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

Joerg S. Steier*, Richard K. Bogan, Irene M. Cano-Pumarega, John A. Fleetham, Giuseppe Insalaco, Chitra Lal, Jean Louis Pépin, Winfried J. Randerath, Susan Redline, Atul Malhotra

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    1 Citation (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)104-115
    Number of pages12
    JournalSleep Medicine
    Volume112
    DOIs
    Publication statusPublished - Dec 2023

    Keywords

    • Expert testimony
    • Practice guideline
    • Sleep apnoea syndromes

    Fingerprint

    Dive into the research topics of 'Recommendations for clinical management of excessive daytime sleepiness in obstructive sleep apnoea – A Delphi consensus study'. Together they form a unique fingerprint.

    Cite this