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Excessive daytime sleepiness

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Excessive daytime sleepiness
Other namesHypersomnolence
SpecialtyPsychiatry, Neurology
SymptomsPersistent sleepiness during the day despite adequate nighttime sleep
CausesNarcolepsy, idiopathic hypersomnia, circadian rhythm sleep disorder, sleep apnea, others

Excessive daytime sleepiness (EDS) is characterized by persistent sleepiness and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. EDS can be considered as a broad condition encompassing several sleep disorders where increased sleep is a symptom, or as a symptom of another underlying disorder like narcolepsy, circadian rhythm sleep disorder, sleep apnea or idiopathic hypersomnia.

Some persons with EDS, including those with hypersomnias like narcolepsy and idiopathic hypersomnia, are compelled to nap repeatedly during the day; fighting off increasingly strong urges to sleep during inappropriate times such as while driving, while at work, during a meal, or in conversations. As the compulsion to sleep intensifies, the ability to complete tasks sharply diminishes, often mimicking the appearance of intoxication. During occasional unique and/or stimulating circumstances, a person with EDS can sometimes remain animated, awake and alert, for brief or extended periods of time. EDS can affect the ability to function in family, social, occupational, or other settings.[1][2] A proper diagnosis of the underlying cause and ultimately treatment of symptoms and/or the underlying cause can help mitigate such complications.[3] According to the National Sleep Foundation, around 20 percent of people experience EDS.[4]

Causes

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EDS can be a symptom of a number of factors and disorders. Specialists in sleep medicine are trained to diagnose them. Some are:

Diagnosis

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An adult who is compelled to nap repeatedly during the day may have excessive daytime sleepiness (EDS); however, it is important to distinguish between occasional daytime sleepiness and EDS, which is chronic.

A number of tools for screening for EDS have been developed. One is the Epworth Sleepiness Scale (ESS) which grades the results of a questionnaire with eight questions referring to situations encountered in daily life. The ESS generates a numerical score from zero (0) to 24 where a score of ten [10] or higher may indicate that the person should consult a specialist in sleep medicine for further evaluation.[12][13][14]

Another tool is the Multiple Sleep Latency Test (MSLT), which has been used since the 1970s. It is used to measure the time it takes from the start of a daytime nap period to the first signs of sleep, called sleep latency. Subjects undergo a series of five 20-minute sleeping opportunities with an absence of alerting factors at 2-hour intervals on one day. The test is based on the idea that the sleepier people are, the faster they will fall asleep.[15][16]

The Maintenance of Wakefulness Test (MWT) is also used to quantitatively assess daytime sleepiness. This test is performed in a sleep diagnostic center. The test is similar to the MSLT as it also relies on a measurement of initial sleep latency. However, during this test, the patient is instructed to try to stay awake under soporific conditions for a defined time.[17][18]

The use of electroencephalography (EEG) readings is essential for the objective diagnosis of EDS. The initial sleep latency employed in the MSLT and the MWT is mainly derived from EEG recordings.[18] Moreover, power characteristics in the alpha-band of resting-state EEG readings, correlating with somnolence, also showed a correlation with the presence of EDS.[19][20][21]

Treatment

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Treatment of excessive daytime sleepiness (EDS) relies on identifying and treating the underlying disorder which may cure the person from the EDS. Drugs like modafinil,[22] armodafinil,[23] pitolisant[24] (Wakix), sodium oxybate (Xyrem) oral solution, have been approved as treatment for EDS symptoms in the United States. There is declining usage of other drugs such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine), amphetamine, lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), and pemoline (Cylert), as these stimulants may have several adverse effects.[25]

If EDS is caused by obstructive sleep apnea (OSA), it is recommended that people with OSA use continuous positive airway pressure (CPAP) therapy, that is a sleep breathing apparatus to prevent OSA, before starting intake of wake-promoting agents such as modafinil.[26][7][6]

