Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Medical University of South Carolina, Charleston, SC, USA.
Sleep Med. 2023 Dec;112:104-115. doi: 10.1016/j.sleep.2023.10.001. Epub 2023 Oct 9.
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.
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").
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.
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.
阻塞性睡眠呼吸暂停患者常伴有日间嗜睡，且尽管已尽力优化主要气道治疗，但这种情况仍可能持续存在。目前，阻塞性睡眠呼吸暂停患者日间嗜睡的鉴别诊断和管理方面的文献仍缺乏相关推荐意见。本研究旨在制定专家共识声明，以弥合现有文献/指南与临床实践之间的差距。
召集了 10 名国际专家组成专家组，采用改良 Delphi 法进行研究。根据通过文献范围界定审查确定的现有证据和专家意见制定声明。通过 3 轮迭代、盲法调查投票和声明修订来达成共识，直到达到预定的一致水平（≥80%的投票者“强烈同意”或“有保留地同意”）。
专家组就 32 条最终声明达成共识。专家组一致认为，日间嗜睡是一种患者报告的症状。专家组认识到在阻塞性睡眠呼吸暂停的初始评估和连续管理中，主观/客观评估日间嗜睡的重要性。还讨论了阻塞性睡眠呼吸暂停患者中残余日间嗜睡的鉴别诊断。优化气道治疗（例如，解决影响疗效的问题）也得到了重视。专家组认识到尽管进行了最佳气道治疗，但仍会出现阻塞性睡眠呼吸暂停患者的残余日间嗜睡，并需要评估患者是否存在潜在病因。
阻塞性睡眠呼吸暂停患者的日间嗜睡是一个公共卫生问题，需要提高认识、识别和重视。实施这些声明可能会改善阻塞性睡眠呼吸暂停患者的患者护理、长期管理和临床结局。
