Season 6 | Episode 16

DRS. KINGMAN STROHL AND LUCAS DONOVAN, GUESTS

Excessive daytime sleepiness is a significant problem for many people who have obstructive sleep apnea (OSA), and persistent sleepiness occurs in some patients despite effective treatment of OSA. Dr. Kingman Strohl and Dr. Lucas Donovan discuss this common clinical scenario, provide tips for the evaluation of persistent sleepiness, and talk about the wake-promoting medications that are available as treatment options.

Kingman Strohl, MD, is a board-certified pulmonologist and sleep medicine physician at Case Western Reserve University in Cleveland. He has specific expertise in respiratory control, mechanics, and physiology, and he has conducted collaborative studies in high altitude physiology, narcolepsy, and basic sleep research. He was on the team that developed the Berlin Questionnaire, a pre-test probability tool that is considered a “benchmark” tool for surveys to predict individuals at high risk for sleep apnea.

Lucas Donovan, MD, MS, is a sleep specialist, pulmonologist, and health services researcher. He is a core investigator at the Seattle-Denver HSR&D Center of Innovation, staff physician at VA Puget Sound, and an assistant professor of medicine at the University of Washington. He received his medical degree from Case Western Reserve University in Cleveland and completed post-graduate clinical training in internal medicine with further specialization in pulmonary, critical care, and sleep medicine at Beth Israel Deaconess Medical Center in Boston and the University of Washington in Seattle.

Resources

  1. Lal C, Weaver TE, Bae CJ, Strohl KP. Excessive daytime sleepiness in obstructive sleep apnea. Mechanisms and clinical management. Ann Am Thorac Soc. 2021;18(5):757-768. https://doi.org/10.1513/annalsats.202006-696fr
  2. Kapur VK, Donovan LM. Taking care of persistent sleepiness in patients with sleep apnea. Am J Respir Crit Care Med. 2019;199(11):1310-1311. https://doi.org/10.1164/rccm.201812-2291ed
  3. Sukhal S, Khalid M, Tulaimat A. Effect of wakefulness-promoting agents on sleepiness in patients with sleep apnea treated with CPAP: a meta-analysis. J Clin Sleep Med. 2015;11(10):1179–1186. https://doi.org/10.5664/jcsm.5096
  4. VA PharmacyBenefits Management Services, MedicalAdvisoryPanel, and VISNPharmacist Executives. Pitolisant (WAKIX) Criteria for Use.  https://www.va.gov/formularyadvisor/DOC_PDF/CFU_Pitolisant_WAKIX_May_2022.pdf. Updated May 2022. Accessed Aug. 15, 2024.