Idiopathic Hypersomnia with and without Long Sleep Time: A Controlled Series of 75 Patients

Vernet, Cyrille; Arnulf, Isabelle

doi:10.1093/sleep/32.6.753

Cited by 239 publications

(187 citation statements)

References 21 publications

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“…An 8-minute MSL threshold, for example, fails to capture 22% to 39% of patients who otherwise meet clinical criteria for a CNS hypersomnia. 9,12 Consistent with this, an average MSL of 8.3 minutes has been reported for patients with idiopathic hypersomnia. 13 Type I error may also be problematic, as MSL < 8 was reported in 25% of one population-based sample.…”

Section: Discussionsupporting

confidence: 72%

“…Recognizing this need, some investigators have advocated for continuous daytime polysomnography, ad libitum sleep polysomnography, or changes to the MSLT scoring criteria. 9,12,33 Similar to the MSLT, however, these alternatives are time and labor intensive. More cost-effective measures are needed, in addition to identification of a biomarker with diagnostic and therapeutic significance.…”

Section: -32mentioning

confidence: 99%

“…5,6 They have many features in common, including hallucinations and sleep paralysis, 1,4 unrefreshing naps, 7,8 sleep drunkenness, 1,7,8 and prolonged nocturnal sleep. [8][9][10] Therefore, differentiation between narcolepsy without cataplexy and idiopathic hypersomnia relies solely on the MSLT 4 and the propensity for REM sleep to intrude into more than one daytime nap.Perhaps because of the lack of a single defi ning characteristic or known pathophysiology, patients with narcolepsy without cataplexy and idiopathic hypersomnia not infrequently present to tertiary sleep centers for a second opinion regarding their diagnoses. In such instances, the clinical question frequently arises of whether or not to repeat an MSLT.…”

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confidence: 99%

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confidence: 99%

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Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia

Trotti

Staab²,

Rye³

2013

Journal of Clinical Sleep Medicine

179

107

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conducted within three weeks of each other.11 Inter-test intervals are generally much longer in clinical practice, and in that case the stability of MSLT features has not been established. We therefore evaluated the test-retest reliability of the MSLT in a clinic population of patients with narcolepsy without cataplexy and idiopathic hypersomnia. METHODS Patient SelectionPatients with a clinical syndrome consistent with a CNS hypersomnia (i.e., reports of problematic, excessive daytime sleepiness persisting ≥ 3 months despite adequate or supra-normal habitual sleep durations, not explained by other causes of daytime sleepiness) who had undergone 2 MSLTs were identiStudy Objectives: Differentiation of narcolepsy without cataplexy from idiopathic hypersomnia relies entirely upon the multiple sleep latency test (MSLT). However, the test-retest reliability for these central nervous system hypersomnias has never been determined. Methods: Patients with narcolepsy without cataplexy, idiopathic hypersomnia, and physiologic hypersomnia who underwent two diagnostic multiple sleep latency tests were identifi ed retrospectively. Correlations between the mean sleep latencies on the two studies were evaluated, and we probed for demographic and clinical features associated with reproducibility versus change in diagnosis. Results: Thirty-six patients (58% women, mean age 34 years) were included. Inter-test interval was 4.2 ± 3.8 years (range 2.5 months to 16.9 years). Mean sleep latencies on the fi rst and second tests were 5.5 (± 3.7 SD) and 7.3 (± 3.9) minutes, respectively, with no signifi cant correlation (r = 0.17, p = 0.31). A change in diagnosis occurred in 53% of patients, and was accounted for by a difference in the mean sleep latency (N = 15, 42%) or the number of sleep onset REM periods (N = 11, 31%). The only feature predictive of a diagnosis change was a history of hypnagogic or hypnopompic hallucinations. Conclusions S C I E N T I F I C I N V E S T I G A T I O N ST he central nervous system (CNS) hypersomnias manifest as excessive daytime sleepiness with or without prolonged nocturnal sleep in the absence of demonstrable nocturnal sleep pathology or insuffi cient sleep. They include the entities of narcolepsy with and without cataplexy and idiopathic hypersomnia. Narcolepsy with cataplexy is a chronic disease characterized by short latencies to both sleep and REM sleep on daytime nap opportunities during the multiple sleep latency test (MSLT) and is caused by immunogenetically mediated loss of hypocretin.1 Cataplexy is a clinical feature highly specifi c to hypocretin-defi cient narcolepsy, although is not always evident near the onset of sleepiness. The remaining CNS hypersomnias begin at a similar age, are much less likely to be associated with hypocretin defi ciency, 1-4 and lack a pathognomonic sign or symptom. 5,6 They have many features in common, including hallucinations and sleep paralysis, 1,4 unrefreshing naps, 7,8 sleep drunkenness, 1,7,8 and prolonged nocturnal sleep. [8][9][10] Therefore, differenti...

