DISORDERS OF EXCESSIVE DAYTIME SLEEPINESS

DISORDERS OF EXCESSIVE DAYTIME SLEEPINESS is a topic covered in the Harrison's Manual of Medicine.

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Differentiation of sleepiness from subjective complaints of fatigue may be difficult. Quantification of daytime sleepiness can be performed in a sleep laboratory using a multiple sleep latency test (MSLT), the repeated daytime measurement of sleep latency under standardized conditions. An approach to the evaluation is summarized in Table 56-2.

TABLE 56-2: EVALUATION OF THE PATIENT WITH EXCESSIVE DAYTIME SLEEPINESS
Findings on History and Physical ExaminationDiagnostic EvaluationDiagnosisTherapy
Difficulty waking in the morning, rebound sleep on weekends, and vacations with improvement in sleepinessSleep logInsufficient sleepSleep education and behavioral modification to increase amount of sleep
Obesity, snoring, hypertensionPolysomnogramObstructive sleep apnea (Chap. 137)Continuous positive airway pressure; upper airway surgery (e.g., uvulopalatopharyngoplasty); dental appliance; weight loss
Cataplexy, hypnogogic hallucinations, sleep paralysisPolysomnogram and multiple sleep latency testNarcolepsyStimulants (e.g., modafinil, methylphenidate); REM sleep-suppressing antidepressants (e.g., venlafaxine); sodium oxybate
Restless legs, kicking movements during sleepAssessment for predisposing medical conditions (e.g., iron deficiency or renal failure)Restless legs syndrome with or without periodic limb movementsTreatment of predisposing condition if possible; dopamine agonists (e.g., pramipexole, ropinirole)
Sedating medications, stimulant withdrawal, head trauma, systemic inflammation, Parkinson’s disease, and other neurodegenerative disorders, hypothyroidism, encephalopathyThorough medical history and examination including detailed neurologic examinationSleepiness due to a drug or medical conditionChange medications, treat underlying condition, consider stimulants

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TY - ELEC T1 - DISORDERS OF EXCESSIVE DAYTIME SLEEPINESS ID - 623568 Y1 - 2017 PB - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623568/all/DISORDERS_OF_EXCESSIVE_DAYTIME_SLEEPINESS ER -