A Wake-Up Call: Improving Recognition and Management of Excessive Daytime Sleepiness in Patients with Obstructive Sleep Apnea




Provided by Integrity Continuing Education, Inc.


This activity is supported by an educational grant from Jazz Pharmaceuticals, Inc.


Obstructive sleep apnea (OSA) is a highly prevalent disorder that is growing in incidence in tandem with an obesity epidemic believed to be at the etiologic core of this chronic respiratory disorder. Excessive daytime sleepiness (EDS) is the most common (but not universal) symptom of OSA — it is also the most overlooked and neglected. While many healthcare providers (HCPs) are appropriately managing breathing obstruction with continuous positive airway pressure (CPAP), EDS often remains under-identified and unassessed, therefore chronically unaddressed.

Perhaps the assumption is that CPAP will resolve this bothersome issue or that EDS, in and of itself, is not significant enough to treat. Research reveals that both suppositions are incorrect. Studies have revealed that even regular, consistent use of CPAP does not diminish persistent sleepiness in up to half of OSA patients. Other research has revealed that disturbed sleep plays a strong role in the etiology of obesity and cardiovascular disease risk, both of which are common in patients with OSA. EDS also reduces quality of life (QOL) and ability to function well in daily life, while simultaneously increasing the risk for motor vehicle or workplace accidents. Outcomes for patients with OSA and EDS could be improved if physicians and other clinicians learned to acknowledge, ask about, and manage EDS in their OSA patients who continue to struggle with sleepiness despite adherence to CPAP.

This initiative will increase HCPs awareness of the role that sleepiness plays in worsening QOL and disease burden in OSA patients. It will also improve their competency in evaluating and individualizing treatment for patients with EDS in OSA, and offering to each individual OSA the most appropriate of the three available treatments that have been approved by the Food and Drug Administration for EDS with OSA.


Paul P. Doghramji, MD
Family Physician​
Collegeville Family Practice​
Collegeville, Pennsylvania
Board Member, National Sleep Foundation


Michael Thorpy, MD 
Professor of Neurology​
Albert Einstein College of Medicine​
Director, Sleep-Wake Disorders Center​
Department of Neurology​
Montefiore Medical Center​
Bronx, New York


Release date: November 5, 2021
Expiration date: November 5, 2022
Estimated time to complete activity: 60 minutes



This educational initiative is directed toward sleep specialists, including neurologists, psychiatrists, and pulmonologists; primary care providers; nurse practitioners; physician assistants; and other healthcare professionals involved in the care of patients with residual EDS in OSA.


Upon completion of this educational activity, participants should be able to:

  • Improve the recognition and diagnosis of EDS in patients with OSA​
  • Identify pathophysiological factors in OSA and EDS that contribute to persistent sleepiness and disease burden ​
  • Summarize available treatments for EDS in OSA, including their impact on daily function and quality of life​
  • Integrate patient education strategies when prescribing wake-promoting agents to optimize patient outcomes and adherence

There are no fees for participating and receiving CME credit for this activity. During the period of November 5, 2021 and November 5, 2022 participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.




Physician Continuing Education

Accreditation Statement
Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.


Integrity Continuing Education, Inc. designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


For information about ACCME accreditation of this activity, please contact Integrity Continuing Education, Inc. at (855) 835-4004 or cme@integrityce.com.


Integrity Continuing Education, Inc. requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Integrity Continuing Education, Inc. for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. All relevant financial relationships have been mitigated.

The following faculty/planners reported the financial relationships or relationships to products or devices they have with ineligible companies related to the content of these CME activities:

Paul P. Doghramji, MD
Speakers’ Bureau: Allergan, Eisai Pharmaceuticals, Harmony Biosciences, LLC, Novo Nordisk​
Advisor: Bayer, Eisai 

 Michael Thorpy, MD 
Consultant/Advisory Board: Axsome, Balance Therapeutics, Eisai Pharmaceuticals, Flamel/Avadel, Harmony Biosciences, LLC, Jazz Pharmaceuticals, NLS Pharmaceuticals, Suven Life Sciences Ltd., Takeda Pharmaceutical Co., Ltd., XW Pharma

The Integrity Continuing Education, Inc. planners and managers have nothing to disclose.


This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Integrity Continuing Education, Inc. does not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


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