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Barateau L, Baillieul S, Andrejak C, Bequignon É, Boutouyrie P, Dauvilliers Y, Gagnadoux F, Geoffroy PA, Micoulaud-Franchi JA, Montani D, Monaca C, Patout M, Pépin JL, Philip P, Pilette C, Tamisier R, Trzepizur W, Jaffuel D, Arnulf I. Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome: Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF). Respir Med Res 2024; 86:101105. [PMID: 38861872 DOI: 10.1016/j.resmer.2024.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/13/2024]
Abstract
Excessive daytime sleepiness (EDS) is frequent among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and can persist despite the optimal correction of respiratory events (apnea, hypopnea and respiratory efforts), using continuous positive airway pressure (CPAP) or mandibular advancement device. Symptoms like apathy and fatigue may be mistaken for EDS. In addition, EDS has multi-factorial origin, which makes its evaluation complex. The marketing authorization [Autorisation de Mise sur le Marché (AMM)] for two wake-promoting agents (solriamfetol and pitolisant) raises several practical issues for clinicians. This consensus paper presents recommendations of good clinical practice to identify and evaluate EDS in this context, and to manage and follow-up the patients. It was conducted under the mandate of the French Societies for sleep medicine and for pneumology [Société Française de Recherche et de Médecine du Sommeil (SFRMS) and Société de Pneumologie de Langue Française (SPLF)]. A management algorithm is suggested, as well as a list of conditions during which the patient should be referred to a sleep center or a sleep specialist. The benefit/risk balance of a wake-promoting drug in residual EDS in OSAHS patients must be regularly reevaluated, especially in elderly patients with increased cardiovascular and psychiatric disorders risks. This consensus is based on the scientific knowledge at the time of the publication and may be revised according to their evolution.
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Affiliation(s)
- Lucie Barateau
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France.
| | - Sébastien Baillieul
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Claire Andrejak
- Pneumology department, CHU Amiens-Picardie, 80054 Amiens, France; UR 4294 AGIR, Picardie Jules-Verne University, Amiens, France
| | - Émilie Bequignon
- ENT and oral maxillofacial surgery department, Intercommunal center Créteil, 94000 Créteil, France; CNRS, ERL 7000, Paris-Est Créteil University, 94010 Créteil, France
| | - Pierre Boutouyrie
- Pharmacology, Inserm PARCC U970, Georges-Pompidou European Hospital, Paris-Cité University, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France
| | - Frédéric Gagnadoux
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Pierre-Alexis Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 75018 Paris, France; Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm U1141, 75019 Paris, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - David Montani
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Christelle Monaca
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Clinical neurophysiology, sleep disorders unit, U1172 - LilNCog - Lille, neurosciences & cognition, Lille university, Lille CHU, 59000 Lille, France
| | - Maxime Patout
- R3S department, Sleep pathologies unit, University hospital group, AP-HP-Sorbonne university, AP-HP, Pitié-Salpêtrière site, 75013 Paris, France; Inserm, UMRS1158 experimental and clinical respiratory neurophysiology, Sorbonne university, 75005 Paris, France
| | - Jean-Louis Pépin
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Pierre Philip
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - Charles Pilette
- Saint-Luc university clinics, Institute for experimental and clinical research (Pneumology unit), UC Louvain, Brussels, Belgium
| | - Renaud Tamisier
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Wojciech Trzepizur
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Dany Jaffuel
- Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France; Inserm U1046, physiology and experimental medicine, heart and muscle, Montpellier university, Montpellier, France
| | - Isabelle Arnulf
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France
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Verhoef VTR, Smolders KCHJ, Remmelswaal L, Peeters G, Overeem S, de Kort YAW. Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders. Clocks Sleep 2024; 6:24-39. [PMID: 38247883 PMCID: PMC10801535 DOI: 10.3390/clockssleep6010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Excessive daytime sleepiness is a common symptom of sleep disorders. Despite its prevalence, it remains difficult to define, detect, and address. The difficulties surrounding sleepiness have been linked to an ambiguous conceptualization, a large variety of scales and measures, and the overlap with other constructs, such as fatigue. The present study aims to investigate patients' descriptions of sleepiness-related daytime complaints and their phenomenology. We performed semi-directed interviews with patients diagnosed with obstructive sleep apnea (N = 15) or narcolepsy (N = 5). The interviewers took care of utilizing the participants' terminology when describing daytime complaints related to their sleep disorder. Various aspects of the daytime complaints were investigated, such as their description and temporality. The transcribed content was thematically analyzed using an eclectic coding system, yielding five themes. The participants used different interchangeable descriptors (tired, sleepy, fatigued, exhausted) to express their daytime complaints. They enriched their description with indexes of magnitude (ranging from 'not especially' to 'most gigantic, extreme'), oppositions to other states (using antipodes like energy, alertness, wakefulness, or rest), and indications of fluctuations over the day. Interestingly, the participants often used metaphors to express their experiences and their struggles. The lived experiences of the patients were found to not always align with common self-reported monitoring tools of sleepiness and to relate only in part with current conceptions. In practice, it is important to probe daytime complaints, such as daytime sleepiness, with a broader consideration, for example, by exploring antipodes, consequences, and time-of-day fluctuations.
