Do you obtain a MSLT or start empiric therapy with modafinil in patients with residual excessive daytime sleepiness despite optimal adherence to PAP therapy?
In patients with average of less than 5 respiratory events per hour, adequate sleep duration and hygiene confirmed on sleep log, absent cataplexy and no SOREM noted on diagnostic PSG.
Answer from: at Academic Institution
In this situation I would start either modafinil, armodafinil, or solriamfetol for residual EDS if the OSA was appropriately controlled without need for MSLT. We have an FDA label for these medications in this situation to support this practice. If I felt like there was concern for a combination of ...
Personally, I am not a strong believer in empiric stimulant use in this context. Usual offenders need to be addressed first: circadian rhythm disorder, behaviorally insufficient sleep, sleep hygiene, exercise, etc. should be the first line. If all that is optimized I would consider MSLT to screen fo...
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at Broward Pulmonary and Sleep Specialists I agree and consider other conditions associated w...
I recently had a patient in this situation with hypersomnia in spite of great pap compliance. BMI 45. Insurance denied MSLT. Modafinil, Ritalin, and caffeine didn't work. Weight loss surgery solved the issue. There was no evidence of hypercapnia. I think MSLT is helpful in corroborating the patient'...
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at Carl Vinson Va Medical Center I personally prefer doing an MSLT in order to atte...