Mehra Reena, Heinzer Raphael, Castillo Pablo
Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, S-73, Cleveland, OH, 44195, USA.
Center for Investigation and Research in Sleep, University Hospital of Lausanne, Lausanne, Switzerland.
Neurol Ther. 2021 Dec;10(2):651-672. doi: 10.1007/s40120-021-00289-6. Epub 2021 Oct 18.
Although excessive daytime sleepiness (EDS) attributable to obstructive sleep apnea (OSA) can be resolved by consistent usage of and effective treatment (often with the use of continuous positive airway pressure therapy), 12-58% of patients report residual EDS (REDS). While REDS is difficult to treat, a proportion of cases are possibly due to reversible issues, and wake-promoting medications can prove useful for the remaining cases. Given the challenges associated with effective management of REDS and its relationship to multiple comorbidities, multidisciplinary management of patients with REDS is often recommended. Here we aim to bridge the knowledge gap on the burden, risk factors, prevalence, and potential pathophysiologic mechanisms of REDS in patients with OSA after first-line treatment. The roles of primary care physicians and sleep specialists, as well as the importance of the use of objective assessment tools for the evaluation of REDS and the effective management of comorbidities, are discussed. An update of approved treatments and emerging candidate treatments is also presented.
尽管阻塞性睡眠呼吸暂停（OSA）所致的日间过度嗜睡（EDS）可通过持续使用有效的治疗方法（通常使用持续气道正压通气治疗）得到解决，但12%至58%的患者报告仍有残余日间过度嗜睡（REDS）。虽然REDS难以治疗，但一部分病例可能是由于可逆性问题导致的，促醒药物对其余病例可能有用。鉴于有效管理REDS存在挑战且其与多种合并症相关，通常建议对REDS患者进行多学科管理。在此，我们旨在填补一线治疗后OSA患者中REDS的负担、危险因素、患病率及潜在病理生理机制方面的知识空白。讨论了初级保健医生和睡眠专家的作用，以及使用客观评估工具评估REDS和有效管理合并症的重要性。还介绍了已批准治疗方法和新兴候选治疗方法的最新情况。