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Section: Discussionsupporting

confidence: 72%

Section: -32mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia

Trotti

Staab²,

Rye³

2013

Journal of Clinical Sleep Medicine

179

107

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“…Esto podría explicar la mayor prevalencia de individuos vespertinos en una muestra de personas con hipersomnia idiopática (Vernet y Arnulf, 2009).…”

Section: Trastornos Del Sueñounclassified

Tipología circadiana y problemas de salud mental

Antúnez¹,

Navarro²,

Adán³

2014

analesps

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Resumen: La tipología circadiana (matutina, vespertina o intermedia) es una diferencia individual que se ha relacionado con numerosos aspectos de la salud mental. En este estudio se revisan los principales hallazgos publicados en el área. Tras la búsqueda bibliográfica en las principales bases de datos se seleccionaron un total de 70 artículos publicados en castellano e inglés entre los años 1990 y 2012, recogidos en las bases de datos ISI, Scopus y Medline, donde se muestra que los individuos vespertinos presentan una mayor prevalencia de trastorno afectivo estacional, depresión mayor, trastorno bipolar, esquizofrenia, trastornos de la conducta alimentaria, trastornos del sueño, conductas adictivas, TDAH y mayores niveles de ansiedad que los matutinos. La tipología vespertina se perfila como un factor de riesgo y la matutina como un factor protector para el desarrollo de diversas psicopatologías, apuntándose como posibles causas polimorfismos de los genes reloj, el jet-lag social y algunos rasgos de personalidad. La tipología circadiana debe considerarse en la evaluación, tratamiento y prevención de las psicopatologías, pues afecta al inicio, curso, remisión y recaída de las mismas. La utilización de terapia cronobiológica es un factor a tener en cuenta en el abordaje terapéutico cuando la expresión rítmica circadiana se halla alterada. Palabras clave: revisión sistemática cualitativa; tipología circadiana; matutinidad-vespertinidad; salud mental; psicopatología. Title:Circadian typology and problems in mental health. Abstract: Circadian typology (morning-type, neither-type, and eveningtype) is an individual difference which has been related to numerous aspects of mental health. In this paper we present a review of the findings published on this topic. After searching in the main databases a total number of 70 works were selected, published in Spanish and English from 1990 to 2012 collected in the databases ISI, Scopus and Medline. These works show that individuals with evening-type typology exhibit a greater prevalence of seasonal affective disorder, mayor depression, bipolar disorder, schizophrenia, eating disorders, sleep disorders, addictive behaviours, ADHD, and higher anxiety levels than morning-type typology individuals. In this sense, the evening-type is considered as a factor of risk whereas the morning-type would be a protective factor for the development of several mental disorders. This could be a result of clock gene polymorphisms, social jet lag and some personality traits. Circadian typology must be considered in the evaluation, treatment and prevention of the mental disorders, as it affects to the start, course, remission and relapse of diverse problems of mental health. Chronobiological therapy must be also considered in the therapeutic approaching when the circadian rhythmical expression is altered. Key words: qualitative systematic review; circadian typology; morningnesseveningness; mental health; psychopathology. IntroducciónLos ritmos circadianos, descritos por de Mairan en 1729 (como se ci...

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Operational Definitions and Algorithms for Excessive Sleepiness in the General Population

Ohayon

Dauvilliers²,

Reynolds³

2012

Arch Gen Psychiatry

104

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Context Excessive sleepiness (ES) is poorly defined in epidemiologic studies, although its adverse implications for safety, health, and optimal social and vocational functioning have been extensively reported. Objective To determine the importance of ES definition, measurement, and prevalence in the general population, together with its coexisting conditions. Design Cross-sectional telephone study. Participants A total of 15 929 individuals representative of the adult general population of 15 states in the United States. Main Outcome Measures Interviews were carried out using Sleep-EVAL, a knowledge-based expert system for use in epidemiologic studies, focusing on sleep, as well as physical and mental disorders, according to classification in DSM-IV and the second edition of the International Classification of Sleep Disorders. The interviews elicited information on ES, naps, frequency, duration, impairment, and distress associated with ES symptoms. Results Excessive sleepiness was reported by 27.8% (95% CI, 27.1%–28.5%) of the sample. Excessive sleepiness with associated symptoms was found in 15.6% of the participants (95% CI, 15.0%–16.2%). Adding an ES frequency of at least 3 times per week for at least 3 months despite normal sleep duration dropped the prevalence to 4.7% of the sample (95% CI, 4.4%–5.0%). The proportion of individuals having social or professional impairment and psychological distress increased with the frequency of ES symptoms during the week and within the same day. In multivariate models, the number of ES episodes per day and severity of ES were identified as the best predictors for impairment/distress. Prevalence of hypersomnia disorder was 1.5% of the participants (95% CI, 1.3%–1.7%). The most common coexisting conditions were mood and substance use disorders. Conclusions Excessive sleepiness is an important problem in the US population, even when using restrictive criteria to define it. Hypersomnia disorder is more prevalent than previously estimated. Excessive sleepiness has to be recognized and given attention by public health authorities, scientists, and clinicians.

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Idiopathic Hypersomnia with and without Long Sleep Time: A Controlled Series of 75 Patients

Abstract: Hypersomnia, especially with long sleep time, is frequently associated with evening chronotype and young age. It is inadequately diagnosed using MSLT.

Cited by 239 publications

References 21 publications

Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia

Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia

Tipología circadiana y problemas de salud mental

Operational Definitions and Algorithms for Excessive Sleepiness in the General Population

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