Update on Persistent Excessive Daytime Sleepiness in OSA.

Chest
Sogol Javaheri, Shahrokh Javaheri

Abstract

OSA is a highly prevalent sleep disorder, and subjective excessive daytime sleepiness (EDS) is the cardinal symptom for which many individuals seek medical advice. Positive airway pressure (PAP) devices, first-line treatment for OSA, eliminates EDS in most patients. However, a subset of patients suffers from persistent EDS despite adherence to therapy. Multiple conditions, some reversible, could account for the residual sleepiness and need to be explored, requiring detailed history, review of PAP data from the smart card, and sometimes additional testing. When all known causes of EDS are excluded, in adequately treated subjects, the purported mechanisms could relate to long-term exposure to the OSA-related sleep fragmentation, sleep deprivation, and hypoxic injury to the arousal system, shifts in melatonin secretion, or altered microbiome. Independent of the mechanism, in well-treated OSA, pharmacological therapy with approved drugs can be considered. Modafinil is commonly prescribed to combat residual EDS, but more recently two drugs, solriamfetol, a dual dopamine-norepinephrine reuptake inhibitor, and pitolisant, a histamine H3 receptor inverse agonist, were approved for EDS. Solriamfetol has undergone randomized controlled t...Continue Reading

Citations

Sep 6, 2020·Current Opinion in Pulmonary Medicine·David C Earl, Kendall M Van Tyle
Jan 28, 2021·Brain Sciences·Oana-Mihaela PlotogeaCamelia Cristina Diaconu
Mar 25, 2021·The Journal of Physiology·Stephen B G Abbott, George M P R Souza
Apr 23, 2021·Journal of Pharmacy Practice·Megan C CuomoJoe K Jordan
Jun 26, 2021·Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine·Lindsay WanbergSusan Redline

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