hypersomnolence

• 傾眠過剰、睡眠過剰

関

disorder of excessive somnolence、hypersomnia

WordNet

1. an inability to stay awake

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/04 20:03:13」(JST)

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Hypersomnia
Classification and external resources
MeSH	D006970

The term hypersomnia refers to a large group of disorders characterized by excessive daytime sleepiness (EDS). As per the revised International Classification of Sleep Disorders, this group of disorders includes numerous different etiologies. Hypersomnia can be primary (of central/brain origin), or it can be secondary to another medical condition (see Differential Diagnosis). If the hypersomnia is of unknown origin, it is considered to be idiopathic hypersomnia.

Both hypersomnia and EDS "are complex traits whose formal study is in its infancy, and whose socioeconomic burden is enormous."

In the proposed 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, due for publication in May 2013, hypersomnia is reclassified under Sleep-Wake Disorders as hypersomnolence, of which there are several subtypes. As of November 2012, the draft diagnostic criteria for DSM-5 are still in flux, and the specific criteria text has been removed from public view on the DSM-5 Development site.

NOTE: One must take care to differentiate between the generic term hypersomnia and the neurological disease currently known as idiopathic hypersomnia (also known as primary hypersomnia; central hypersomnia; hypersomnia of brain origin; or after publication of DSM-V, major hypersomnolence disorder)

Symptoms

The main symptom of hypersomnia is excessive daytime sleepiness (EDS), which has occurred for at least 3 months prior to diagnosis.

Epidemiology

Hypersomnia affects approximately 5% of the general population, "with a higher prevalence for men due to the sleep apnea syndromes".

Diagnosis

"The severity of daytime sleepiness needs to be quantified by subjective scales (at least the Epworth Sleepiness Scale) and objective tests such as the multiple sleep latency test (MSLT)." After it is determined that EDS is present, a complete medical examination and full evaluation of potential disorders in the differential diagnosis should be undertaken. For the patient, the process can be tedious, expensive and time-consuming.

Differential Diagnosis

Hypersomnia can be primary (of central/brain origin), or it can be secondary to any of numerous medical conditions.

Primary Hypersomnia

The true primary hypersomnias include: narcolepsy (with and without cataplexy); idiopathic hypersomnia; and recurrent hypersomnias (like Klein-Levin syndrome).

Primary Hypersomnia Mimics

There are also several genetic disorders that may be associated with primary/central hypersomnia. These include: Prader-Willi syndrome; Norrie disease; Niemann–Pick disease, type C; and myotonic dystrophy). However, hypersomnia in these syndromes may also be associated with other secondary causes, so it is important to complete a full evaluation. Interestingly, myotonic dystrophy is often associated with SOREMPs (sleep onset REM periods, such as occur in narcolepsy).

There are many neurological disorders that may mimic the primary hypersomnias narcolepsy and idiopathic hypersomnia: brain tumors; stroke-provoking lesions; and dysfunction in the thalamus, hypothalamus, or brainstem. Also, neurodegenerative conditions such as Alzheimer's disease, Parkinson's disease, or multiple system atrophy are frequency associated with primary hypersomnia. However, in these cases, one must still rule out other secondary causes.

Early hydrocephalus can also cause severe EDS. Additionally, head trauma can be associated with a primary/central hypersomnia, and symptoms similar to those of idiopathic hypersomnia can be seen within 6-18 months following the trauma. However, the associated symptoms of headaches, memory loss, and lack of concentration may be more frequent in head trauma than in idiopathic hypersomnia. "The possibility of secondary narcolepsy following head injury in previously asymptomatic individuals has also been reported."

Secondary Hypersomnia

Secondary hypersomnias are extremely numerous.

Hypersomnia can be secondary to disorders such as clinical depression, bipolar disorder, celiac disease, uremia, chronic fatigue syndrome, and fibromyalgia. Hypersomnia can also be a symptom of other sleep disorders such as narcolepsy, sleep apnea, restless leg syndrome and periodic limb movement disorder. It may also occur as an adverse effect of taking certain medications (e.g. some psychotropics for depression, anxiety, or bipolar disorder), of withdrawal from some medications, or of drug or alcohol abuse. A genetic predisposition may also be a factor.

