Residual Excessive Sleepiness Research Articles

Pharmacological interventions for the treatment of obstructive sleep apnea syndrome.

Obstructive Sleep Apnea Syndrome (OSAS) affects 13-33% of males and 6-9% of females globally and poses significant treatment challenges, including poor adherence to Continuous Positive Airway Pressure (CPAP) and residual excessive sleepiness (RES). This review aims to elucidate the emerging interest in pharmacological treatments for OSAS, focusing on recent advancements in this area. A thorough analysis of extensive clinical trials involving various drugs, including selective dopamine reuptake inhibitors, selective norepinephrine inhibitors, combined antimuscarinic agents, and orexin agonists, was conducted. These trials focused on ameliorating respiratory metrics and enhancing sleep quality in individuals affected by OSAS. The studied pharmacological agents showed potential in improving primary outcomes, notably the apnea-hypopnea index (AHI) and the Epworth sleepiness scale (ESS). These improvements suggest enhanced sleep quality and symptom management in OSAS patients. With a deeper understanding of OSAS, pharmacological interventions are emerging as a promising direction for its effective management. This review provides a comprehensive overview of the current state of drug research in OSAS, highlighting the potential of these treatments in addressing the disorder's complex challenges.

The association between residual excessive sleepiness and polysomnography parameters in patients with obstructive sleep apnea using oral appliances

ObjectiveOral appliances (OA) are effective in reducing apnea-hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). However, residual excessive sleepiness (RES) may occur despite successful OA treatment, and there is limited evidence on the cause of this. Furthermore, few studies have examined the association between changes in sleepiness after OA treatment and polysomnography (PSG) parameters. The purpose of this study was to evaluate the prevalence of RES after OA treatment and examine the effects of changes in sleepiness on PSG parameters. MethodsThe study sample included 121 participants who were diagnosed with OSA and had evaluated RES after OA treatment outcomes using PSG. All patients were scored using the Epworth sleepiness scale (ESS) at baseline and after OA treatment, and the association between changes in ESS and PSG parameters were examined statistically. ResultsApproximately 20.5% of OA responders (n = 73) exhibited RES. The ESS change better group (n = 24, ESS decreased by ≥2 points after treatment) exhibited significantly lower baseline lowest SpO2 values (82.0 ± 7.9 vs. 87.5 ± 4.2; p-value <0.01) and higher baseline CT90 value (2.4 ± 4.0 vs. 0.5 ± 0.9; p-value <.05) compared to the ESS change worse group (n = 19, ESS increased by ≥2 points after treatment). Moreover, the CT90 change rate after OA treatment was also significantly higher in the former group. ConclusionOSA patients can exhibit RES despite improvements in AHI after OA treatment. Furthermore, improvements in ESS can potentially help predict hypoxia parameters in PSG.

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&amp;lt; 0.0001), gastrointestinal (7.7%; p&amp;lt; 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

Effects of mindfulness meditation and Acceptance and commitment therapy in patients with obstructive sleep apnea with residual excessive sleepiness: A randomized controlled pilot study

ObjectiveAssessing the effects of Mindfulness-Based Stress Reduction (MBSR) on symptoms of OSA, especially on the primary outcome, excessive daytime sleepiness (EDS). MethodsParallel randomized controlled trial. 16 OSA patients with residual EDS (rEDS) were randomized and assigned to either a standardized 8-week MBSR program or a time-matched program on Acceptance and Commitment Therapy (ACT). Both programs were conducted online. Participants answered questionnaires online at baseline (pre), post-intervention (post), three months after the intervention (follow-up) and were blinded to whether their group was the treatment or active control group but not to group allocation (partial blinding). Three participants dropped out early. Most analyses are based on the remaining 13 patients. ResultsThere was a significant difference between the MBSR (n = 7) and ACT group (n = 6) in changes of EDS between pre and post (Cohen's d = 1.24, CI [0.01, 2.42]) and a significant reduction of EDS for patients in the ACT group at post (Cohen's d = 1.18 and [0.08, 2.22]). This EDS reduction averaging 2.17 points on the Epworth Sleepiness Scale reached the prespecified bar for clinical significance of two points on that scale. Insomnia symptoms, a secondary outcome, reduced significantly following ACT (Cohen's d = 1.43 [0.23, 2.58]). In MBSR, both participants and the MBSR-trainer judged movement-based exercises to be most efficacious. ConclusionACT shows potential as adjunctive therapy for OSA with rEDS, although further studies are needed. It seems promising to develop therapeutic approaches for OSA with rEDS using ACT, especially if they are tailored to the needs specific to this patient group. Trial registrationhttps://www.drks.de; Identifier: DRKS00026812.