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Affiliation(s)
- Vaida T. R. Verhoef
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Karin C. H. J. Smolders
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Lysanne Remmelswaal
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Geert Peeters
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands; (G.P.); (S.O.)
| | - Sebastiaan Overeem
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands; (G.P.); (S.O.)
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Yvonne A. W. de Kort
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
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Craig S, Pépin JL, Randerath W, Caussé C, Verbraecken J, Asin J, Barbé F, Bonsignore MR. Investigation and management of residual sleepiness in CPAP-treated patients with obstructive sleep apnoea: the European view. Eur Respir Rev 2022; 31:31/164/210230. [PMID: 35613742 DOI: 10.1183/16000617.0230-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Sonya Craig
- Liverpool Sleep and Ventilation Centre, University Hospital Aintree, Liverpool University Foundation Trust, Liverpool, UK
| | - Jean-Louis Pépin
- University Grenoble Alpes, HP2 Laboratory INSERM U1042, Grenoble, France
| | - Winfried Randerath
- Bethanien Hospital, Institute of Pneumonology, University of Cologne, Solingen, Germany
| | | | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Antwerp, Belgium
| | - Jerryll Asin
- Amphia Ziekenlius, AFD, Longziekten, Breda, The Netherlands
| | - Ferran Barbé
- Respiratory Dept, Institut Ricerca Biomedica de Vilanova, Lleida, Spain
| | - Maria R Bonsignore
- PROMISE Dept, University of Palermo; Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
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Kallweit U, Pevernagie D, Lammers GJ. “Sleepiness” in obstructive sleep apnea: getting into deep water. Sleep Med 2022; 92:64-66. [DOI: 10.1016/j.sleep.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/12/2022] [Accepted: 02/20/2022] [Indexed: 10/19/2022]
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El-Solh AA, Rudraraju A, Pasrija D, Bui H. Pharmacotherapy of residual excessive sleepiness among continuous positive airway pressure (CPAP) treated patients with sleep apnea. Expert Opin Pharmacother 2022; 23:507-516. [PMID: 35045769 DOI: 10.1080/14656566.2022.2029408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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.
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Affiliation(s)
- Ali A El-Solh
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Department of Epidemiology and Environmental Health; School of Public Health and Health Professions, University at Buffalo, USA
| | - Avantika Rudraraju
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Divij Pasrija
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Hoang Bui
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA
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Pevernagie D, Bauters FA, Hertegonne K. The Role of Patient-Reported Outcomes in Sleep Measurements. Sleep Med Clin 2021; 16:595-606. [PMID: 34711384 DOI: 10.1016/j.jsmc.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Several questionnaires aka patient-reported outcome measures (PROMs) have been developed for specific use in sleep medicine. Some PROMS are "disease-specific," that is, related to a specific sleep disorder, whereas others are generic. These PROMS constitute a valuable add-on to the conventional history taking. They can be used in the areas of research, clinical practice, and quality of health care appraisal. Still, these instruments have inherent limitations, requiring proficient application in the various areas of interest. Disease-specificity includes a risk for nosologic bias that may confound diagnostic and therapeutic results. Future research should provide solutions for shortcomings of presently available questionnaires.
