Causes Of Excessive Daytime Sleepiness Research Articles

Temporal patterns of sleep latency in central hypersomnia and attention deficit hyperactivity disorder: a cluster analysis exploration using Multiple Sleep Latency Test.

Excessive daytime sleepiness (EDS) is a crucial symptom that diminishes the quality of life. The primary causes of EDS are central hypersomnia, including narcolepsy type 1 (NT1), type 2 (NT2), and idiopathic hypersomnia (IH). EDS is often associated with other psychiatric disorders, particularly attention deficit hyperactivity disorder (ADHD). The Multiple Sleep Latency Test (MSLT) is the standard assessment tool for EDS. Although the MSLT yields numerous parameters, most are not employed in clinical practice. In this study, we leveraged novel MSLT parameters to discern central hypersomnia and ADHD presence. Our analysis focused on sleep latency variability and employed cluster analysis to identify unique temporal patterns. We examined the MSLT data from 333 patients; of these, 200 (aged 14-54, mean: 24.9 ± 8.1, years; 114 females) met the inclusion criteria comprising comprehensive data an Apnea-Hypopnea Index (AHI) below 5, and no prior diagnosis of sleep apnea syndrome. We employed a time-course cluster approach that specifically targeted sleep latency variability during the MSLT. Considering both multiple clustering quality evaluations and the study's objectives, we identified 9 distinct clusters. Clusters 1 and 3 predominantly had MSLT-positive results; Cluster 2 was entirely MSLT-positive; Clusters 4, 5, 6, 8, and 9 were mainly MSLT-negative; and Cluster 7 had mixed results. The diagnosis of hypersomnia varied notably among Clusters 1, 2, 3, and 7, with Cluster 2 demonstrating a pronounced tendency towards NT1 and NT2 diagnoses (p < 0.005). However, no significant correlation was observed between ADHD diagnoses and specific sleep latency patterns in any cluster. Our study highlights the value of time-course clustering in understanding sleep latency patterns of patients with central hypersomnia.

Excessive Daytime Sleepiness Prevalence and Its Correlation with the Educational Level among Patients in the Pulmonary Diseases Department - Sleep Unit - Hassan II University Hospital, Fes – Morocco

This study aims to assess the prevalence of excessive daytime sleepiness (EDS) among adults. We conducted a descriptive and analytical study of 151 patients at Hassan II University Hospital in Fes. With the objective of identifying the causes of EDS and its impact on individuals with lower educational levels. The study tools included an Arabic translation of the Epworth Sleepiness Scale, after verifying its validity and reliability. The scale effectively identifies sleep disorders and risk factors for EDS. The participants' ages ranged from 18 to 65+ years, with a male ratio of 34.4% (52) and a female ratio of 65.6% (99). Results showed no high prevalence of EDS in the sample. However, statistically significant differences were found in sleepiness on the basis of the educational level.

Excessive daytime sleepiness in Parkinson's disease: the key is beyond sleep macrostructure.

The so-called “non-motor symptoms” are present in almost all patients with Parkinson’s disease (PD), and sleep disorders are among the most common ones [1, 2]. Excessive daytime sleepiness (EDS), defined as the difficulty to remain awake and alert during the day and/or sleep attacks (unintended and inappropriate episodes of falling sleep with minimal or no prodromes of drowsiness), affects a large portion of patients with PD, ranging from 20% to 75% [3–5]. This wide range depends on both the personal ability of the patient and/or the caregiver to recognize and report EDS and the methods used for its evaluation. EDS significantly impairs the quality of life of patients with PD and its disabling consequences include undesired sleep episodes, reduced attention, cognitive impairment, depressed mood, increased accidents, decreased productivity, and worsening of motor function [6–8]. EDS is often multifactorial in etiology, which complicates its treatment. Comorbid sleep disorders, older age, advanced PD stage, presence of autonomic dysfunction, and psychiatric comorbidities are all the multiple factors implicated as possible causes of EDS [9–11].

Protocolo diagnóstico de la somnolencia diurna excesiva

Excessive daytime sleepiness (EDS) is a common symptom that indicates the inability to remain alert during the day, an irresistible need to sleep, spontaneous daytime sleep, or prolonged nighttime sleep. EDS is a cause of functional impairment in the school, work, social, or family sphere as well as traffic accidents and cardiovascular risk. Therefore, it must be identified and treated. The most common cause of EDS is sleep deprivation. Other causes are toxic, drug, psychiatric disorders (depression), medical problems (obesity, hypothyroidism), primary sleep disorders (obstructive sleep apneas), or central hypersomnias (type 1 and 2 narcolepsy, idiopathic hypersomnia, or Kleine-Levin syndrome). With a detailed case history, it can be verified whether there is a known and treatable cause, although performing a sleep study is usually necessary to confirm the diagnosis. This document proposes an algorithm for an evaluation in the clinic, indications for additional tests in a sleep laboratory, and the management of these disorders.