Sleep apnea is the most frequent cause of secondary hypersomnia, affecting up to 4% of middle-aged adults, mostly men. Upper airway resistance syndrome is a clinical variant of sleep apnea that can also cause hypersomnia.

Hypothyroidism and iron deficiency with or without (iron-deficiency anemia) can also cause secondary hypersomnia. Blood tests for these disorders should be done so they can be treated as appropriate.

Hypersomnia can also develop within months after viral infections such as Whipple's disease, mononucleosis, HIV, and Guillain–Barré syndrome.

Primary hypersomnia in diabetes, hepatic encephalopathy, and acromegaly is rarely reported, but these medical conditions may be associated with the secondary hypersomnias sleep apnea and periodic limb movement disorder (PLMD).

Behaviorally induced insufficient sleep syndrome must also be considered in the differential diagnosis of secondary hypersomnia. This disorder occurs in individuals who fail to get sufficient sleep for at least 3 months. In this case, the patient has chronic sleep deprivation, although is not necessarily aware of it. This situation is becoming more prevelant in Western Society due to the modern demands and expectations placed upon the individual.

Many medications can also lead to secondary hypersomnia. Therefore, a patient's complete medication list should be carefully reviewed for sleepiness or fatigue as side effects. In these cases, careful withdrawal from the possibly offending medication(s) is needed; then, medication substitution can be undertaken.

Mood disorders can also be associated with hypersomnia. The complaint of EDS in these conditions is often associated with poor sleep at night. "In that sense, insomnia and EDS are frequently associated, especially in cases of depression." Hypersomnia in mood disorders seems to be primarily related to "lack of interest and decreased energy inherent in the depressed condition rather than an increase in sleep or REM sleep propensity." In all cases with these mood disorders, the MSLT is normal (not too short and no SOREMPs)."

Treatment

Appropriate treatment will depend on the specific cause or causes of hypersomnia that are diagnosed.

See also

• Idiopathic hypersomnia
• Insomnia
• Reticular Formation

External links

• Hypersomnia Foundation
• Living With Hypersomnia - Support community created and maintained by volunteers suffering from Idiopathic Hypersomnia
• National Sleep Foundation
• Talk About Sleep - Idiopathic Hypersomnia
• Help: I can't stay awake! - Public Radio Interview with Dr. David Rye
• med/3129 at eMedicine - "Primary Hypersomnia"
• 06-081c. at Merck Manual of Diagnosis and Therapy Home Edition - "Circadian Rhythm Sleep Disorders"
• -483065848 at GPnotebook

References

UpToDate Contents

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• 1. 過度な日中の眠気を有する患者へのアプローチ approach to the patient with excessive daytime sleepiness
• 2. 特発性過眠症 idiopathic hypersomnia
• 3. クライネ・レビン症候群（反復性過眠症） kleine levin syndrome recurrent hypersomnia
• 4. 眠気の定量化 quantifying sleepiness
• 5. Unipolar major depression in adults: Augmentation of antidepressants with stimulants and stimulant-like drugs

English Journal

• Pediatric insomnia: clinical, diagnosis, and treatment.

• Miano S, Peraita-Adrados R.Author information Civic Hospital (EOC) of Lugano, Lugano, Suiza.Abstractin

English, SpanishTITLE: Insomnio pediatrico: clinica, diagnostico y tratamiento.

• Revista de neurologia.Rev Neurol.2014 Jan 1;58(1):35-42.
• in

English, SpanishTITLE: Insomnio pediatrico: clinica, diagnostico y tratamiento.El insomnio pediatrico es un trastorno de sueño extrinseco que puede subdividirse en dos categorias: insomnio conductual e insomnio relacionado con trastornos medicos, neurologicos y psiquiatricos. En esta revisio

• PMID 24343539

• Immunology. