The American Academy of Sleep Medicine has released a new position statement asserting that sleepiness is a critical patient-reported outcome with significant implications for health, safety, and quality of life. The statement, authored by the Academy's board of directors, states that addressing sleepiness in clinical care is necessary.
According to the position statement published in the Journal of Clinical Sleep Medicine, "It is the position of the American Academy of Sleep Medicine (AASM) that sleepiness is a critical patient-reported outcome that is associated with increased risk for adverse health effects and diminished quality of life. The evaluation and management of sleepiness is essential for patient safety and patient-centered care."
Excessive sleepiness—defined as "the inability to stay awake and alert during the major waking episodes of the day"—affects approximately one-third of U.S. adults and is associated with significant cognitive and functional impairments that can negatively impact performance, health, mood, safety, and quality of life, according to the statement.
Clinical Significance of Sleepiness
The AASM outlines several key aspects of sleepiness in the statement. They write:
- Sleepiness represents a potentially debilitating symptom of sleep-wake disorders, making its resolution a clinically significant, long-term, patient-centered outcome of treatment.
- Excessive daytime sleepiness is a primary symptom of multiple sleep-wake disorders, including central disorders of hypersomnolence such as narcolepsy and idiopathic hypersomnia, as well as obstructive sleep apnea (OSA), chronic insomnia disorder, restless legs syndrome, and circadian rhythm sleep-wake disorders.
- Sleepiness can cause cognitive and functional impairments, including slower response times, lapses in attention, and increased errors—effects that are comparable with those caused by alcohol intoxication.
- Sleepiness has been associated with increased risk of motor vehicle accidents, workplace accidents, absenteeism, reduced productivity, and worse academic performance in students at all levels.
Implications for Patient Care
The statement addresses the importance of sleepiness as a marker for therapeutic effectiveness in treating sleep-wake disorders.
"The amelioration of daytime sleepiness is a key marker of therapeutic effectiveness for sleep-wake disorders such as narcolepsy, idiopathic hypersomnia, and OSA," AASM note.
They point out that, even with treatment, residual sleepiness often persists in patients with narcolepsy and OSA, which can continue to impact quality of life. They cite research that shows residual sleepiness in OSA patients "is associated with poorer mental and physical health and well-being, lower disease-specific functional status, more activity and work impairment, and more driving impairment."
Future Directions
The AASM calls for continued research, particularly identifying sleepiness as a primary outcome measure in clinical trials that evaluate treatments for sleep-wake disorders, specifically:
- Development of objectively measured and reliable biomarkers of excessive sleepiness, including blood biomarkers, physiologic markers, and metrics derived from electroencephalogram recordings.
- Large prospective studies to better define causal mechanisms and predictive baseline characteristics of residual sleepiness.
- Improved pharmacologic options and identification of genetic variations that affect therapeutic actions and adverse effects of medications.
- Research to bridge the gap between measurable patient characteristics, phenotypes, and underlying pathophysiological traits to develop tailored therapies for daytime sleepiness.
The position statement has been endorsed by 20 medical and scientific organizations, including the American Academy of Neurology, American College of Chest Physicians, American Thoracic Society, and Sleep Research Society. Disclosures can be found in the position statement.