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Affiliation(s)
- Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Corneel Heymanslaan 10, Gent 9000, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium.
| | - Fré A Bauters
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Corneel Heymanslaan 10, Gent 9000, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium
| | - Katrien Hertegonne
- Department of Respiratory Medicine, Ghent University Hospital, Gent, Corneel Heymanslaan 10, Gent 9000, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium
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Bonsignore MR, Pepin JL, Cibella F, Barbera CD, Marrone O, Verbraecken J, Saaresranta T, Basoglu OK, Trakada G, Bouloukaki I, McNicholas WT, Bailly S, Pataka A, Kvamme JA, Hein H, Mihaicuta S, Grote L, Fanfulla F. Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database. Front Neurol 2021; 12:690008. [PMID: 34434158 PMCID: PMC8381644 DOI: 10.3389/fneur.2021.690008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (n = 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3–13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1–15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea–hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use <4 h, occurred with similar frequency in patients with and without EDS at follow-up. Prevalence of residual EDS was highest (40%) in patients with a first follow-up visit at 0–3 months, then it was 13–19% in patients with a first follow-up visit after 4 months to 2 years. The change in ESS (n = 2,190) was weakly correlated with CPAP use (R2 = 0.023, p < 0.0001). Logistic regression showed that an ESS score >10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R2 of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.
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Affiliation(s)
- Maria R Bonsignore
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy.,National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Jean L Pepin
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Fabio Cibella
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Calogero D Barbera
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy
| | - Oreste Marrone
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University Hospital Antwerp, Antwerp, Belgium
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, School of Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Sébastien Bailly
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John A Kvamme
- Ear, Nose and Throat-Department, Foerde Central Hospital, Foerde, Norway
| | - Holger Hein
- Private Practice and Sleep Lab for Internal Medicine, Pulmonary Medicine and Sleep Medicine, Geesthacht, Germany
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, CardioPrevent Foundation, Timisoara, Romania
| | - Ludger Grote
- Sleep Disorders Centre, Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Sleep and Wake Disorders, Institute for Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, Scientific Institutes of Pavia and Montescano, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
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Moore BA, Tison LM, Palacios JG, Peterson AL, Mysliwiec V. Incidence of insomnia and obstructive sleep apnea in active duty United States military service members. Sleep 2021; 44:6127013. [PMID: 33532830 DOI: 10.1093/sleep/zsab024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/04/2021] [Indexed: 01/01/2023] Open
Abstract
STUDY OBJECTIVES Epidemiologic studies of obstructive sleep apnea (OSA) and insomnia in the U.S. military are limited. The primary aim of this study was to report and compare OSA and insomnia diagnoses in active duty the United States military service members. METHOD Data and service branch densities used to derive the expected rates of diagnoses on insomnia and OSA were drawn from the Defense Medical Epidemiology Database. Single sample chi-square goodness of fit tests and independent samples t-tests were conducted to address the aims of the study. RESULTS Between 2005 and 2019, incidence rates of OSA and insomnia increased from 11 to 333 and 6 to 272 (per 10,000), respectively. Service members in the Air Force, Navy, and Marines were diagnosed with insomnia and OSA below expected rates, while those in the Army had higher than expected rates (p < .001). Female service members were underdiagnosed in both disorders (p < .001). Comparison of diagnoses following the transition from ICD 9 to 10 codes revealed significant differences in the amounts of OSA diagnoses only (p < .05). CONCLUSION Since 2005, incidence rates of OSA and insomnia have markedly increased across all branches of the U.S. military. Despite similar requirements for overall physical and mental health and resilience, service members in the Army had higher rates of insomnia and OSA. This unexpected finding may relate to inherent differences in the branches of the military or the role of the Army in combat operations. Future studies utilizing military-specific data and directed interventions are required to reverse this negative trend.
