEDS after CPAP initiation. Methods The retrospective observational cohort study used the Clinical Practice Research Datalink (CPRD) AURUM, a primary care database, linked at the patient level to the Hospital Episode Statistics (HES) database, which covers secondary care for all of England. The population included 10,746 adult OSA patients with a first record of CPAP treatment during the eligibility period (Jan 1, 2009-Mar 21, 2018). rEDS patients were identified 6 months after initiating CPAP treatment. Results Among all eligible OSA patients in the AURUM database, 596 (5.6%) had rEDS; 80.5% of rEDS patients were identified using recorded diagnosis code of daytime fatigue, and 21.7% using ESS score ≥11 (13 patients had both measures). A greater percentage of patients had a history of psychiatric (21.5%; p< 0.0001), gastrointestinal (7.7%; p< 0.0001), and neurodegenerative (13.6%; p=0.003) disorders in the rEDS group, compared with the non-rEDS group, while the prevalence of obesity, cardiovascular, and sleep disorders did not significantly differ between groups. Across all patients, rates of prescription for stimulants or modafinil were low during the 12 months prior to CPAP initiation. Patients with rEDS had significantly higher HCRU compared to non-rEDS patients in the first and second years after CPAP initiation. Conclusion Despite low rates of rEDS identified in this study, the clinical needs of patients with rEDS are significant, as evidenced by the volume of HCRU, low use of pharmacotherapy, and high comorbidity rates, highlighting the need to improve patient care in rEDS. Support (if any) Axsome Therapeutics and Jazz Pharmaceuticals

Prevalence, incidence, and characteristics of CPAP treated OSA patients with residual excessive daytime sleepiness, as indicated by health-related data – A population representative study

PurposeExcessive daytime sleepiness (EDS) is a symptom experienced by patients with obstructive sleep apnea (OSA) that may persist despite primary CPAP therapy (residual EDS; rEDS). This study aimed to estimate the age- and gender-specific prevalence and incidence for CPAP-treated OSA patients that showed indicators of rEDS in health-related data. MethodsThis study used the InGef research database, an anonymized representative dataset of 4 million persons covered by statutory health insurance in Germany. OSA patients receiving CPAP therapy were analyzed and data indicators for rEDS, or with EDS not satisfactorily treated by primary OSA therapy, were identified using an expert-opinion based diagnostic scheme in two study cohorts: The objective of the first cohort was to estimate the 12-month prevalence and incidence of rEDS in OSA (study period: 2016). The second cohort investigates patient characteristics and health care utilization (study period: 2013–2018). Results1298 OSA patients with indicators of rEDS after initiation of CPAP therapy were identified, giving an overall prevalence estimate of 41.1 (95%-CI 38.9-43.4) per 100,000 persons in Germany. Of all CPAP-users, 6.4% were affected by rEDS. Annual incidence was estimated to be 6.4 (95%-CI 5.6-7.4) per 100,000 persons. In the year before CPAP treatment started, 46% received antidepressants, 45% were in psychotherapeutic treatment and 58% of employees were unable to work, on average for 71 days within one year. ConclusionPatients that were identified with indicators of residual EDS showed a high socioeconomic burden potentially leading to an increased demand of healthcare services and incapacity for work.

Consensus statement of the Austrian Sleep Medicine Society on the management of residual excessive daytime sleepiness in obstructive sleep apnea

Six to ten percent of patients with obstructive sleep apnea suffer from residual excessive daytime sleepiness (rEDS) despite adequate nocturnal positive airway pressure therapy or effective alternative treatment. The differential diagnosis of rEDS is an interdisciplinary challenge in clinical practice. Development of aclear guideline for the detection, differential diagnostic considerations, and options for the continuing treatment of rEDS in clinical practice. MeSH analysis-based research and interdisciplinary consensus among specialists in internal medicine and pneumology, neurology, as well as psychiatry and psychotherapy. The SPAIN checklist for systematic differential diagnostic exploration of rEDS with the parameters: Sleep behavior, Psychological causes, Anamesis of medication, Internal causes and Neurological causes. rEDS should be recognized as asymptom worthy of treatment. It requires an interdisciplinary assessment and the individual adaptation of the treatment to the needs of the affected person.

Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes.

Although excessive daytime sleepiness (EDS) attributable to obstructive sleep apnea (OSA) can be resolved by consistent usage of and effective treatment (often with the use of continuous positive airway pressure therapy), 12–58% of patients report residual EDS (REDS). While REDS is difficult to treat, a proportion of cases are possibly due to reversible issues, and wake-promoting medications can prove useful for the remaining cases. Given the challenges associated with effective management of REDS and its relationship to multiple comorbidities, multidisciplinary management of patients with REDS is often recommended. Here we aim to bridge the knowledge gap on the burden, risk factors, prevalence, and potential pathophysiologic mechanisms of REDS in patients with OSA after first-line treatment. The roles of primary care physicians and sleep specialists, as well as the importance of the use of objective assessment tools for the evaluation of REDS and the effective management of comorbidities, are discussed. An update of approved treatments and emerging candidate treatments is also presented.

Solriamfetol for Residual Sleepiness in Patients with Obstructive Sleep Apnea

Solriamfetol (Sunosi) is a dopamine and norepinephrine reuptake inhibitor that was approved in 2019 to manage residual excessive daytime sleepiness in

839 Not Your Everyday Daytime Sleepiness: Two Peas in a Pod

Abstract Introduction Obstructive sleep apnea (OSA) and narcolepsy are both causes of excessive daytime sleepiness (EDS). OSA is a more prevalent diagnosis, but it can coexist with narcolepsy and confound diagnosis. We present a case of a delayed diagnosis of type 2 narcolepsy in a patient with known OSA. Report of case(s) A 31-year-old man with depression treated with sertraline and prior history of severe OSA diagnosed at an outside facility presented to our clinic for residual excessive daytime sleepiness. He demonstrated adequate adherence to continuous positive airway pressure (CPAP) of 13 cmH2O over a period of one year, good sleep hygiene and adequate sleep duration. He reported vivid dreams and sleep paralysis in the past, but none recently. There was no history of a delayed sleep phase. He denied hypnagogic or hypnopompic hallucinations or cataplexy. An in-lab polysomnogram (PSG) followed by multiple sleep latency test (MSLT) was ordered for further evaluation. Sertraline was held 2 weeks prior to the study. Overnight PSG on CPAP showed adequate treatment of OSA on CPAP pressures of 13–16 cmH2O. MSLT showed 3/5 sleep-onset rapid eye movement periods with a mean sleep latency of 5.8 minutes. A diagnosis of coexisting type 2 narcolepsy was made. Treatment was initiated with modafinil; however, his symptoms of EDS persisted and he was changed to methylphenidate with subsequent improvement. Conclusion The case above highlights the importance of maintaining a broad differential when investigating the etiology of EDS. In particular, patients with narcolepsy often experience a significant delay between onset of symptoms and receiving a diagnosis. Diagnosis can be confounded by a lack of classic symptoms and/or the presence of another sleep-related breathing disorder, as in the patient above. Residual EDS can be seen in patients with adequately treated OSA. There is sparse data regarding the co-prevalence of narcolepsy as the etiology of residual EDS in adequately treated OSA. Patients should still be screened for symptoms suggestive of narcolepsy. Persistence of EDS symptoms in young adults with adequately treated OSA should raise suspicion for another sleep-related disorder and merits further investigation. Support (if any):

Predictors of residual sleepiness in patients with obstructive sleep apnea syndrome on continuous positive airway pressure

