Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Dec:112:104-115.
doi: 10.1016/j.sleep.2023.10.001. Epub 2023 Oct 9.

Recommendations for clinical management of excessive daytime sleepiness in obstructive sleep apnoea - A Delphi consensus study

Joerg S Steier  1 , Richard K Bogan  2 , Irene M Cano-Pumarega  3 , John A Fleetham  4 , Giuseppe Insalaco  5 , Chitra Lal  6 , Jean-Louis Pépin  7 , Winfried J Randerath  8 , Susan Redline  9 , Atul Malhotra  10
Affiliations
Review

Recommendations for clinical management of excessive daytime sleepiness in obstructive sleep apnoea - A Delphi consensus study

Joerg S Steier et al. Sleep Med. 2023 Dec.

Abstract

Study objective: Excessive daytime sleepiness is common with obstructive sleep apnoea and can persist despite efforts to optimise primary airway therapy. The literature lacks recommendations regarding differential diagnosis and management of excessive daytime sleepiness in obstructive sleep apnoea. This study sought to develop expert consensus statements to bridge the gap between existing literature/guidelines and clinical practice.

Methods: A panel of 10 international experts was convened to undertake a modified Delphi process. Statements were developed based on available evidence identified through a scoping literature review, and expert opinion. Consensus was achieved through 3 rounds of iterative, blinded survey voting and revision to statements until a predetermined level of agreement was met (≥80 % voting "strongly agree" or "agree with reservation").

Results: Consensus was achieved for 32 final statements. The panel agreed excessive daytime sleepiness is a patient-reported symptom. The importance of subjective/objective evaluation of excessive daytime sleepiness in the initial evaluation and serial management of obstructive sleep apnoea was recognised. The differential diagnosis of residual excessive daytime sleepiness in obstructive sleep apnoea was discussed. Optimizing airway therapy (eg, troubleshooting issues affecting effectiveness) was addressed. The panel recognised occurrence of residual excessive daytime sleepiness in obstructive sleep apnoea despite optimal airway therapy and the need to evaluate patients for underlying causes.

Conclusions: Excessive daytime sleepiness in patients with obstructive sleep apnoea is a public health issue requiring increased awareness, recognition, and attention. Implementation of these statements may improve patient care, long-term management, and clinical outcomes in patients with obstructive sleep apnoea.

Keywords: Expert testimony; Practice guideline; Sleep apnoea syndromes.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest J. Steier has received consultancy fees from Jazz Pharmaceuticals. R. Bogan is a shareholder of WaterMark Medical and Healthy Humming, LLC; serves on the board of directors for WaterMark Medical; receives consultancy fees from Jazz Pharmaceuticals, Harmony Biosciences, Avadel Pharmaceuticals, Takeda, and Oventus; performs industry-funded research for Avadel, Axsome, Bresotec, Bayer, Idorsia, Suven, Jazz, Balance, NLS, Vanda, Merck, Eisai, Philips, Fresca, Takeda, Liva Nova, Roche, Sanofi, Sommetrics, and Noctrix; and serves on the speakers bureau for Jazz, Eisai, and Harmony. I. Cano-Pumarega has received consultancy fees from Jazz Pharmaceuticals and Bioprojet, as well as fees for speaking activities from Jazz Pharmaceuticals. J. Fleetham has received consultancy fees and fees for speaking activities from Jazz Pharmaceuticals. G. Insalaco has received consultancy fees and fees for speaking activities from Jazz Pharmaceuticals and Bioprojet. C. Lal has received consultancy fees from Jazz Pharmaceuticals and Chest/GSK. J.-L. Pepin has received lecture fees or conference traveling grants from Resmed, Perimetre, Philips, Fisher and Paykel, AstraZeneca, Jazz Pharmaceuticals, Agiradom, and Bioprojet, and has received unrestricted research funding from ResMed, Philips, GlaxoSmithKline, Bioprojet, Fondation de la Recherche Medicale (Foundation for Medical Research), Direction de la Recherche Clinique du CHU de Grenoble (Research Branch Clinic CHU de Grenoble), and fond de dotation “Agir pour les Maladies Chroniques” (endowment fund “Acting for Chronic Diseases”). W. Randerath is a member of the advisory board and receives consultancy fees, personal fees, and travel grants from Jazz Pharmaceuticals and Bioprojet and (outside this topic) from Philips Respironics (ended 2021) and Desitin (ended 2020). S. Redline received grants from Jazz and NIH and consultancy fees from Jazz, Eli Lilly, Apnimed Inc, and Eisai Inc. A. Malhotra receives funding from NIH; receives income related to medical education from Livanova, Jazz, Equillium, and Corvus; and reports that ResMed provided a philanthropic donation to UC San Diego.

References

    1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019;7(8):687–98. - PMC - PubMed
    1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
    1. Bailly S, Destors M, Grillet Y, et al. Obstructive sleep apnea: a cluster analysis at time of diagnosis. PLoS One 2016;11(6):e0157318. - PMC - PubMed
    1. Koutsourelakis I, Perraki E, Economou NT, et al. Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients. Eur Respir J 2009;34(3): 687–93. - PubMed
    1. Bonsignore MR, Pepin JL, Cibella F, et al. 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. - PMC - PubMed

MeSH terms