![]() Therefore, for many European respiratory physicians, treatment of RES with medication represents a new scenario, since they may lack experience in pharmacologic treatment of EDS, while new wake-promoting drugs have been recently developed and approved for clinical use in OSA patients in United States and Europe. Some drugs used to treat EDS despite CPAP, so-called residual EDS or residual sleepiness (RES), have been available in the United States but were discontinued in Europe about 10 years ago. The reliability and repeatability of the ESS have been recently challenged. A score ≥11 is considered as positive for EDS, and ≥16 indicates severe sleepiness. Subjective EDS can be evaluated by using the Epworth Sleepiness Scale (ESS), in which the patient reports the probability of dozing off in eight different situations. In patients with OSA, they are not commonly used, since they require full nocturnal polysomnography, additional daytime testing and are expensive. The latter include the multiple sleep latency test (MSLT) and the maintenance of wakefulness test (MWT), which measure the propensity to fall asleep and the ability to stay awake, respectively. Ĭlinical evaluation of EDS can be performed by using subjective and objective tests. ![]() Patients’ symptoms may improve with OSA therapy such as continuous positive airway pressure (CPAP), but a proportion will remain sleepy. ![]() Insufficient sleep, diseases such as diabetes, hypothyroidism or depression, and habitual use of some medications like hypnotics are amongst the most common. Moreover, the pathogenesis of EDS is complex and sleep disorders are not the only cause of EDS. Sleepiness is defined as the inability to stay awake during the day, but its clinical descriptors remain elusive in both central disorders of hypersomnolence, such as narcolepsy or idiopathic hypersomnia and in OSA. Patients often seek medical advice for excessive daytime sleepiness (EDS), which is a major symptom of obstructive sleep apnoea (OSA). 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. 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. Drugs for EDS are available in the United States but were discontinued in Europe some time ago. 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. 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. Its clinical descriptors remain elusive, and the pathogenesis is complex, with disorders such as insufficient sleep and depression commonly associated. Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnoea (OSA), defined as the inability to stay awake during the day.
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