Screening of non-restorative sleep by quantitative EEG

BackgroundNon-restorative sleep is the major cause of excessive daytime sleepiness and causes injures of the central nervous system. The most common cause of Excessive day sleepiness in a clinical setting is obstructive sleep apnea. Sleepiness scales can assess multiple aspects of the sleep and include subjective and objective measures. The present study aim to disclose the capability of quantitative electroencephalography to screen, as well as to know the pathogenesis of non-restorative sleep in patients with excessive day time sleepiness.ResultsTwenty obstructive sleep apnea patients and 20 healthy control subjects were recruited. All patients were subjected to Epworth sleepiness scale and polysomnography. Quantitative electroencephalography and Karolinska sleepiness scale were done before and after sleep for patients as well as controls. The patients group revealed a significant power reduction in delta and alpha bands, comparing before and after sleep records. Interestingly, there was a significant change in delta power in the temporal delta waves power. Yet, the changes were opposite among cases (significant decrease) versus controls (significant increase). In addition, there were significant correlations between sleepiness scales; Epworth sleepiness scale and Karolinska Sleepiness Scale scores, and alpha band results in quantitative electroencephalography.ConclusionQuantitative electroencephalography with further research, could provide us with clues to the pathogenesis of EDS and non-restorative sleep accompanying OSA and an objective screening tool.

857 Too sleepy: A pediatric case of Prader Willi Syndrome and Narcolepsy

Abstract Introduction Prader Willi syndrome (PWS) is a genetic disorder due to deletion of the paternal copies of genes within the chromosome region 15q11-q13. Individuals with PWS are commonly seen with obesity, sleep disordered breathing, and excessive daytime sleepiness (EDS). While the exact cause of EDS in individuals with PWS is not fully understood, there have been reports of PWS with narcolepsy-like syndrome. We report a case of a patient with PWS with findings suggesting the diagnosis of Narcolepsy Type 2. Report of case(s) Our patient is a 12-year-old male with PWS and 2nd degree heart block who was evaluated in our pediatric sleep center. He has a previous diagnosis of mild obstructive sleep apnea (OSA) with an apnea hypopnea index (oAHI) of 3.2. At 12 years of age, mother and patient reported that he had increased snoring, weight gain, EDS with a Pediatric Daytime Sleepiness Score (PDSS) of 10 and frequent refreshing naps during the daytime. Patient denied cataplexy during that visit. Subsequently, 2-week actigrapghy was performed which demonstrated an average total night sleep of 8 hours and 8 minutes. Overnight PSG with Multiple Sleep Latency Test (MSLT) demonstrated an oAHI of 4.8, total sleep time of 6.88 hours. During the MSLT, the mean sleep latency was 6.2 minutes and 5 sleep onset REM periods were observed over 5 nap opportunities. At his follow-up visit, methylphenidate was initiated after clearance by his cardiologist. Patient and mother opted for medical management of his mild OSA with Fluticisone and Montelukast. At his follow-up appointment, the patient had improvement in daytime sleepiness with a PDSS of 2 despite taking his Methylphenidate at night. Patient was instructed to switch to morning Methylphenidate dosing to optimize treatment of his EDS. Conclusion EDS is a common complaint seen in patients with PWS, however the etiology of it is not entirely understood. It is thought to be centrally mediated with components of hypersomnia and narcolepsy like-symptoms. More research is needed to better understand, diagnose and adequately treat patients with PWS and EDS. Support (if any):

