Sleepiness, or hypersomnia, is a relatively common complaint and one of the main problems of modern society. Accurate evaluation and diagnosis of sleepiness are important. The methods used for evaluating sleepiness are subjective measures or self-evaluations, performance decrease measures, sleep propensity measures, and arousal decrease measures. A clear and detailed history is important in differential diagnosis of sleepiness because symptoms of sleepiness may be expressed in terms of 'tiredness' or 'fatigue' that do not directly denote sleepiness. Comprehensive diagnostic evaluation is also invaluable because these symptoms may result from a variety of causes ranging from medical disorders to insufficient nocturnal sleep.
Arousal ; Diagnosis* ; Diagnosis, Differential ; Diagnostic Self Evaluation ; Disorders of Excessive Somnolence

A total of 85 sleep disorders are described in the International Classification of Sleep Disorders, 2nd ed. Knowledge about those sleep disorders will be essential not only for good and healthy sleep but also for maintaining adequate physical and mental function during daytime. Sleep medicine has a relatively short history compared to other medical fields, thus, many sleep disorders are not familiar to the general public and even to physicians. In this small review about various sleep disorders, I will briefly introduce basic concepts about insomnia, sleep-related breathing disorder, hypersomnia, circadian rhythm sleep disorders, parasomnia and sleep-related movement disorders. These sleep disorders are frequently encountered in clinical settings, and understanding them will give us insight about the basic mechanism of sleep-wake states.
Classification ; Diagnosis ; Disorders of Excessive Somnolence ; Movement Disorders ; Parasomnias ; Respiration ; Sleep Wake Disorders* ; Sleep Disorders, Circadian Rhythm ; Sleep Initiation and Maintenance Disorders

PURPOSE: The purpose of the present study was to identify prevalence of excessive daytime sleepiness(EDS) and its associations with sleep habits, sleep problems, depression, subjective health status and obesity in community dwelling adults. METHOD: Data was collected from adults aged 20-59 years by random sampling. Subjects completed a questionnaire which was composed of the Epworth Sleepiness Scale, Center for Epidemiologic Studies Depression Scale, and questions that included items about sleep habits, sleep problems, subjective health status and sociodemographic characteristics. Height and weight were measured for calculation of body mass index. The statistical analyses was based on 3,302 adults (51.5% males and 48.5% females). Descriptive statistics, univariate logistic regression and multiple logistic regression were used. RESULT: The prevalence of EDS was 17.1%. Multiple logistic regression showed that the associated factors of EDS were depression, obesity, dissatisfaction with sleep time, irregular sleep, and habitual snoring. Depression was the most significant associated factor(adjusted odds ratio for severe depression=2.27, 95% Confidence Interval=1.73-2.96). CONCLUSION: EDS is a common symptom in adults. Our finding suggested that persons with a complaint of EDS should be completely assessed for depression and obesity as well as sleep problems.
Activities of Daily Living ; Adult ; Cross-Sectional Studies ; Demography ; Depression ; Disorders of Excessive Somnolence/*diagnosis/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Questionnaires ; Sleep Initiation and Maintenance Disorders/epidemiology

Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressivebehavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proimal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.
Adult ; Angiography ; Brain ; Dexamethasone ; Diagnosis ; Disorders of Excessive Somnolence ; Follow-Up Studies ; Humans ; Hyperphagia ; Magnetic Resonance Imaging ; Meningoencephalitis* ; Middle Cerebral Artery ; Neurologic Manifestations ; Thorax ; Tuberculosis ; Tuberculosis, Meningeal ; Vasculitis

PURPOSE: The aim of the research was to evaluate the psychometric properties of the Pediatric Daytime Sleepiness Scale-Turkish Version (PDSS-T). METHODS: The researchers chose a study sample of 522 grade 5e11 students. Data were collected using a demographic data collection form and the PDSS-T. RESULTS: Cronbach a for the scale was .79 and Kaiser-Meyer-Olkin coefficient was .78. Item-total correlations for the scale varied between .53 and .73 (p < .001). The indices of model fit were determined to be the root mean square error of approximation at .07, the goodness of fit index at .97, and the comparative fit index at .97. CONCLUSIONS: The study's results showed that PDSS-T is a valid and reliable instrument for detecting Turkish-speaking children's and adolescents' daytime sleepiness. PDSS-T is convenient for professionals to prevent and manage daytime sleepiness.
Adolescent ; Child ; Cross-Sectional Studies ; Disorders of Excessive Somnolence/*diagnosis ; Female ; Humans ; Male ; Psychometrics/*instrumentation ; Reproducibility of Results ; Severity of Illness Index ; Surveys and Questionnaires ; Translations ; Turkey

