Investigation and management of residual sleepiness in CPAP-treated patients with obstructive sleep apnoea: the European view.

Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Subjective EDS can be evaluated using the Epworth Sleepiness Scale, in which the patient reports the probability of dozing in certain situations; however, its reliability has been challenged. Objective tests such as the multiple sleep latency test or the maintenance of wakefulness test are not commonly used in patients with OSA, since they require nocturnal polysomnography, daytime testing and are expensive. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. For European respiratory physicians, treatment of EDS with medication is new and they may lack experience in pharmacological treatment of EDS, while novel wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in the USA and Europe. This review will discuss 1) the potential prognostic significance of EDS in OSA patients at diagnosis, 2) the prevalence and predictors of residual EDS in treated OSA patients, and 3) the evolution of therapy for EDS specifically for Europe.

Informations de copyright

Copyright ©The authors 2022.

Déclaration de conflit d'intérêts

Conflict of interest: S. Craig reports receiving grants or contracts from UCB (Xyrem), outside the submitted work. Support for attending meetings and/or travel received from Bioprojet, outside the submitted work. Other disclosures outside the submitted work: Member of advisory board for Bioprojet. NICE committee meetings 2021 on behalf of British Thoracic Society investigating Pitolisant and Solriamfetol. Conflict of interest: J-L. Pépin reports receiving grants or contracts from Air Liquide Foundation, AstraZeneca, Agiradom, Fisher and Paykel, Mutualia, Philips, Resmed, Vitalaire, Agiradom, AstraZeneca, Boehringer Ingelheim, Jazz pharmaceuticals, Night Balance, Philips, Resmed, and Sefam, outside the submitted work. Conflict of interest: W. Randerath reports receiving payment for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Weinmann, Heinen & Löwenstein, Resmed, Jazz Pharmaceuticals, Inspire, Philips Respironics, Bioprojet, and Vanda Pharma, outside the submitted work. Support for attending meetings and/or travel from Heinen & Löwenstein, Resmed, Inspire, Philips Respironics, and Bioprojet, outside the submitted work. Participation on an Advisory Board for Bioprojet, Jazz Pharmaceuticals, and Philips Respironics, outside the submitted work. Conflict of interest: C. Caussé reports support for the present manuscript received from Bioprojet company, for whom they are a current paid employee. Conflict of interest: J. Verbraecken reports grants or contracts received from Air Liquide, Bekaert Deslee Academy, Bioprojet, Fisher & Paykel, Heinen & Löwenstein, Inspire, Jazz Pharmaceuticals, Medidis, Mediq Tefa, Nightbalance, OSG, Philips, ResMed, Sanofi, SomnoMed, Total Care, UCB Pharma, Vivisol, Wave Medical, and Westfalen Medical, outside the submitted work. Consulting fees received from Ectosense, outside the submitted work. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from AstraZeneca, Bioprojet, SomnoMed, TotalCare, and OSA Academy, outside the submitted work. Support for attending meetings and/or travel from Bioprojet, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for Bioprojet, Desitin, Idorsia, Resmed Arval, outside the submitted work. Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: past-president of the Belgian Association for Sleep research and Sleep medicine, outside the submitted work. Conflict of interest: J. Asin reports receiving grants or contracts from Philips and Somnomed, Academy and Somnomed, and Jazz Pharmaceuticals, outside the submitted work. Support for attending meetings and/or travel received from Jazz Pharmaceuticals, Bioproject and GSK, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for Bioproject and Jazz Pharmaceuticals, outside the submitted work. Leadership or fiduciary role in other board, society, committee or advocacy group: SVNL (Dutch Sleep Society) committee meetings as member of the board, unpaid. Involvement with the Dutch OSA Guidelines as member of the SRBD committee of the NVALT, unpaid. All disclosures made outside the submitted work. Conflict of interest: F. Barbé reports receiving consulting fees from Jazz Pharmaceuticals, outside the submitted work. Support for attending meetings and/or travel received from Bioprojet, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for Bioproject, outside the submitted work. Conflict of interest: M.R. Bonsignore reports receiving payments for lectures, presentations, speakers’ bureaus, manuscript writing or educational events for Bioprojet and Jazz Pharmaceuticals, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for Bioprojet and Eisai, outside the submitted work.