839 Not Your Everyday Daytime Sleepiness: Two Peas in a Pod

Abstract Introduction Obstructive sleep apnea (OSA) and narcolepsy are both causes of excessive daytime sleepiness (EDS). OSA is a more prevalent diagnosis, but it can coexist with narcolepsy and confound diagnosis. We present a case of a delayed diagnosis of type 2 narcolepsy in a patient with known OSA. Report of case(s) A 31-year-old man with depression treated with sertraline and prior history of severe OSA diagnosed at an outside facility presented to our clinic for residual excessive daytime sleepiness. He demonstrated adequate adherence to continuous positive airway pressure (CPAP) of 13 cmH2O over a period of one year, good sleep hygiene and adequate sleep duration. He reported vivid dreams and sleep paralysis in the past, but none recently. There was no history of a delayed sleep phase. He denied hypnagogic or hypnopompic hallucinations or cataplexy. An in-lab polysomnogram (PSG) followed by multiple sleep latency test (MSLT) was ordered for further evaluation. Sertraline was held 2 weeks prior to the study. Overnight PSG on CPAP showed adequate treatment of OSA on CPAP pressures of 13–16 cmH2O. MSLT showed 3/5 sleep-onset rapid eye movement periods with a mean sleep latency of 5.8 minutes. A diagnosis of coexisting type 2 narcolepsy was made. Treatment was initiated with modafinil; however, his symptoms of EDS persisted and he was changed to methylphenidate with subsequent improvement. Conclusion The case above highlights the importance of maintaining a broad differential when investigating the etiology of EDS. In particular, patients with narcolepsy often experience a significant delay between onset of symptoms and receiving a diagnosis. Diagnosis can be confounded by a lack of classic symptoms and/or the presence of another sleep-related breathing disorder, as in the patient above. Residual EDS can be seen in patients with adequately treated OSA. There is sparse data regarding the co-prevalence of narcolepsy as the etiology of residual EDS in adequately treated OSA. Patients should still be screened for symptoms suggestive of narcolepsy. Persistence of EDS symptoms in young adults with adequately treated OSA should raise suspicion for another sleep-related disorder and merits further investigation. Support (if any):

Advances in treatment of narcolepsy

Narcolepsy is the most common cause of excessive daytime sleepiness (EDS) following obstructive sleep apnea. Its treatment aims to reduce EDS and cataplexy, improve nighttime sleep disturbance, sleep paralysis and sleep-related hallucinations. Pitolisant (a histamine H3 receptor antagonist) and solriamfetol (a norepinephrine reuptake inhibitor) have recently been approved effective for narcolepsy in the United States and the European Union. Pitolisant has proved to be effective for both EDS and cataplexy. Besides being effective on EDS, solriamfetol seems to have advantages in abuse potential and withdrawal syndrome. As potential treatments for EDS and cataplexy associated with narcolepsy, several new drugs are being developed and tested. These new drugs include new hydroxybutyrate preparations (controlled release sodium hydroxybutyrate FT218, low sodium hydroxybutyrate JZP-258), selective norepinephrine reuptake inhibitor (AXS-12), and modafinil combined with astroglial junction protein inhibitor (THN102). This paper reviews the recently approved drugs and potential treatments for narcolepsy.

0692 Difference In Improvement Of ESS Score After CPAP Use In Patients From Different Workforces

Abstract Introduction Obstructive sleep apnea (OSA) is characterized by recurrent occurrences of apnea and hypopnea throughout the night during sleep. Reported to prevail in 23.4% women and 49.7% men aged 40 years or older, OSA is considered to be the most preventable cause of excessive daytime sleepiness. Methods After obtaining approval from the institutional review board (IRB) for this retrospective study, a total of 825 patient records from a prospective registry of obstructive sleep apnea from our sleep lab affiliated with the University of Missouri Hospital were searched for variables including but not limited to age, race, gender, occupation, medications any sleep-related comorbidities, psychiatric comorbidities, cardiovascular comorbidities, pre CPAP ESS score and post CPAP ESS score. The mean improvement score of ESS in both these populations was compared and possible causes for the difference in these groups were analyzed. Results Initial analysis from 22 patients belonging to the white-collar and 22 patients belonging to the blue-collar workforce with a mean age of 49.27 (±14.28) years and a mean BMI of 37.60 (±9.41) showed a mean improvement of -1.27 and 0.63 respectively with no significance statistically. Statistical analysis will be performed after gathering data from a larger sample size. Conclusion Although insignificant, the blue-collar workforce showed more improvement than the white-collar workforce in the initial analysis. Support No support, financial or otherwise was used for this study.

