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Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome : Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF) - 11/06/24

Doi : 10.1016/j.resmer.2024.101105 
Lucie Barateau a, b, c, , Sébastien Baillieul d, e, Claire Andrejak f, g, Émilie Bequignon h, i, Pierre Boutouyrie j, Yves Dauvilliers a, b, c, Frédéric Gagnadoux e, k, l, Pierre-Alexis Geoffroy m, n, o, Jean-Arthur Micoulaud-Franchi p, q, David Montani r, Christelle Monaca e, s, Maxime Patout t, u, Jean-Louis Pépin d, e, Pierre Philip a, p, q, Charles Pilette v, Renaud Tamisier d, e, Wojciech Trzepizur e, k, l, Dany Jaffuel w, x, Isabelle Arnulf a, t
a National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France 
b Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France 
c Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France 
d Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France 
e National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France 
f Pneumology department, CHU Amiens-Picardie, 80054 Amiens, France 
g UR 4294 AGIR, Picardie Jules-Verne University, Amiens, France 
h ENT and oral maxillofacial surgery department, Intercommunal center Créteil, 94000 Créteil, France 
i CNRS, ERL 7000, Paris-Est Créteil University, 94010 Créteil, France 
j Pharmacology, Inserm PARCC U970, Georges-Pompidou European Hospital, Paris-Cité University, Assistance publique-Hôpitaux de Paris, Paris, France 
k Pneumology and Sleep Medicine department, Angers CHU, Angers, France 
l Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France 
m Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 75018 Paris, France 
n Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France 
o Université de Paris, NeuroDiderot, Inserm U1141, 75019 Paris, France 
p University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France 
q SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France 
r Université Paris–Saclay, AP-HP, INSERM UMR_S 999, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital de Bicêtre, Le Kremlin Bicêtre, France 
s Clinical neurophysiology, sleep disorders unit, U1172 - LilNCog - Lille, neurosciences & cognition, Lille university, Lille CHU, 59000 Lille, France 
t R3S department, Sleep pathologies unit, University hospital group, AP-HP-Sorbonne university, AP-HP, Pitié-Salpêtrière site, 75013 Paris, France 
u Inserm, UMRS1158 experimental and clinical respiratory neurophysiology, Sorbonne university, 75005 Paris, France 
v Saint-Luc university clinics, Institute for experimental and clinical research (Pneumology unit), UC Louvain, Brussels, Belgium 
w Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France 
x Inserm U1046, physiology and experimental medicine, heart and muscle, Montpellier university, Montpellier, France 

Corresponding author at: Sleep disorders unit, neurology department, Gui-de-Chauliac hospital, 80 avenue Augustin-Fliche, 34295 Montpellier Cedex 5, France.Sleep disorders unit, neurology departmentGui-de-Chauliac hospital80 avenue Augustin-Fliche, 34295 Montpellier Cedex 5France

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→ Publication en français dans la revue Médecine du Sommeil en aout 2023 : https://doi.org/10.1016/j.msom.2023.06.001

Abstract

Excessive daytime sleepiness (EDS) is frequent among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and can persist despite the optimal correction of respiratory events (apnea, hypopnea and respiratory efforts), using continuous positive airway pressure (CPAP) or mandibular advancement device. Symptoms like apathy and fatigue may be mistaken for EDS. In addition, EDS has multi-factorial origin, which makes its evaluation complex. The marketing authorization [Autorisation de Mise sur le Marché (AMM)] for two wake-promoting agents (solriamfetol and pitolisant) raises several practical issues for clinicians. This consensus paper presents recommendations of good clinical practice to identify and evaluate EDS in this context, and to manage and follow-up the patients. It was conducted under the mandate of the French Societies for sleep medicine and for pneumology [Société Française de Recherche et de Médecine du Sommeil (SFRMS) and Société de Pneumologie de Langue Française (SPLF)]. A management algorithm is suggested, as well as a list of conditions during which the patient should be referred to a sleep center or a sleep specialist. The benefit/risk balance of a wake-promoting drug in residual EDS in OSAHS patients must be regularly reevaluated, especially in elderly patients with increased cardiovascular and psychiatric disorders risks. This consensus is based on the scientific knowledge at the time of the publication and may be revised according to their evolution.

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Keywords : Residual sleepiness, sleep apnea, Consensus, Recommendations, Stimulant

Abbreviations : AASM, MA, BDI, CGI-C, CV, ESS, EEG, EQ-5D, HR, FDG, FOSQ, HAD, HAS, PAH, AHI, IHSS, MRI, IRSNa, ISRS, PR, ABPM, NHP, MAD, BP, PGI-C, PHQ4, PLMS, PNDS, POMS, PPC, PSG, PSQI, RP, PVT, RERA, RDI, SAS, OSAHS, EDS, rEDS, SF36, SFRMS, SPLF, PET, MSLT, MWT, PPV


Mappa


 Coordination: I. Arnulf and L. Barateau. Working groups: Neurology: Arnulf, L. Barateau, C. Monaca; Pneumology: S. Baillieul, F. Gagnadoux, D. Jaffuel, M. Patout, J.L. Pépin; Psychiatry: P.A. Geoffroy, J.A. Micoulaud-Franchi, P. Philip.
Validated by SFRMS scientific committee. Validated by SPLF scientific committee.
Revisions and validation by: C. Andrejak (pneumologist, general secretary of the SPLF scientific board), E. Bequignon (ENT, chair of the French ENT sleep association, ASFORL), P. Boutouyrie (pharmacologist, cardiologist), Y. Dauvilliers (neurologist, coordinator of the narcolepsy hypersomnias rare reference/competence centers), D. Montani (pneumologist, pulmonary hypertension reference center), C. Pilette (pneumologist, SPLF “non-sleep expert” representative), R. Tamisier (pneumologist, chair of the SFRMS scientific board), W. Trzepizur (pneumologist, member of the SPLF scientific board). by SFRMS scientific committee. Validated by SPLF scientific committee.


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