Despite optimal treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure, a fair proportion of patients have residual excessive daytime sleepiness (REDS); prevalent globally, REDS remains underdiagnosed and undertreated.

The multifactorial pathophysiologic mechanisms of REDS involve the chronic cyclical hypoxia–reoxygenation effects on dopaminergic and orexinergic neurons, oxidative stress, systemic inflammation, neuronal injury to areas of the brain responsible for maintaining alertness, genetic factors, and sleep fragmentation.

Options for the management of REDS due to OSA include implementing lifestyle changes, ensuring sufficient sleep, addressing the influence of medications with somnogenic effects, effectively treating mood disorders, verifying OSA treatment adherence and effectiveness, evaluating for the existence of other disruptors, and utilizing pharmacologic intervention (when clinically appropriate).