See also

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References

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  1. ^ "How to Manage Excessive Sleepiness During the Day". Health. Archived from the original on 29 June 2024. Retrieved 29 June 2024.
  2. ^ Hein M, Mungo A, Hubain P, Loas G (2020). "Excessive daytime sleepiness in adolescents: current treatment strategies". Sleep Science. 13 (2): 157–171. doi:10.5935/1984-0063.20190143 (inactive 1 November 2024). ISSN 1984-0659. PMC 7384526. PMID 32742588.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  3. ^ Guilleminault C, Brooks, SN (August 2001). "Excessive daytime sleepiness: a challenge for the practising neurologist". Brain: A Journal of Neurology. 124 (Pt 8): 1482–91. doi:10.1093/brain/124.8.1482. PMID 11459741.
  4. ^ "Do I Have Excessive Sleepiness?". National Sleep Foundation. 3 December 2020. Archived from the original on 16 November 2021. Retrieved 16 November 2021.
  5. ^ Abad VC, Guilleminault C (2003). "Diagnosis and treatment of sleep disorders: a brief review for clinicians". Dialogues in Clinical Neuroscience. 5 (4): 371–388. doi:10.31887/DCNS.2003.5.4/vabad. PMC 3181779. PMID 22033666.
  6. ^ a b Wang Y, Zhang W, Ye H, Xiao Y (August 2024). "Excessive daytime sleepiness in obstructive sleep apnea: Indirect treatment comparison of wake-promoting agents in patients adherent/nonadherent to primary OSA therapy". Sleep Med Rev. 78: 101997. doi:10.1016/j.smrv.2024.101997. PMID 39243682.
  7. ^ a b Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, et al. (November 2007). "Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report". Sleep. 30 (11): 1445–1459. doi:10.1093/sleep/30.11.1445. PMC 2082098. PMID 18041479.
  8. ^ "How to Stop Snoring". Sleep Apnea. Archived from the original on 4 March 2016. Retrieved 15 August 2015.
  9. ^ Arnold R, Issar T, Krishnan AV, Pussell BA (2016). "Neurological complications in chronic kidney disease". JRSM Cardiovascular Disease. 5: 204800401667768. doi:10.1177/2048004016677687. ISSN 2048-0040. PMC 5102165. PMID 27867500.
  10. ^ Wang H, Lane JM, Jones SE, Dashti HS, Ollila HM, Wood AR, et al. (13 August 2019). "Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes". Nature Communications. 10 (1): 3503. Bibcode:2019NatCo..10.3503W. doi:10.1038/s41467-019-11456-7. ISSN 2041-1723. PMC 6692391. PMID 31409809.
  11. ^ Roya Y, Farzaneh B, Mostafa AD, Mahsa S, Babak Z (2023). "Narcolepsy following COVID-19: A case report and review of potential mechanisms". Clinical Case Reports. 11 (6): e7370. doi:10.1002/ccr3.7370. PMC 10213711. PMID 37251741.
  12. ^ Johns MW (November 1991). "A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale". Sleep. 14 (6): 540–545. doi:10.1093/sleep/14.6.540. PMID 1798888. Retrieved 14 March 2021.
  13. ^ Johns MW (July 1992). "Reliability and Factor Analysis of the Epworth Sleepiness Scale". Sleep. 15 (4): 376–381. doi:10.1093/sleep/15.4.376. PMID 1519015. Archived from the original on 13 March 2022. Retrieved 14 March 2021.
  14. ^ Kendzerska TB, Smith PM, Brignardello-Petersen R, Leung RS, Tomlinson GA (August 2014). "Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review" (PDF). Sleep Medicine Reviews. 18 (4): 321–331. doi:10.1016/j.smrv.2013.08.002. PMID 24135493. Retrieved 14 March 2021.