Context Excessive daytime sleepiness is a common symptom of obstructive sleep apnea, which improves with the application of the continuous positive airway pressure (CPAP). However, it is not unusual that some patients continue to complain of residual excessive sleepiness (RES). Aims We aimed in this study to evaluate the predictors of residual sleepiness in these patients. Settings and design This is a retrospective study done in a tertiary center, and data for the years 2010–2015 were collected. Materials and methods The inclusion of patients with obstructive sleep apnea syndrome and compliant on CPAP was done. We included the pretreatment apnea-hypopnea index and epworth sleepiness scale (ESS) in addition to the CPAP using parameters. Comparison between the compliant obstructive sleep apnea syndrome with RES and without RES was done. Statistical analysis We compared between the patients with RES and without. Regression analysis was used to detect the predictors for RES. Results The mean age of the compliant patients with RES was significantly younger than compliant patients without RES (54.15±10.1 vs. 59.23±10.7; P=0.001). All the patients used the CPAP adequately (≥4 h per night for ≥70% of the nights); the patients with RES used the CPAP significantly lower than the patients without RES. As for the predictors for residual sleepiness on CPAP for those patients, we found that the pretreatment ESS was a predictor as well as the CPAP-use parameters. Conclusion Residual excessive daytime sleepiness is common in compliant patients with obstructive sleep apnea syndrome on CPAP, and the predictors for the occurrence of residual sleepiness on CPAP are younger age, higher baseline ESS, and lower CPAP usage percent.

Pitolisant for Residual Excessive Daytime Sleepiness in OSA Patients Adhering to CPAP: A Randomized Trial

Excessive daytime sleepiness (EDS) in individuals with OSA syndrome persisting despite good adherence to CPAP is a disabling condition. Pitolisant is a selective histamine H3-receptor antagonist with wake-promoting effects. Is pitolisant effective and safe for reducing daytime sleepiness in individuals with moderate to severe OSA adhering to CPAP treatment but experiencing residual EDS? In a multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was titrated individually at up to 20mg/day and taken over 12weeks. The primary end point was change in the Epworth Sleepiness Scale (ESS) score in the intention-to-treat population. Key secondary end points were maintenance of wakefulness assessed by the Oxford Sleep Resistance Test, Clinical Global Impressions scale of severity, the patient's global opinion, EuroQoL quality-of-life questionnaire score, Pichot fatigue questionnaire score, and safety. Two hundred forty-four OSA participants (82.8%men; mean age, 53.1 years; mean Apnea Hypopnea Index with CPAP, 4.2/h; baseline ESS score, 14.7) were randomized to pitolisant (n= 183) or placebo (n= 61). ESS significantly decreased with pitolisant compared with placebo (-2.6; 95%CI, -3.9 to -1.4; P< .001), and the rate of responders to therapy (ESS≤ 10 or change in ESS≥ 3) was significantly higher with pitolisant (71.0%vs54.1%; P= .013). Adverse event occurrence (mainly headache and insomnia) was higher in the pitolisant group compared with the placebo group (47.0%and 32.8%, respectively; P= .03). No cardiovascular or other significant safety concerns were reported. Pitolisant used as adjunct to CPAP therapy for OSA with residual sleepiness despite good CPAP adherence significantly reduced subjective and objective sleepiness and improved participant-reported outcomes and physician-reported disease severity. ClinicalTrials.gov; No.: NCT01071876; URL: www.clinicaltrials.gov; EudraCT N°: 2009-017248-14; URL: eudract.ema.europa.eu.

Residual excessive daytime sleepiness in patients with obstructive sleep apnea treated with positive airway pressure therapy.

Patients with obstructive sleep apnea (OSA) commonly report residual excessive daytime sleepiness (EDS) despite treatment with positive airway pressure (PAP). The present study aimed to determine whether patients presenting with subjective sleepiness after treatment with PAP therapy had objective evidence of residual sleepiness. We conducted a retrospective analysis of 29 adults with OSA on PAP therapy who underwent a standardized evaluation for EDS. Patients were evaluated with the Epworth Sleepiness Scale (ESS) and attend an in-lab polysomnogram (PSG) with PAP followed by a multiple sleep latency test (MSLT). Our cohort consisted of 23 men (79%) and 6 women (21%) with a mean age of 40.7years. All patients were subjectively sleepy with an ESS score of > 10 and met minimal PAP usage of 4h a night for at least 70% of nights with a residual apnea-hypopnea index (AHI) ≤ 10. On MSLT, 31% of patients had an average sleep onset latency (SOL) < 8min, 35% had a SOL between 8 and 11min, and 35% had SOL > 11min. After optimizing PAP therapy and sleep in patients with OSA and residual EDS, the majority were found to have objective findings of an abnormally short SOL on MSLT. This is further evidence that there is a distinct OSA phenotype that will have persistent EDS despite appropriate treatment of their sleep-disordered breathing. Objective testing to quantify the degree of sleepiness is recommended for OSA patients with residual EDS.