The ability to distinguish between unipolar and bipolar depression and the knowledge to bring the appropriate effective treatment is particularly crucial to psychiatrists. Because the pharmacologic strategies indicated for each disorder differ. Failure to make the correct diagnosis may lead to a lack of response to treatment, or complications such as switches into mania or rapid cycling. Common mood symptoms are melancholy, tearfulness, and irritability; common cognitive and perceptual symptoms are self-deprecatory and self-accusatory thoughts, poor concentration, diminished clarity and speed of thought, and suicidal ideation. Absence of a history of hypomania or mania does not rule out a bipolar diagnosis. Retardation, hypersomnia, hyperphagia, suicide attempts, and psychotic symptoms are more frequently found in these patients than in patients with unipolar depression. Few studies have examined the efficacy of somatic treatments in acute bipolar depression. Less than 20 controlled pharmacological studies have been conducted for the depressive phase of bipolar disorder. In addition, these studies examined small sample sizes and with only a few of the available treatment options. Because there is very little data specific to treatment of bipolar depression, most of the approaches to bipolar depression are derived from experience with unipolar depression. The basic premise of treatment os that these patients frequently respond to mood stabilizing agents without antidepressants, and that antidepressants should be reserved for those cases in which mood stabilizers alone have not worked, because of the well-known risk of triggering manic episodes(switching) and rapid cycling. Antidepressants should not be continued any longer than necessary. Mood stabilizers should be considered as first-line agents in view of the fact that their efficacy is at lease equal to, if not greater than, treatment with antidepressant, and that their use is rarely associated with the complications of cycle acceleration or with manic switch. It is recommended to use bupropion or SSRI because of low risk of manic switch and rapid cycling. In the future, research and pharmaceutical communities will have to focus on the short- and long-term effectiveness of antidepressants, and the development of new drugs for the treatment of bipolar depression. More experience is needed with the anticonvulsant lamotrigine, gabapentin, topiramate. The preliminary studies of lamotrigine suggests the antidepressant effect and mood stabilizing efficacy.
Acceleration ; Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Depressive Disorder ; Diagnosis ; Disorders of Excessive Somnolence ; Excipients ; Humans ; Hyperphagia ; Psychiatry ; Sample Size ; Suicidal Ideation ; Suicide

Excessive daytime sleepiness (EDS) is a prevalent complaint among patients in psychiatric and medical care. Patients with EDS have often been misdiagnosed with depression due to their complaints of lack of energy and poor concentration. Also, they have even been diagnosed erroneously with a psychotic disorder in case of coexistence with hypnagogic hallucination. EDS can seriously affect the person's quality of life by causing decreased academic achievement or work performance, low self esteem, and social withdrawal. EDS is also frequently associated with various medical and psychiatric conditions, and often fatal traffic or on-the-job accidents. The causes of EDS range from insufficient sleep to central nervous system-originated hypersomnia. The conditions that can lead to EDS include circadian rhythm disorders, primary disorders of alertness such as narcolepsy, sleep-related breathing disorders such as obstructive sleep apnea syndrome, sleep-related movement disorders such as periodic limb movement disorder and restless legs syndrome, chronic medical conditions such as cancer, and medications causing sleepiness. Treatment options should be tailored according to the underlying condition and include sufficient sleep time, light therapy, sleep scheduling, wakefulness-promoting medications, or mechanical airway managements such as nasal continuous positive airway pressure (CPAP).
Achievement ; Chronobiology Disorders ; Continuous Positive Airway Pressure ; Depression ; Diagnosis, Differential ; Disorders of Excessive Somnolence ; Hallucinations ; Humans ; Movement Disorders ; Narcolepsy ; Nocturnal Myoclonus Syndrome ; Phototherapy ; Psychotic Disorders ; Quality of Life ; Respiration ; Restless Legs Syndrome ; Self Concept ; Sleep Apnea, Obstructive