1248 Hypersomnia with Pseudo-Cataplexy Associated with Schizoaffective Disorder: A Case Report

Abstract Introduction Psychiatric illness is an important potential cause of excessive daytime sleepiness (EDS), hypersomnia, and narcolepsy-like symptoms. We report a case of hypersomnia and pseudo-cataplexy associated with schizoaffective disorder. Report of Case A 28-year-old man with obstructive sleep apnea (OSA) and schizoaffective disorder presented to our sleep medicine clinic complaining of EDS, cataplexy-like attacks, sleep paralysis, depressed mood, and dream intrusion. Questions about cataplexy often provoked brief episodes of speech arrest, eye closure, and neck flexion lasting a few seconds. An MSLT with CPAP showed a mean sleep latency of 3 minutes and 3 sleep onset REM periods (SOREMPs); however, actigraphy showed that the SOREMPs occurred during the patient’s habitual sleep period and the patient discontinued a REM-suppressing medication within a few days of the study. The HLA-DQB1*0602 allele was absent. Following circadian adjustment, a repeat MSLT with CPAP showed zero sleep and no SOREMPs. The preceding polysomnogram showed a total sleep time (TST) of 7.8 hours, no epileptiform activity, adequately-treated OSA, and a REM latency of 53 minutes. Prior to these studies, two weeks of sleep diary and actigraphy showed a TST greater than 10 hours. Ultimately, treatment of the patient’s psychiatric disorder resulted in a reduction of his EDS and TST. Conclusion Patients with psychiatric illness can present with hypersomnia, EDS, and narcolepsy-like symptoms such as pseudo-cataplexy. Misdiagnosing such a patient with narcolepsy can lead to treatments capable of worsening the primary underlying psychiatric disturbance. MSLT results must be interpreted in the context of a patient’s clinical history and sleep schedule; if there is concern for a false positive result, repeat testing should be considered.

A retrospective study about the causes of excessive daytime sleepiness except for sleep-disordered breathing in Japan

A retrospective study about the causes of excessive daytime sleepiness except for sleep-disordered breathing in Japan

Excessive daytime sleepiness in adolescents: current treatment strategies.

The complaints of excessive daytime sleepiness are very common among adolescents. In addition, in this particular subpopulation, the presence of excessive daytime sleepiness is associated with negative impact on school performances, interpersonal difficulties (school friends or family), extracurricular activities, health and driving. In adolescents with complaints of excessive daytime sleepiness, it is important to perform a complete clinical assessment including systematic clinical interview, physical examination, sleep diaries, use of specific questionnaires and possible confirmatory tests. In adolescents, the main causes of excessive daytime sleepiness are sleep deprivation, inadequate sleep hygiene, insomnia disorders, circadian rhythm disorders, chronic somatic pathologies, psychiatric disorders, movement disorders related to sleep, respiratory disorders related to sleep, parasomnias, hypersomnia disorders and use of drugs or medications. Given the multiple aetiologies of excessive daytime sleepiness in adolescents, the implementation of targeted therapeutic strategies is essential in order to allow optimal management of this symptom and better prevention of its negative consequences. The aim of this review is therefore to provide health care professionals caring for adolescents with excessive daytime sleepiness complaints the currently recommended therapeutic strategies for the main aetiologies of excessive daytime sleepiness in this particular subpopulation.

Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses.

Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs). Obstructive sleep apnea (OSA) is the most frequent medical cause of EDS. Therefore, the European Union Directive 2014/85/EU determined that "untreated moderate to severe OSA coincident with EDS constitutes a medical disorder leading to unfitness to drive." The paper aims are to provide a brief review of sleepiness and its implications for driving safety, as well as to describe the subjective and objective methods to accurately evaluate EDS in order to assess fitness to drive in patients with OSA. We examined databases including PubMed, Medline, and EMBASE using the search terms "sleepiness at the wheel, excessive daytime sleepiness, sleepiness measure, sleep-wake cycle, obstructive sleep apnea, driving license, fitness to drive." Significant interindividual variability in EDS exists in patients with comparable severity of OSA. Objective methods of measuring EDS are too expensive and time consuming to be suitable for the certification of driving licenses. The reliability of subjective methods depends upon the clinical setting and subjective tools assess only limited aspects of EDS. Objective measures, such as biochemical biomarkers, must, therefore, support subjective methods. Extensive data have supported different subjective and objective methods for the appraisal of EDS in patients with OSA depending upon the clinical and experimental setting. Challenges remain to determine an appropriate tool for the evaluation of fitness to drive.

Excessive daytime sleepiness and its impact on quality of life in de novo Parkinson's disease.

Excessive daytime sleepiness (EDS) is one of the most common sleep problems in patients with Parkinson's disease (PD); however, its clinical implications are not clear, especially in early stage, non-medicated PD patients. This study investigated EDS in Korean patients with de novo PD and its impact on quality of life. This cross-sectional study was carried out with 198 PD patients who underwent a structured clinical interview and examination based on common and conventional scales. Motor and nonmotor symptoms were assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) and Non-Motor Symptoms Scale (NMSS). EDS was evaluated with the Epworth Sleepiness Scale (ESS), the nocturnal disabilities and nighttime sleep problems were assessed with Parkinson's Disease Sleep Scale 2nd version, and quality of life was measured with the Parkinson's Disease Quality of Life 39 (PDQ-39). The relationships between ESS score and each scale were investigated. Among the patients studied, 42 patients had EDS defined as ESS > 10. Patients with EDS had a higher motor burden, greater nocturnal disabilities, more severe non-motor symptoms, and lower quality of life than did patients without EDS. Partial correlations revealed that ESS score was related to PDQ-39 summary index, irrespective of age, body mass index, or disease duration. These results show that EDS can have an immense negative impact on quality of life. The causes of EDS are multifactorial, which complicates its treatment. Further investigations are required to determine the safety and efficacy of potential EDS therapies and to develop novel EDS treatments in PD.

