22010_Practices for Managing Excessive Daytime Sleepiness

Practices for Managing Excessive Daytime Sleepiness in Patients with Narcolepsy and Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) and narcolepsy are sleep disorders associated with high prevalence and symptomatic burden including excessive daytime sleepiness (EDS) and poor nocturnal sleep. Narcolepsy is a debilitating disease with substantial clinical and socioeconomic burden resulting from its early onset, severe symptoms, delay in diagnosis, lack of cure, and a need for life-long therapy. Many narcolepsy patients have cardiometabolic comorbidities, and many experience disrupted and fragmented nighttime sleep and nocturnal blood pressure dipping, both of which have been associated with adverse cardiovascular outcomes.  The increased cardiovascular risk may be associated with the pathophysiology of the disorder, which is due to the loss of hypocretin neurons in the hypothalamus, leading to downstream consequences that may include atherosclerosis and insulin resistance. Some of the medications that narcolepsy patients are taking for management of cardiovascular morbidities and sleep disorders contain high amounts of sodium; excessively high sodium intake can lead to increased risk for adverse cardiovascular outcomes. Therefore, clinicians need to be educated on the prevalence of cardiovascular morbidities in narcolepsy patients, the relationship of the disease pathophysiology to cardiovascular disease risk, the importance of reducing sodium intake and management of cardiovascular morbidities, and emerging narcolepsy treatments with lower sodium content.

EDS despite the use of continuous positive airway pressure (CPAP) is a long-standing clinical dilemma.  Identifying the cause of the EDS requires a comprehensive evaluation by the clinician.  Management of narcolepsy and EDS in individuals with OSA involves the use of nonpharmacologic and pharmacologic strategies; new therapies are changing the therapeutic landscape. It is therefore important for clinicians to make accurate diagnoses, identify patients for consideration of pharmacologic therapy, and tailor therapy to the individual patient. In this educational initiative, experts in sleep medicine will describe, in a case-based format, best practices in managing EDS in patients with narcolepsy and OSA.

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