Residual Sleepiness Risk in Aircrew Members with -Obstructive Sleep Apnea Syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a major problem in aviation medicine because it is responsible for sleepiness and high cardiovascular risk, which could jeopardize flight safety. Residual sleepiness after the treatment is not a rare phenomenon and its management is not homogenous in aviation medicine. Thus, we decided to perform a study to describe this management and propose guidelines with the help of the literature.METHODS: This is a retrospective study including all aircrew members with a history of OSAS who visited our aeromedical center between 2011 and 2018. Residual sleepiness assessment was particularly studied.RESULTS: Our population was composed of 138 aircrew members (mean age 50.1 ± 9.6 yr, 76.8% civilians, 80.4% pilots); 65.4% of them had a severe OSAS with a mean Epworth Sleepiness Scale (ESS) at 8.5 ± 4.7 and a mean apnea hypopnea index of 36.2 ± 19.2/h. Of our population, 59.4% performed maintenance of wakefulness tests (MWT) and 10.1% had a residual excessive sleepiness. After the evaluation, 83.1% of our population was fit to fly.DISCUSSION: An evaluation of treatment efficiency is required in aircrew members with OSAS. Furthermore, it is important to have an objective proof of the absence of sleepiness. In this case, ESS is not sufficient and further evaluation is necessary. Many tests exist, but MWT are generally performed and the definition of a normal result in aeronautics is important. This evaluation should not be reserved to solo pilots only.Monin J, Rebiere E, Guiu G, Bisconte S, Perrier E, Manen O. Residual sleepiness risk in aircrew members with obstructive sleep apnea syndrome. Aerosp Med Hum Perform. 2023; 94(2):74-78.

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.

Residual sleepiness in veterans with post-traumatic stress disorder and obstructive sleep apnea.

The causes of residual excessive sleepiness (RES) in patients withpost-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) are multifactorial and modulated by comorbid conditions. The aim of the present study was to elucidate clinical and polysomnographic determinants of RES in continuous positive airway pressure (CPAP)-adherent OSA veterans with PTSD. The study protocol consisted of a retrospective analysis of consecutive cases of patients withPTSD who presented to the Veterans Affairs sleep clinics with adequately treated OSA between June 1, 2017 and October 15, 2021. Based on the Epworth Sleepiness Scale (ESS), patients were categorized into RES (ESS ≥ 11) and no RES (ESS < 11) groups. Demographic and PSG data were subjected to univariate and multivariate analyses to ascertain predictive factors of RES. Out of 171 veterans withPTSD who were adherent to CPAP, 59 (35%) continued to experience RES. The RES group had a decrease in mean ESS score of 1.2 ± 4.5 after CPAP treatment compared with 4.6 ± 4.9 for the no RES group (< 0.001). A dose-response was observed between CPAP use and RES (p = 0.003). Multivariate regression analysis identified higher baseline ESS (OR 1.30; 95% CI 1.16-1.44), greater percentage of time spent in REM sleep (OR 0.91; 95% CI 0.85-0.96), CPAP use less than 6h (OR 2.82; 95% CI 1.13-7.01), and a positive screen for depression (OR 1.69; 95% CI 1.03-4.72) as independent predictors of RES in patients withPTSD and OSA. RES is highly prevalent in patients withPTSD and OSA despite adherence to CPAP and is independently associated with percentage time spent in REM, duration of CPAP utilization, and symptoms of depression.