Central Disorders of Hypersomnolence in Children and Adults: A Comparative Study from South India.

Background:Narcolepsy and idiopathic hypersomnolence (IHS) are rare disorders. In Western populations, the reported prevalence of narcolepsy is 0.02%–0.05%. In Indian subcontinent, there are few reports on narcolepsy and none on IHS so far. Here, we compared the clinical and polysomnographic profile of narcolepsy/IHS among the pediatric and adult groups.Materials and Methods:The patients presenting with excessive daytime sleepiness (EDS) attending sleep clinic from January 2010 to December 2015 were included. Patients were diagnosed with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and IHS based on the International Classification for Sleep Disorders criteria. Patients with secondary causes of EDS were excluded from the study.Results:A total of 56 patients were included in the study (29 males and 27 females). The mean age of symptom onset was 29 years (males – 34 years and females – 24 years). Twelve (21%) patients had NT1, five (9%) patients had NT2, whereas 38 (68%) patients had IHS compared to narcolepsy, the IHS had an older mean age at presentation. The average time from symptom onset to diagnosis was 71 months. Classical tetrad of narcolepsy was rarely found in pediatric cohort, but they had more behavioral problems and weight gain. Pediatric cohort of IHS also reported behavioral problems. The mean sleep-onset latency was 3.1 min, while the mean rapid eye movement latency was 7.2 min.Conclusion:The pediatric narcolepsy patients tend to have less classical symptoms and more behavioral/eating problems as compared to adult cohort. There is significant delay in diagnosing narcolepsy, indicating the need to increase awareness among the physicians about this rare treatable disorder.

Obstructive Sleep Apnea With or Without Excessive Daytime Sleepiness: Clinical and Experimental Data-Driven Phenotyping.

Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common—but not universal—accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients.Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed.Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas.Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment.The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient's specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA.

Myotonic dystrophytype 1 – report of non-24-h sleep-wake disorder with excessive daytime sleepiness

ABSTRACTMyotonic dystrophy (MD) is a neuromuscular disease with myotonia, progressive weakness, and involvement of CNS, heart, and gastrointestinal system. Excessive daytime sleepiness (EDS) in myotonic dystrophy type 1 (MD1) is related to sleep breathing diseases, restless leg syndrome, periodic limb movements during sleep and narcoleptic-like phenotype. However, authors highlight a central dysfunction of sleep regulation.We describe a 26-year-old, female, MD1 patient with EDS. Sleep diary/actigraphy evidenced two different circadian periods with values of 1442 and 1522 min. Agomelatine, 50 mg at night, was prescribed with improvement of the circadian rhythm and complaints of sleepiness.The identification of unanticipated causes of EDS, such as circadian rhythm disorders permits an appropriated treatment. As we know, it is the first relate of non-24-h sleep-wake disorder in patient with MD1. Sleep diary and actigraphy could be good options to investigate sleep-wake cycle disorder in patients with MD and EDS.

Sleep apnea and its role in transportation safety.

Obstructive sleep apnea (OSA) is a main cause of excessive daytime sleepiness and increases the risk for driving accidents, which can be normalized by treatment with continuous positive airway pressure ventilation. Since it is estimated that OSA is not diagnosed in about 80% of cases, recognition of patients at risk for driving accidents is a problem from both medical and societal points of view. Strategies to screen and identify subjects at high risk for driving accidents are under study in order to improve safety on the road, especially for commercial drivers, who show a high prevalence of OSA.

Sleep Apnea-A Review

Sleep apnea literally means “cessation of breath.” Sleep apnea is a common disorder in which we have one or more pauses in breathing or shallow breaths during our sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. Sleep apnea usually is a chronic condition that disrupts sleep 3 or more nights each week. This results in poor sleep quality that makes one tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness. The airway can become obstructed at several possible sites like the excess tissue in the airway enlarged tonsils, a large tongue, the airway muscle which relaxes and collapses during sleep.

Identification of possible causes of excessive daytime sleepiness in patients with normal MSLT

Identification of possible causes of excessive daytime sleepiness in patients with normal MSLT