PURPOSE: To document the need for initiation of medical therapy for sleep apnea patients with excessive daytime sleepiness.
METHODS: A prospective study was performed over a period of 3 years. Patients on nasal continuous airway pressure (NCPAP) therapy that continued to have persistent excessive daytime sleepiness (EDS) or patients with mild sleep apnea that complained of EDS were evaluated. NCPAP titration was performed followed by Mean Sleep Latency time (MSLT) the next morning. Patients were discarded if their sleep efficiency was less than 80% the previous night.
RESULTS: Forty eight patients were evaluated of which sixteen were mild (SI below50; MSLT above 10 minutes), fifteen were of moderate severity (SI between 50 and 75; MSLT between 5 and 10 minutes) and 17 were severe (SI above 75; MSLT below 5 minutes). Seven patients had narcolepsy and 4 patients had inadequate response to CPAP (AHI > 5 but below 10/hr). Only two patients needed medical therapy with mild sleepiness index (SI) compared to 9/15 patients with moderate SI. All patients with severe SI and patients diagnosed with narcolepsy needed medical therapy.
CONCLUSION: We conclude that patients with sleep apnea that continue to have persistent EDS need NCPAP titration followed by an MSLT to diagnose other sleep disorders and to document the severity of their SI. Patients with Mild SI need good sleep hygiene techniques and very seldom need medications. Some patients with Moderate SI and most patients with severe SI will need medications to control their symptoms.
CLINICAL IMPLICATIONS: Not all patents with sleep apnea that complain of excessive daytime sleepiness need medical therapy.
DISCLOSURE: GEORGE THOMMI, No Financial Disclosure Information; No Product/Research Disclosure Information