Pharmacotherapy of residual excessive sleepiness among continuous positive airway pressure (CPAP) treated patients with sleep apnea

ABSTRACT Introduction Patients with persistent sleepiness after adequate treatment of obstructive sleep apnea (OSA) with nasal continuous positive airway pressure (nCPAP) experience impaired cognition, reduced productivity, and worse quality of life. Although the mechanisms responsible for this phenomenon are not completely understood, neuroimaging studies have identified reduced gray matter in the frontal cortex and alterations in white matter integrity suggestive of axonal and myelin damage. The intermittent hypoxia with resulting oxidative injury is considered a prime culprit behind the loss of wake-promoting catecholaminergic neurons. Areas covered This narrative review gives an overview of the pathophysiology and approaches to managing patients with residual sleepiness. The authors explore different targeted strategies aimed at improving selection of appropriate pharmacotherapy. Expert opinion Wake-stimulant medications (modafinil and armodafinil) have demonstrated efficacy in reducing sleepiness in adequately treated OSA. The recent FDA approval of pitolisant and solriamfetol complements the use of modafinil by substituting for direct sympathomimetic agents. The distinctive pharmacologic profile and mode of action of each of these agents offer the opportunity of a personalized approach to the management of this disorder. Further studies should be conducted on the long-term effect of these agents alone or in combination on brain structural and functional changes.

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.

0635 Effects of Donepezil in Patients with Residual Excessive Sleepiness of Obstructive Sleep Apnea: A Double Blind; Randomized Placebo; Controlled Study

Abstract Introduction Residual excessive sleepiness (RES) is presented by 6% of obstructive sleep apnea patients despite effective CPAP therapy. Few interventions have been tested for this condition and are focused on daytime stimulants. Recently, cholinergic activity decline was suggested as a potential mechanism in the pathophysiology of RES. This study aimed to investigate the effects of donepezil, an anticholinesterase inhibitor, in patients with RES. Methods This double-blind, randomized, placebo-controlled crossover study included participants with RES (35-65 years). Neuropsychiatric disorders, alcoholism, smoking, shiftwork, psychoactive drugs, other sleep disorders were exclusion criteria. Participants were assigned to one intervention arm (donepezil 5 mg for 15 days followed by donepezil 10mg for 15 days or placebo in the morning). After a 20-day wash-out, the same procedure was repeated following the crossover design. Somnolence measured by the Epworth sleepiness scale (ESS) and Maintenance of Wakefulness Test (MWT) were the primary endpoints. PSG, cognitive (trail test, continuous performance test) and Beck’s depression scale parameters were secondary endpoints. General Linear Models for repeated measures compared interventions responses. Cohen’s d measured effect sizes. Adverse events (AEs) were assessed by questionnaire. Results The study enrolled eight individuals. ESS was lower in the donepezil arm than in the placebo arm (8.9±4.4 vs 15.7±4.1, p&amp;lt;0.05). Effect size for ESS was high (d 1.61). Other endpoints were not different among study arms. Randomization order didn’t affect the results. No AEs were reported. Conclusion Donepezil improved subjective sleepiness in individuals with RES. To our knowledge, this is the first study to report the effects of a cholinergic intervention in patients with RES. Effect size was high for self-reported sleepiness, which may impact on quality of life and risk of disability in people with RES. Agents acting on the cholinergic system are potential targets for treating RES. Support Acknowledgements Brazilian National Council for Scientific and Technological Development (CNPq) This study is supported by AFIP (Associacao Fundo Incentivo a Pesquisa).

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

Quantifying residual excessive sleepiness in patients with OSA despite CPAP therapy

Quantifying residual excessive sleepiness in patients with OSA despite CPAP therapy

Residual excessive sleepiness in patients with obstructive sleep apnea on treatment with continuous positive airway pressure.

One of the most common causes of excessive daytime sleepiness in clinical practice is obstructive sleep apnea syndrome (OSAS). So far, continuous positive airway pressure (CPAP) is the most effective treatment for OSA. Some of the patients do not improve on CPAP and remain sleepy despite using CPAP.This review provides updated information about the possible causes of residual sleepiness whilst using the CPAP in patients with OSAS. Prevalence of OSAS has increased recently to 23.4% in women and 49.7% in men. Periodic limb movement, behaviorally induced insufficient sleep syndrome and depression are the most common causes of persistent sleepiness on CPAP. Residual sleepiness after exclusion of all possible causes is 6%. There is still lack of sufficient evidence about the accurate characteristics and possible causes of this residual sleepiness and how to address this in large prospective studies.