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Uptodate Reference Title
Evaluation of residual excessive daytime sleepiness in patients with treated obstructive sleep apnea
Evaluation of residual excessive daytime sleepiness in patients with treated obstructive sleep apnea
This algorithm mostly applies to patients who require CPAP for treatment of their OSA but the general principles remain the same for those who are treated with alternate modes of therapy.
OSA: obstructive sleep apnea; EDS: excessive daytime sleepiness; CPAP: continuous positive airway pressure. * This is the most challenging step in the evaluation of residual EDS in patients with OSA receiving therapy. Ruling out other significant causes of EDS is determined mostly by history and examination. Further testing including multiple sleep latency testing, magnetic resonance imaging of the brain, and laboratory tests (eg, blood count, thyroid function tests, testosterone level, iron studies, Epstein-Barr virus antibodies) may be performed depending upon the suspicion for specific etiologies. The etiologies and approach to a patient with EDS are discussed in UpToDate. ΒΆ Wakefulness promoting agents are generally reserved for patients with adequately-treated OSA who have persistent burdensome daytime sleepiness and in whom alternative causes of daytime sleepiness have been excluded. However, adjunctive pharmacotherapy for residual sleepiness in patients with adequately-treated OSA is controversial, and the level of daytime sleepiness at which a trial of stimulant therapy is warranted has not been well-defined.