  15. ^ Carskadon MA (December 1986). "Guidelines for the Multiple Sleep Latency Test (MSLT): A Standard Measure of Sleepiness". Sleep. 9 (4): 519–524. doi:10.1093/sleep/9.4.519. PMID 1798888. Archived from the original on 25 May 2021. Retrieved 14 March 2021.
  16. ^ Littner MR, Kushida C, Wise M, Davila DG, Morgenthaler T, Lee-Chiong T, et al. (January 2005). "Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test". Sleep. 28 (1): 113–121. doi:10.1093/sleep/28.1.113. PMID 15700727. Archived from the original on 13 August 2021. Retrieved 14 March 2021.
  17. ^ Mitler MM, Gujavarty KS, Browman CP (June 1982). "Maintenance of wakefulness test: A polysomnographic technique for evaluating treatment efficacy in patients with excessive somnolence". Electroencephalography and Clinical Neurophysiology. 53 (6): 658–661. doi:10.1016/0013-4694(82)90142-0. PMC 2480525. PMID 6177511.
  18. ^ a b Arand D, Bonnet M, Hurwitz T, Mitler M, Rosa R, Sangal RB (January 2005). "The Clinical Use of the MSLT and MWT". Sleep. 28 (1): 123–144. doi:10.1093/sleep/28.1.123. PMID 15700728. Archived from the original on 3 August 2022. Retrieved 14 March 2021.
  19. ^ Breitenbach J, Baumgartl H, Buettner R (August 2020). Detection of Excessive Daytime Sleepiness in Resting-State EEG Recordings: A Novel Machine Learning Approach Using Specific EEG Sub-Bands and Channels. AMCIS 2020 Proceedings. Salt Lake City. pp. 1–10. Archived from the original on 19 September 2020. Retrieved 14 March 2021.
  20. ^ Kalauzi A, Vuckovic A, Bojić T (December 2012). "EEG alpha phase shifts during transition from wakefulness to drowsiness". International Journal of Psychophysiology. 86 (3): 195–205. doi:10.1016/j.ijpsycho.2012.04.012. PMID 22580156. Archived from the original on 9 May 2021. Retrieved 14 March 2021.
  21. ^ Lin CT, Wu RC, Liang SF, Chao WH, Chen YJ, Jung TP (December 2005). "EEG-based drowsiness estimation for safety driving using independent component analysis". IEEE Transactions on Circuits and Systems I: Regular Papers. 52 (12): 2726–2738. CiteSeerX 10.1.1.145.2320. doi:10.1109/TCSI.2005.857555. S2CID 12252030. Archived from the original on 9 October 2021. Retrieved 14 March 2021.
  22. ^ Valentino RM, Foldvary-Schaefer, N (August 2007). "Modafinil in the treatment of excessive daytime sleepiness". Cleveland Clinic Journal of Medicine. 74 (8): 561–6, 568–71. doi:10.3949/ccjm.74.8.561. PMID 17708127.
  23. ^ Nishino S, Okuro, M (June 2008). "Armodafinil for excessive daytime sleepiness". Drugs of Today. 44 (6): 395–414. doi:10.1358/dot.2008.44.6.1223892. PMID 18596995.
  24. ^ Zhan S, Ye H, Li N, Zhang Y, Cheng Y, Wang Y, et al. (2023). "Comparative Efficacy and Safety of Multiple Wake-Promoting Agents for the Treatment of Excessive Daytime Sleepiness in Narcolepsy: A Network Meta-Analysis". Nat Sci Sleep. 15: 217–230. doi:10.2147/NSS.S404113. PMC 10112483. PMID 37082610.
  25. ^ Harris SF, Monderer, RS, Thorpy, M (November 2012). "Hypersomnias of central origin". Neurologic Clinics. 30 (4): 1027–44. doi:10.1016/j.ncl.2012.08.002. PMID 23099128.
  26. ^ Hashemian SM, Farhadi T (2020). "A review on modafinil: the characteristics, function, and use in critical care". Journal of Drug Assessment. 9 (1): 82–86. doi:10.1080/21556660.2020.1745209. PMC 7170336. PMID 32341841.
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