Prevalence and predictors of residual excessive daytime sleepiness in CPAP users

Prevalence and predictors of residual excessive daytime sleepiness in CPAP users

Findings of the Maintenance of Wakefulness Test and its relationship with response to modafinil therapy for residual excessive daytime sleepiness in obstructive sleep apnea patients adequately treated with nasal continuous positive airway pressure

ObjectiveWe aimed to examine the relationship between subjective and objective sleepiness in obstructive sleep apnea syndrome (OSAS) patients with residual sleepiness, and to determine whether baseline objective sleepiness severity predicts the response to modafinil therapy. MethodsData were obtained from a randomized, placebo-controlled modafinil (200 mg/day) study in Japanese OSAS patients with residual sleepiness receiving nasal continuous positive pressure (n-CPAP) treatment. We analyzed 50 participants whose subjective (Epworth Sleepiness Scale [ESS] total score) and objective (Maintenance of Wakefulness Test [MWT] sleep latency) sleepiness were evaluated before and after treatment. Subjects were dichotomized into two subgroups according to the mean baseline MWT sleep latency. ESS total score and MWT sleep latency changes after treatment were compared between the placebo and modafinil groups in both subgroups. ResultsThe mean baseline ESS total score and MWT sleep latency were 14.1 ± 2.8 and 14.2 ± 4.9 min, respectively; there was no significant correlation between these two variables. Patient characteristics were similar between the two subgroups (MWT sleep latency: <14 min, n = 23; ≥14 min, n = 27). In the <14-min subgroup, changes in ESS total score and MWT sleep latency after treatment were significantly greater in the modafinil group than in the placebo group (p = 0.005). In the ≥14-min subgroup, changes in these parameters did not differ between the treatment groups. ConclusionIn OSAS patients with residual sleepiness, the objective sleepiness level was not as high as expected, despite increased subjective sleepiness. Improvements in subjective and objective sleepiness seemed difficult to achieve with modafinil treatment among subjects with less objective sleepiness.

Residual Sleepiness in Obstructive Sleep Apnea

There is evidence that patients with obstructive sleep apnea (OSA) can have residual excessive daytime sleepiness (EDS), possibly related to other underlying sleep disorders. Further areas of study concerning patients treated adequately for OSA include looking for a biomarker that can easily measure alertness or sleepiness. Radiological modalities may offer another means of assessing patients with EDS. A modality that can provide data without costing too much is key. Some patients continue to have sleepiness after adequate treatment with continuous positive airway pressure, and until these patients can be better classified, it will be difficult to outline better treatment options.

Efficacy and safety of adjunctive modafinil treatment on residual excessive daytime sleepiness among nasal continuous positive airway pressure-treated japanese patients with obstructive sleep apnea syndrome: a double-blind placebo-controlled study.

This double-blind study evaluated the efficacy and safety of modafinil for treating excessive daytime sleepiness in Japanese patients with obstructive sleep apnea syndrome (OSAS). Patients with residual excessive sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11) on optimal nasal continuous positive airway pressure (nCPAP) therapy (apnea-hypopnea index ≤ 10) were randomized to either 200 mg modafinil (n = 52) or placebo (n = 62) once daily for 4 weeks. Outcomes included baseline-week 4 changes in ESS total score, sleep latency on maintenance of wakefulness test (SL-MWT), nocturnal polysomnography, Pittsburgh Sleep Quality Index (PSQI), and safety. All 114 randomized patients completed the study. Mean change in ESS total score (-6.6 vs -2.4, p < 0.001) and SL-MWT (+2.8 vs -0.4 minutes, p = 0.009) were significantly greater with modafinil than with placebo. ESS total score decreased from > 11 to < 11 at the final assessment in 69.2% of modafinil-treated patients and 30.6% of placebo-treated patients (p < 0.001). Corresponding rates at week 1 were 57.7% and 33.9% (p = 0.014). Changes in nocturnal polysomnography, PSQI, and apnea-hypopnea index from baseline to the final assessment were similar in both groups. Adverse drug reactions occurred in 36.5% and 22.6% of patients in the modafinil and placebo groups, respectively (p = 0.146). Once-daily modafinil was effective and well tolerated for managing residual daytime sleepiness in Japanese OSAS patients with residual excessive daytime sleepiness on optimal nCPAP therapy.

