Panelists discuss how obstructive sleep apnea affects potentially up to 1 billion people globally, with excessive daytime sleepiness being a common but often underreported presenting complaint that patients may not recognize or admit to experiencing.
Panelists discuss how the traditional profile of older, overweight men with thick necks remains valid for OSA risk, but clinicians must also recognize that less obvious cases in younger, smaller individuals can be easily missed and require more sensitive screening approaches.
Panelists discuss how to differentiate true excessive daytime sleepiness from general fatigue or tiredness, emphasizing the importance of collaborative care with other specialists to address underlying mood disorders and comorbid conditions that may complicate diagnosis.
Panelists discuss how excessive daytime sleepiness significantly impacts patients' work productivity and quality of life, yet many patients rationalize their symptoms as normal or fail to recognize the severity of their condition, making thorough clinical questioning essential.
Panelists discuss how approximately 20% to 30% of patients compliant with CPAP therapy still experience pathological sleepiness, requiring clinicians to plant early expectations about potential need for additional pharmacological treatment and address patient disappointment when CPAP alone isn't sufficient.
Panelists discuss how FDA-approved medications like modafinil, armodafinil, and solriamfetol serve both therapeutic and diagnostic purposes in treating residual sleepiness, with responses varying across different sleep disorder populations but consistently helping patients recognize their true level of impairment.
Panelists discuss how they approach measuring sleepiness in patients with OSA, with emphasis on trusting patient reports over relying solely on objective tests like the Epworth Sleepiness Scale, which they view as a useful screening tool but inadequate by itself due to patients often minimizing their symptoms.
Panelists discuss how they select between wake-promoting medications (modafinil, armodafinil, and solriamfetol) by explaining neurotransmitter mechanisms to patients while acknowledging that practical factors like insurance coverage and accessibility often drive treatment decisions more than theoretical mechanisms.
Panelists discuss how solriamfetol distinguishes itself from existing wake-promoting medications through its dual dopamine-norepinephrine reuptake inhibition, with patients reporting they "feel better" on it beyond just improved wakefulness, while emphasizing careful dose titration to minimize adverse effects like anxiety and cardiovascular changes.
Panelists discuss how they are excited about future treatments like orexin agonists and nighttime approaches to sleep-wake balance, but express concern that insurance barriers and approval difficulties may prevent patients from accessing even the most effective new medications.
Panelists discuss how clinicians should approach OSA evaluation by clearly defining what brought the patient in, establishing that sleep apnea encompasses more than just breathing issues, taking a comprehensive snapshot of current symptoms, and framing the sleep study as the beginning rather than the end of the treatment process.
