Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization

Chapman, Jennifer; Serinel, Yasmina; Marshall, Nathaniel S.; Grunstein, Ronald R.

doi:10.1016/j.jsmc.2016.05.005

Cited by 33 publications

(16 citation statements)

References 68 publications

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“…Moreover, the American Academy of Sleep Medicine recommends that a reduction in ES is one of the most critical aspects in the management of narcolepsy (Krahn et al, 2015). ES in OSA is a prominent symptom and may not resolve despite effective therapy with positive airway pressure (Veasey et al, 2006;Weaver and Chasens, 2007;Pépin et al, 2009;Gasa et al, 2013;Chapman et al, 2016). In patients with narcolepsy or OSA, ES can be a debilitating condition and often has a substantial impact on patients' quality of life (Aldrich, 1989;George, 2007;Ozaki et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Characterization of the Neurochemical and Behavioral Effects of Solriamfetol (JZP-110), a Selective Dopamine and Norepinephrine Reuptake Inhibitor

Baladi

Forster

Gatch

et al. 2018

J Pharmacol Exp Ther

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Excessive sleepiness (ES) is associated with several sleep disorders, including narcolepsy and obstructive sleep apnea (OSA). A role for monoaminergic systems in treating these conditions is highlighted by the clinical use of US Food and Drug Administration-approved drugs that act on these systems, such as dextroamphetamine, methylphenidate, modafinil, and armodafinil. Solriamfetol (JZP-110) is a wake-promoting agent that is currently being evaluated to treat ES in patients with narcolepsy or OSA. Clinical and preclinical data suggest that the wake-promoting effects of solriamfetol differ from medications such as modafinil and amphetamine. The goal of the current studies was to characterize the mechanism of action of solriamfetol at monoamine transporters using in vitro and in vivo assays. Results indicate that solriamfetol has dual reuptake inhibition activity at dopamine (DA; IC = 2.9 M) and norepinephrine (NE; IC = 4.4 M) transporters, and this activity is associated in vivo with increased extracellular concentration of DA and NE as measured by microdialysis. Solriamfetol has negligible functional activity at the serotonin transporter (IC > 100 M). Moreover, the wake-promoting effects of solriamfetol are probably owing to activity at DA and NE transporters rather than other neurotransmitter systems, such as histamine or orexin. The dual activity of solriamfetol at DA and NE transporters and the lack of significant monoamine-releasing properties of solriamfetol might explain the differences in the in vivo effects of solriamfetol compared with modafinil or amphetamine. Taken together, these data suggest that solriamfetol may offer an important advancement in the treatment of ES in patients with narcolepsy or OSA.

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Section: Introductionmentioning

confidence: 99%

Characterization of the Neurochemical and Behavioral Effects of Solriamfetol (JZP-110), a Selective Dopamine and Norepinephrine Reuptake Inhibitor

Baladi

Forster

Gatch

et al. 2018

J Pharmacol Exp Ther

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“…Thus, alternative diagnoses for EDS should be considered if the patient does not respond to the primary management 4. Residual sleepiness in adequately treated patients with OSA can be multifactorial and requires further investigation and management 5…”

Section: Introductionmentioning

confidence: 99%

<p>Management Of Excessive Sleepiness In Patients With Narcolepsy And OSA: Current Challenges And Future Prospects</p>

Sahni

Carlucci

Malik

et al. 2019

NSS

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Excessive daytime sleepiness (EDS) can be caused by insufficient sleep but is also a manifestation of medical or sleep disorders and a side effect of medications. It impacts quality of life and creates safety concerns in the home, at work, and on the roads. Screening questionnaires can be used to estimate EDS, but further evaluation is necessary. EDS is a common symptom of both narcolepsy and obstructive sleep apnea (OSA). Polysomnography and multiple sleep latency testing are used to diagnose these disorders. However, isolating the primary etiology of EDS can be challenging and may be multifactorial. Untreated OSA can show polysomnographic findings that are similar to narcolepsy. The effects of sleep deprivation and certain medications can also affect the polysomnographic results. These challenges can lead to misdiagnosis. In addition, narcolepsy and OSA can occur as comorbid disorders. If EDS persists despite adequate treatment for either disorder, a comorbid diagnosis should be sought. Thus, despite advances in clinical practice, appropriate management of these patients can be challenging. This review is focused on EDS due to OSA and narcolepsy and addresses some of the challenges with managing this patient population.

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“…These inflammatory cells and cytokines can cause endothelial injury and further aggravate obesity ( 8 ) and hypertension ( 9 ). Obesity is the most dangerous pathogenic factor causing OSAHS ( 10 ). The brain is the organ with the largest oxygen consumption in the body during sleep.…”

Section: Introductionmentioning

confidence: 99%

Effect of transoral endoscopic adenoidectomy on peripheral blood T-lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome and its treatment strategy

Yang

Liu

2017

Experimental and Therapeutic Medicine

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The objective of the present study was to investigate the effect of transoral endoscopic adenoidectomy on peripheral blood T lymphocyte subsets in pediatric patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its treatment strategy. Ninety-eight pediatric patients with adenoidal hypertrophy associated with OSAHS admitted to the Department of Otolaryngology, Xuzhou Children's Hospital were selected. After admission, patients received perfected 24 h polysomnogram monitoring, routine blood examination, fasting blood biochemistry examination, T-lymphocyte subset count, 24 h ambulatory blood pressure monitoring, and nasopharyngeal computed tomography. After patients were diagnosed with adenoidal hypertrophy associated with OSAHS, they underwent transoral endoscopic adenoidectomy with a power microdebrider. Patients were evaluated at 3-, 6- and 12-week follow-up visits. The CD3+, CD4+, and CD8+ T-cell counts, CD4+/CD8+ T lymphocyte ratio, and changes of 24 h ambulatory blood pressure before and after surgery were recorded. After the 6-week follow-up visit, the mean CD4+ T lymphocyte count in patients was increased significantly compared with that before surgery, the CD4+/CD8+ T lymphocyte ratio increased gradually, and the differences were statistically significant (P<0.05). The frequency of nocturnal awakening of patients was decreased significantly after surgery and the duration of nocturnal sleep was extended significantly (P<0.05). Through analysis of the preoperative and postoperative clinical data of pediatric patients, the CD4+/CD8+ T lymphocyte ratio was negatively correlated with mean arterial pressure (MAP) (r=−1.06, P=0.003). In conclusion, adenoidectomy can significantly decrease the MAP in pediatric patients with OSAHS and increase the duration of nocturnal sleep. The peripheral blood CD4+/CD8+ T lymphocyte ratio in pediatric patients was significantly negatively correlated with MAP.

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Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization

Cited by 33 publications

References 68 publications

Characterization of the Neurochemical and Behavioral Effects of Solriamfetol (JZP-110), a Selective Dopamine and Norepinephrine Reuptake Inhibitor

Characterization of the Neurochemical and Behavioral Effects of Solriamfetol (JZP-110), a Selective Dopamine and Norepinephrine Reuptake Inhibitor

<p>Management Of Excessive Sleepiness In Patients With Narcolepsy And OSA: Current Challenges And Future Prospects</p>

Effect of transoral endoscopic adenoidectomy on peripheral blood T-lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome and its treatment strategy

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