On Treatment but Still Sleepy

Cause and Management of Residual Sleepiness in Obstructive Sleep Apnea

Sandrine H. Launois; Renaud Tamisier; Patrick Lévy; Jean-Louis Pépin


Curr Opin Pulm Med. 2013;19(6):601-608. 

In This Article


In OSA patients treated with CPAP, residual sleepiness affects approximately 10% of individuals. The positive diagnosis of residual sleepiness requires a thorough evaluation to exclude other cause(s) of sleepiness. This evaluation is time-consuming, and may require a full PSG on CPAP and objective measurement of vigilance. However, such an evaluation is crucial to rule out treatable causes of sleepiness and adequately select patients for pharmacological treatment.

In spite of a substantial prevalence, residual sleepiness remains still poorly understood. This review of our current knowledge on persistent sleepiness in OSA patients treated by CPAP underlines the need for large prospective studies, in particular to better define predictive baseline characteristics in order to implement tailored treatment, and for further research on causal mechanisms and pharmacological treatments including large, long-term clinical trials of wakefulness promoting agents.