PURPOSE: Sleep disorders are common diseases in childhood and adolescence. Daytime sleepiness, fatigue, headache, etc caused by sleep disorders may affect daily activities and school performance. Authors conducted this study to understand the clinical characteristics of sleep disorders in pediatric patients. METHODS: The subjects consisted of 88 patients under 16 years of age who visited Kangnam Sacred Heart Hospital and Kangdong Sacred Heart Hospital with sleep disorders for one and half years. Diagnosis was made according to the international classification of sleep disorders-2(ICSD-2) with sleep questionnaire, sleep diaries, night-time video recordings and performed electroencephalogram or polysomnography when needed. RESULTS: The mean age was 7.5 years old, and the male to female ratio was 1.1:1(46: 42). A total of 88 patients consisted of parasomnia of 31(35.2%), insomnia of 27(30.7%), circadian-rhythm sleep disorders of 15(17.0%), sleep-related breathing disorders of 11 (12.5%), and hypersomnia of 4(4.5%). While sleep-onset associated disorders were most common in patients under 3 years old, parasomnia, insomnia, and obstructive sleep apnea syndrome(OSAS) were common in a descending order of frequency in 3-8 years old. Furthermore, school-age patients had circadian-rhythm sleep disorders, insomnia, and hypersomnia in order of frequency. 38 patients(43.2%) complained of headache, 15 patients(17%) fatigue, and others difficulty in waking up in the morning, abdominal pain, attention deficit, hyperactivity, and learning difficulty. CONCLUSION: Pediatric sleep disorders, which variably decrease the quality of life in childhood and adolescence, frequently overlooked by their parents or physicians. Therefore it is important for pediatricians have more interest and better understanding of sleep disorders.
Abdominal Pain ; Adolescent* ; Child, Preschool ; Classification ; Diagnosis ; Disorders of Excessive Somnolence ; Electroencephalography ; Fatigue ; Female ; Headache ; Heart ; Humans ; Learning ; Male ; Parasomnias ; Parents ; Polysomnography ; Quality of Life ; Surveys and Questionnaires ; Respiration ; Sleep Apnea, Obstructive ; Sleep Wake Disorders* ; Sleep Initiation and Maintenance Disorders ; Video Recording

A 4-yr-old girl has exhibited severe snoring, restless sleep and increasing daytime sleepiness over the last 3 months. The physical examination showed that she was not obese but had kissing tonsils. Polysomnography demonstrated increased apnea-hypopnea index (AHI) of 5.2, and multiple sleep latency tests (MSLT) showed shortened mean sleep latency and one sleep-onset REM period (SOREMP). She was diagnosed with obstructive sleep apnea (OSA) and underwent tonsillectomy and adenoidectomy. After the surgery, her sleep became much calmer, but she was still sleepy. Another sleep test showed normal AHI of 0.2, the mean sleep latency of 8 min, and two SOREMPs. Diagnosis of OSA to be effectively treated by surgery and narcolepsy without cataplexy was confirmed. Since young children exhibiting both OSA and narcolepsy can fail to be diagnosed with the latter, it's desirable to conduct MSLT when they have severe daytime sleepiness or fail to get better even with good treatment.
Adenoidectomy ; Asian Continental Ancestry Group ; Child, Preschool ; Disorders of Excessive Somnolence/diagnosis ; Female ; Humans ; Methylphenidate/therapeutic use ; Narcolepsy/complications/*diagnosis/surgery ; Polysomnography ; Republic of Korea ; Sleep Apnea, Obstructive/*diagnosis/drug therapy/surgery ; Tonsillectomy

INTRODUCTIONPatients with obstructive sleep apnoea (OSA) often present with excessive daytime sleepiness (EDS) as measured by the Epworth Sleepiness Scale (ESS). However, the relationship between EDS and OSA severity as measured by the apnoea-hypopnoea index (AHI) remains inconsistent. We hypothesise that this may be due to the usage and equal weightage of apnoea and hypopnoea events used in determining AHI and that apnoea and hypopnoea load as measured by their total durations may be a better metric to use. We sought to investigate if apnoea or hypopnoea load can display better correlation with ESS.

MATERIALS AND METHODSRetrospective analysis of 821 patients with AHI ≥5, who underwent in-laboratory polysomnogram for suspected OSA from January 2015-December 2015, was performed. Objective factors on polysomnogram were correlated with ESS.

RESULTSESS was correlated with age (r = -0.148, <0.001), number of apnoeas (r = 0.096, = 0.006), apnoea load (r = 0.102, = 0.003), apnoea index (r = 0.075, = 0.032), number of desaturations (r = 0.081, = 0.020), minimum SpO (r = -0.071, = 0.041), time SpO <85% (r = 0.075, = 0.031) and REM sleep duration (r = 0.099, = 0.004). Linear regression analysis found age ( <0.001), apnoea load ( = 0.005), REM ( = 0.021) and stage 1 sleep duration ( = 0.042) as independent factors correlated to ESS. The apnoea load calculated using duration in apnoea correlate with ESS in patients with severe OSA by AHI criteria compared to the mild category.

CONCLUSIONAHI does not correlate with ESS. Younger age, longer apnoea, stage 1 and REM sleep were independently related to higher ESS though the correlations were weak. Apnoea load should be taken into account when determining OSA severity.

Adult ; Age Factors ; Disorders of Excessive Somnolence ; diagnosis ; etiology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; methods ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Sleep Apnea Syndromes ; physiopathology ; Sleep Apnea, Obstructive ; complications ; diagnosis ; physiopathology ; Sleep, REM ; physiology ; Statistics as Topic