Residual hypersomnia in unipolar and bipolar depression: A systematic review

The primary objective in managing depression is achieving full recovery, but some patients experience ongoing symptoms that affect daily life, with residual hypersomnia being notably prevalent. Understanding its extent, frequency, and potential treatments is limited.

This systematic review consolidates existing knowledge on the prevalence and treatment of residual hypersomnia in depression, drawing from PubMed, Web of Science, and Scopus databases. The protocol was registered in PROSPERO (CRD42023392062).

Residual hypersomnia is highly prevalent in depression. Modafinil is the only pharmacological intervention studied, showing short-term effectiveness in randomised placebo-controlled trials. For patients with comorbid obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) appears promising for reducing excessive sleepiness. Challenges arise from ambiguous definitions of 'residual symptoms', 'partial response', and 'hypersomnia', and the use of various scales to assess hypersomnia. The scarcity of placebo-controlled randomised trials complicates evaluating treatment efficacy and standardising management approaches.

Given its high prevalence, managing residual hypersomnia is a significant challenge with current treatments appearing ineffective long-term. Data suggest benefits from modafinil augmentation and CPAP treatment, but more research is needed.