CC Nov 2015 Hypersomnia

echoecho's version from 2015-12-25 17:58


Question Answer
Define hypersomnia?excessive daytime sleepiness that interferes with daily activities
Range of daytime sleepiness?1) cause patients to take multiple daytime naps OR 2) may be so severe that it causes the patient to fall asleep during critical activities such as driving or working
List the two categories of hypersomnia?1) primary 2) secondary
What is primary hypersomnia due to?due to central brain pathology
What is secondary hypersomnia due to?underlying disease states
List 4 causes of primary hypersomnia?1) idiopathic hypersomnia 2) narcolepsy 3) recurrent (periodic) 4) hypersomnia
List the 6 causes of secondary hypersomnia?1) alcohol use 2) depression 3) medications that cause sedation 4) OSA 5) Parkinson's disease 6) traumatic brain injury
What is the first step in patients with suspected hypersomnia to do?quantifying the degree of daytime sleepiness
What scale is useful to estimate daytime sleepiness, what is the website?1) Epworth Sleepiness Scale 2) www.
Describe the Epworth Sleepiness Scale?consists of 8 items for which pts indicate indicate their likelihood of falling asleep during common activities
What is indicated if pts experience significant daytime sleepiness?further evaluation
Because primary hypersomnia requires more intensive investigation, evaluation for what causes is usually the first step?secondary causes
Assessment for secondary causes includes what?1) medication review for drugs that cause sedation (antihistamines, beta-blockers, muscle relaxants, benzodiazepines) or result in poor sleep (diuretics), a query regarding substance use/abuse (alcohol, marijuana, central depressants) and depression screening using Zung or Beck inventories) 2) the med hx should inquire about a hx of head trauma, sleep apnea or medical conditions that might cause poor sleep (restless legs syndrome, frequent urination, orthopnea)
What is the one of the more common causes of daytime sleepiness?OSA
What is OSA associated with an increased risk of?accidents including fatal automobile accidents
OSA increases the risk of what?occupational injuries
Indentification and management of OSA can significantly reduce what?daytime sleepiness and incidence of pulmonary HTN and right ventricular hypertrophy seen with long-standing untreated OSA
What is the STOP test? ask 4 questions to identify if patient has a high risk (> 2 questions/4 positive) or low risk (<2 questions/4 positive)?STOP = snoring, tiredness during the daytime, observed apnea and high BP)
The STOP test is used for what?identifying paitents who may require more comprehensive sleep apnea evaluation
Dx for sleep apnea is usually confired by what?nocturnal polysomnogram (PSG)
What is the most common management for OSA?1) weight reduction 2) continuous positive airway pressure (CPAP) devices
What 2 other managements may be needed for OSA?1) oral devices 2) surgery in select patients
Primary hypersomnias are due to what?alterations in normal sleep patterns, altered central nervous neurotransmitters (dopamine, norepinephrine) or both
How does narcolepsy present clinically?sudden sleep onset from an awakened state, during the transition patients may suffer injury
Symptoms of narcolepsy most commonly begin when?in the teens and early 20's (although symptoms may start earlier or later)
*** What test can be performed at most sleep centers to confirm a dx of narcolepsy?The Multiple Sleep Latency Test (MSLT)
*** What is a positive Multiple Sleep Latency Test?when patients experience 2 or more sleep-onset rapid eye movements (SOREMK) periods during the test
What human leukocyte antigen do most patients with narcolepsy carry?HLA-DR15 and HLA-DQ6 haplotypes
Narcolepsy can occur with or without what?cataplexy
Define cataplexy?it is a condition marked by loss of muscle tone in response to significant emotional stress or excitement
Symptoms of cataplexy?patients literally become limp or collapse while laughing or crying
What is the pathogenesis of narcolepsy?neurochemical disorder of the hypothalamus resulting in diminished levels of hypocretin / orexin
Narcolepsy is a lifelong disorder with clear evidence of involvement in what age groups?children and adolescents
While the vast majority of narcolepsy cases are hereditary, a small cluster of cases have been reported in Europe related to what?possible contaminants of an H1N1 influenza A vaccine that was used in 2009 (this prep was not used in the US or Canada)
Define idiopathic hypersomnia?1) primary hypersomnia that is a dx of exclusion 2) patients have daytime sleepiness in addition to having prolonged periods of sleep (>10 hours) 3) some patients experience "sleep drunkenness" confusion and difficulty functioning after awakening from a daytime nap
The basis for confirmation of idiopathic hypersomnia is what?the clinical presence of significant daytime sleepiness in the absence of both secondary insomnia and other forms of hypersomnia
Is there genetic association with idiopathic hypersomnia as there is with narcolepsy?no
List the 2 conditions where there is recurrent or episodic hypersomnias?1) Kleine-Levin syndrome 2) menstrual hypersomnia
What symptoms are there in Kleine-Levin syndrome and menstrual hypersomnia?1) episodic hypersomnia followed by periods of normal daytime alertness 2) during periods of hypersomnia, patients may also experience daytime hallucinations, aggressive behavior and binge eating
Kleine-Levin syndrome is most common in what age group and gender?adolescent males
Menstrual hypersomnia is associated with what in young women?ovulatory menstrual periods
What is the mainstay of treatment for the primary hypersomnias?stimulant therapy
List the medications that are increasingly used because they are less addictive than amphetamines and methylphenidate (Concerta, Ritalin) in primary hypersomnias?Modafinal (Provigil) and armodafinil (Nuvigil) which are both nonamphetamine stimulants
*** For patients with BOTH narcolepsy and cataplexy, what is the first-line treatment of choice medication?sodium oxybate (Xyrem)
While in the above patients, medications are not curative, what do they reduce? what do they improve?1) daytime sleepiness 2) functional status
For patients who do not respond to the above agents, what medications may be of benefit?1) selegiline (Anipryl) 2) reboxetine (Edronax) 3) SSRIs 4) TCAs 5) venlafaxine (Effexor)
What are the findings of a Cochrane review regarding evidence that antidepressants are effective for narcolepsy and evidence of benefit of cataplexy?no evidence for antidepressants and scarce evidence for cataplexy
*** SUMMARY = What Scale is useful to estimate daytime sleepiness? What does it consist of?1) Epworth Sleepiness Scale 2) 8 items for which patients indicate their likelihood of falling asleep during common activities
*** SUMMARY = because primary hypersomnia requires more intensive investigations, what evaluation for what is usually the first step?secondary causes
*** SUMMARY = most patients with narcolepsy carry what haplotypes and the presence of these haplotypes can provide further evidence of narcolepsy in cases for which the dx is in question?HLA-DR 15 and HLA-DQ6
*** SUMMARY = What therapy is the mainstay of treatment for primary hypersomnias?stimulant therapy