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Affiliation(s)
- Brian A Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, GA, USA.,Department of Psychiatry and Behavioral Science, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Javier G Palacios
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Science, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA.,Office of Research and Development, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Science, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Schweitzer PK, Strohl KP, Mayer G, Rosenberg R, Chandler P, Baladi M, Lee L, Malhotra A. Effects of solriamfetol in a long-term trial of participants with obstructive sleep apnea who are adherent or nonadherent to airway therapy. J Clin Sleep Med 2021; 17:659-668. [PMID: 33179591 DOI: 10.5664/jcsm.8992] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVES Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved in the United States and European Union to treat excessive daytime sleepiness in patients with obstructive sleep apnea (OSA) (37.5-150 mg/day) and narcolepsy (75-150 mg/day). This analysis evaluated solriamfetol's efficacy in subgroups of participants with OSA who were adherent or nonadherent to primary OSA therapy at baseline and examined whether solriamfetol affected the use of primary therapy in an open-label extension trial. METHODS Participants with OSA who completed prior solriamfetol studies received solriamfetol 75, 150, or 300 mg/day for ≤ 52 weeks. The main efficacy outcome was the Epworth Sleepiness Scale score. Primary therapy use was summarized as the percentage of nights, the number of hours/night, and the percentage of nights with use ≥ 50%/night (%). Efficacy and primary therapy use are reported for participants who directly enrolled from a previous 12-week study and had ≤ 40 weeks of open-label treatment (n = 333). Safety data are reported for all participants (n = 417). RESULTS Mean ESS scores in adherent (n = 255) and nonadherent (n = 78) subgroups, respectively, were 15.0 and 15.8 at baseline (of 12-week study) and 6.5 and 6.8 at week 40. For participants using an airway therapy, mean use at baseline was 90% of nights, 6.6 hours/night, and use ≥ 50%/night on 90% of nights; changes from baseline to week 40 were minimal (0.9%, -0.8 hours, and 6.5%, respectively). Common adverse events (both subgroups) included headache, nasopharyngitis, insomnia, dry mouth, nausea, anxiety, and upper respiratory tract infection. CONCLUSIONS Long-term efficacy and safety of solriamfetol were similar regardless of adherence to primary OSA therapy. Solriamfetol did not affect primary therapy use. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A Long-Term Safety Study of JZP-110 in the Treatment of Excessive Sleepiness in Subjects with Narcolepsy or OSA; URL: https://clinicaltrials.gov/ct2/show/NCT02348632; Identifier: NCT02348632 and Registry: EU Clinical Trials Register; Identifier: 2014-005489-31; URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-005489-31..
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Affiliation(s)
- Paula K Schweitzer
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, Missouri
| | | | - Geert Mayer
- Hephata Klinik, Schwalmstadt, Germany.,Philipps University, Marburg, Germany
| | - Russell Rosenberg
- NeuroTrials Research, Inc., Atlanta, Georgia.,Atlanta School of Sleep Medicine, Atlanta, Georgia
| | | | | | | | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego Medical Center, La Jolla, California
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Diagnostik und Therapie der residualen Tagesschläfrigkeit bei Patienten mit therapierter obstruktiver Schlafapnoe. SOMNOLOGIE 2021. [DOI: 10.1007/s11818-021-00305-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ZusammenfassungDie residuale Tagesschläfrigkeit tritt bei 12–65 % der Schlafapnoe-Patienten unter eingeleiteter Positivdrucktherapie („positive airway pressure“) auf. Eine häufige Ursache ist die geringe PAP-Nutzungszeit. Mögliche weitere Gründe sind ein hoher Rest-Apnoe-Hypopnoe-Index und eine vorhandene Komorbidität. Prädiktoren sind ein initial hoher Epworth-Schläfrigkeitsscore, jüngeres Alter und die erst kurze PAP-Nutzung. Gesichert wird die Restschläfrigkeit mittels objektiver Testverfahren (z. B. multipler Wachbleibetest oder Oxford Sleep Resistance Test [Osler-Test]). Eine der wesentlichen Ursachen für die residuale Schläfrigkeit nach Ausschluss konkurrierender Auslöser ist die stattgehabte intermittierende nächtliche Hypoxämie, die zu nervalen Zellschädigungen, zu hormonellen und genetischen Veränderungen und zu Änderungen des Mikrobioms führen kann.Die klinischen Beschwerden werden bestimmt durch eine ausgeprägte Tagesschläfrigkeit, depressive Verstimmung und eine Minderung der Lebensqualität.Nach Ausschluss möglicher therapiebedingter Ursachen kann die residuale Tagesschläfrigkeit medikamentös mit u. a. Modafinil, Armodafinil, Pitolisant oder Solriamfetol behandelt werden. Die genannten Arzneimittel haben unterschiedliche Wirkmechanismen. Die Studien und die Effekte der Substanzen auf die Tagesschläfrigkeit, die Lebensqualität und die Leistungsfähigkeit der Betroffenen werden vorgestellt. Das Nebenwirkungsprofil der Wirkstoffe ist ähnlich. Für die Indikation residuale Schläfrigkeit einer therapierten obstruktiven Schlafapnoe ist in Europa derzeit nur Solriamfetol zugelassen.Ein vom Autorenteam entworfener Behandlungspfad für Patienten mit therapierter obstruktiver Schlafapnoe mit residualer Tagesschläfrigkeit, von der Erstvorstellung nach Therapiebeginn über die Therapieoptimierung bis hin zu einer medikamentösen Behandlung, wird vorgestellt.
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Use of Wake-Promoting Agents in OSA: When Patients Do Not Achieve a Minimum of 6 Hours of PAP Usage per Night? CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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