Excessive daytime sleepiness (EDS) is commonly associated with obstructive sleep apnea (OSA), which is the most common sleep disorder. EDS is a major facet of OSA that can persist despite patients receiving adequate treatment for their OSA. Currently available treatments for OSA, including continuous positive airway pressure (CPAP) and oral appliances, are often underused or rejected by patients. There are several reasons for this such as insurance coverage, discomfort, inconvenience, as well as perceived efficacy. A review by Léger and Stepnowsky (2020) found demonstrated rates of EDS in OSA of 12%-65% using the most commonly reported definition of EDS (Epworth Sleepiness Scale ≥11), and a prevalence of persistent EDS in OSA following continuous positive airway pressure treatment of 12%-65%. EDS manifests in multiple ways with adverse behavioral health outcomes, such as the serious safety issue of falling asleep while driving. There is a 2-3-fold increase in risk for patients with OSA experiencing a driving accident. Thus, EDS in OSA has a significant negative impact on quality of life, increasing socio-economic burden and damaging public health.
In your experience, what are the critical unmet needs associated with excessive daytime sleepiness and obstructive sleep apnea?
1. Leger, Damien, and Carl Stepnowsky. "The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea." Sleep medicine reviews (2020): 101275.
I am a psychiatrist who was diagnosed with OSA and EDS while in my 50s. I've repeatedly been told that my CPAP is working perfectly and that my compliance is good. I use my CPAP nightly for at least 6 hours and often more. I have to rely on Adderall ER and IR to stay awake during the day and without them I am exhausted. I am not obese. I exercise and I eat well. It is extremely frustrating to be told that some people "just have EDS" despite their OSA being adequately treated, and it's frustrating to have to rely on Adderall just to function. Even with Adderall my EDS is negatively impacting my functioning and I am unaware of any solution for this.
Getting approval (prior authorization) is the PITS!! Takes days, then appeals, often months go by til we can get the sleep study approved for suspected OSA....
Cpap, improves EDS, but unfortunately some patients are unable to tolerate it. Pt compliance can be an issue
Trial of modanifil , amphetamines, life style modification, weight loss should be considered
Insurance approval is sometimes an issue. Could try a non-medicine approach, but patients may not see the value in it.
As stated in the synopsis, even with proper therapy EDS can persist. Reasons like these are why compliance with NIV is poor. The majority of my noncompliant patients will continue to be noncompliant regardless of the benefits they are made aware of. Inspire has helped improve compliance though insurance approval is difficult.
I totally agree with this issue. EDS is very crucial disorder that our patients struggle with and we do not have much to offer. I would like to know more about options, their efficacy, side effects and tolerance.
The most unmet need is the same as in any chronic condition: treatment adherence and motivation for healthy life style ( wt loss, healthy eating)
The most significant unmet need of efficacy combined with safety, its hard to manage the symptomd with minimum side effects,
For my patient population the greatest unmet need is a tx that my patients will actually use. The majority of my pts d/c CPAP after an inadequate trial. I'd like to see new technology that does not involve masks/machines. The Inspire device looks promising, but I've only had 1 pt qualify for it--he loves it, but we need better insurance coverage so that more pts can benefit.
Adherence problems with standard of care treatments like CPAP are a major unmet need. Patients often stop using the masks within the first few weeks because they find them so uncomfortable. Also there’s often reimbursement problems to find a different mask if one doesn’t work well.
Although I do not treat SA as such in my practice but I have seen lot of nurses who have worked with me in the psych ER who suffered tiredness associated with night shift work.I used to prescribe them Provigil small dose before their shift and it will gently "wake" them up.I have also prescribed Provigil as an adjunct to antidepressants in patients who suffered tiredness/lack of motivation with very good results.
Excessive daytime sleepiness (EDS) is definitely a problem in Psychiatry and certainly can present as a problem in terms of differential diagnosis given that many patients are also on psychiatric medications.
OSA , medications, obesity, drug or alcohol use, circadian rhythms and sleep patterns and comorbid medical conditions all need to be considered .
If a patient is willing to have a sleep study and is able to navigate the necessary steps such as having it completed during the pandemic and insurance issues and OSA is diagnosed,
then tolerability of CPAP can become problematic.
CPAP masks, nasal cannula, sanitation issues and insurance coverage can present as barriers to effective treatment. Seeing a doctor for follow-up with EDS and adjustments to CPAP and again insurance issues continue. Efficacy and tolerability all impact complance.
The incidence of EDS therefore can still be high.
Modafanil and other similar medications can improve EDS. Amphetamines at times with appropriate consideration is another option for treatment of EDS.
Overall the effective treatment continues to be problematic largely based on the barriers encountered.
While CPAP has been demonstrated to be highly effective at reversing the negative health effects of OSA and improving EDS, tolerability remains a huge problem. For select patients, upper airway surgery or hypoglossal nerve stimulation can also be curative, but patients and other physicians may not be as aware of alternative treatments for OSA.
One of the critical unmet need is early diagnosis of EDS. For some patients it can take years before they are diagnosed with EDS. This could involve lifelong treatment for EDS.