Effects of Armodafinil on Simulated Driving and Self-Report Measures in Obstructive Sleep Apnea Patients prior to Treatment with Continuous Positive Airway Pressure

Obstructive sleep apnea (OSA) has been associated with an increased risk of motor vehicle crashes. This driving risk can be reduced (≥ 50%) by treatment with continuous positive airway pressure (CPAP). However residual excessive daytime sleepiness (EDS) can persist for some patients who regularly use CPAP. The current study was designed to assess the effect of armodafinil on simulated driving performance and subsequent CPAP treatment compliance in newly diagnosed OSA patients with EDS during a 2-week "waiting period" prior to initiation of CPAP. Sixty-nine newly diagnosed OSA patients, awaiting CPAP therapy, were randomized (1:1) to placebo or armodafinil (150 mg/day) treatment. Simulated driving tests and self-report measures were completed at baseline, after 2 weeks of drug treatment, and following 6 weeks of CPAP treatment. CPAP compliance was evaluated at the end of 6 weeks of CPAP. Compared to placebo, armodafinil improved simulated driving safety performance in OSA patients awaiting CPAP therapy (p = 0.03). Improvement was seen in lane position deviation (p = 0.002) and number of lane excursions (p = 0.02). Improvement was also observed on measures of sleepiness using the Epworth Sleepiness Scale (ESS) and sleep related quality of life. Following 6 weeks of CPAP, there was also significant improvement observed on multiple measures of simulated driving performance. CPAP compliance did not differ between armodafinil-treated and placebo-treated patients (p = 0.80). Armodafinil was found to improve simulated driving performance in OSA patients with EDS prior to initiation of CPAP. Treatment with armodafinil showed no effect on subsequent CPAP compliance.

Endothelial Function in Patients with Post-CPAP Residual Sleepiness

The significance of residual excessive daytime sleepiness (EDS) on cardiovascular markers in patients with adequately treated obstructive sleep apnea (OSA) remains unclear. The objective of this study was to investigate flow-mediated dilatation (FMD) and inflammatory markers (C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha, and interleukin [IL]-6) in continuous positive airway pressure (CPAP)-compliant patients with residual EDS compared with CPAP-compliant patients without residual EDS. FMD of the brachial artery was measured by ultrasound in 12 CPAP-compliant patients with OSA who had residual EDS and 12 age-, sex-, and body mass index-matched CPAP-compliant patients with OSA who did not have residual EDS on week 8 after initiation of CPAP. Twelve otherwise-healthy subjects without sleep disordered breathing were used as control subjects. Serum concentrations of CRP, TNF-alpha, and IL-6 were quantified by enzyme-linked immunosorbent assays. Baseline FMD was comparable among CPAP-compliant patients with residual EDS (7.2 +/- 2.3), CPAP-compliant patients without residual EDS (8.6 +/- 2.1), and control subjects (7.7 +/- 1.4) (p = 0.37). The concentrations of CRP, TNF-alpha, and IL-6 were also not significantly different between subjects with CPAP-compliant residual EDS and those without residual EDS (p = 0.44, p = 0.37, and p = 0.42; respectively). Residual EDS in patients with adequately treated OSA may not represent a risk factor for cardiovascular diseases.

Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients

Some patients with obstructive sleep apnoea syndrome (OSAS; respiratory distress index (RDI) of >5 events.h(-1)) experience residual excessive daytime subjective sleepiness (Epworth Sleepiness Scale (ESS) score of >10), despite adequate use of continuous positive airway pressure (CPAP) therapy. The aim of the present study was to identify clinical and polysomnographic predictors of this sleepiness. Clinical and polysomnographic variables and ESS score were evaluated in 208 OSAS patients with an ESS score of >10 before (initial assessment) and after > or =6 months of adequate (> or =4 h.day(-1)) CPAP use. Following CPAP treatment, 114 (55%) patients showed an abnormal ESS score (>10; CPAP nonresponders), whereas 94 (45%) showed a normal ESS score (<11; CPAP responders). Of the CPAP responders, none had a history of depression, whereas the converse was true for 38.8% of CPAP nonresponders. In addition, multivariate logistic regression analysis revealed that the independent predictors of residual excessive daytime sleepiness following CPAP therapy were a history of diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment. In conclusion, predictors of residual excessive sleepiness in adequately CPAP-treated OSAS were a history of depression, diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment.

Placebo and modafinil effect on sleepiness in obstructive sleep apnea

Introduction Previous studies have evaluated the effect of modafinil on residual excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS) under effective CPAP treatment. Even though those trials also used placebo groups, we suppose that the placebo effect might influence the patients' response to modafinil. Methods Twenty sleepy patients with OSAS under CPAP treatment were selected. All of them had Epworth Sleepiness Scale (ESS) > 10. Following baseline evaluation (T1), all subjects were instructed to take placebo for 7 days. After this single-blind placebo phase and second evaluation (T2), patients were randomly allocated to placebo or modafinil treatment for 21 days in a double-blind protocol. Patients underwent a final evaluation (T3) on the last day of drug intake. The evaluations at T1, T2 and T3 consisted of: medical and laboratory examinations, nocturnal polysomnography, ESS, maintenance of wakefulness test (MWT) and complex reaction time (CRT-NY). In addition, in T2 and T3 the change of illness severity scale (CGI-C) and the evaluation of quality of life (SF-36) were applied. Results The comparison between the two groups during the three periods studied, showed the following results: in the modafinil group, ESS score did not change during the initial placebo period, but there was a significant reduction during the modafinil treatment period ( p = 0.0006); in the placebo group a significant reduction occurred during the initial placebo period ( p = 0.05), and no further change was observed in the treatment (placebo) period. A significant difference was found between the two groups after the placebo period (T2) ( p = 0.02). Three patients (33%) of the modafinil group and 9 patients (81%) of the placebo group were classified as placebo-responsive ( X 2: p = 0.039). In the treatment period, reaction time was significantly reduced in the modafinil group compared to the placebo group ( p < 0.02). There was a trend toward improvement in overall clinical condition and also in some domains of SF-36 in the modafinil group. Conclusion In summary, our study confirms that modafinil used adjunctively with CPAP therapy improves subjective daytime sleepiness in patients with OSAS who were regular users of CPAP therapy but still experienced sleepiness. Moreover, it could help in the improvement of objective measures of behavioral alertness and reduce functional impairments. The usefulness of a blinded placebo period for systematic investigation of placebo role in studies based on subjective response is a point that should be considered in this type of drug trial.

135 Prevalence of subjective residual excessive daytime sleepiness in patients correctly treated with continuous positive airway pressure

135 Prevalence of subjective residual excessive daytime sleepiness in patients correctly treated with continuous positive airway pressure

Risk factors for traffic accidents in patients with obstructive sleep apnea syndrome

A survey of traffic accidents incurred by 440 patients with obstructive sleep apnea syndrome determined the prevalence of traffic accidents in this group. The study also determined the independent risk factors for accidents in these patients with obstructive sleep apnea syndrome before and after the initiation of continuous positive airway pressure therapy. Before continuous positive airway pressure therapy, 43.4% of the patients had had traffic accidents. The independent risk factors for accidents were higher body mass index, excessive daytime sleepiness, frequent driving and long-distance driving. Accidents occurred most frequently under circumstances of driving at a low speed, as in a traffic jam. The accident rate after continuous positive airway pressure therapy was 5.7%, and significant risk factors were higher age, presence of residual excessive daytime sleepiness, and higher body mass index. We conclude that it would be beneficial to establish a system for detecting unrecognized obstructive sleep apnea syndrome with a view to treatment, in order to reduce the prevalence of traffic accidents. Additionally, it is necessary to check for residual sleepiness after treatment with continuous positive airway pressure, and advice to lose weight is essential.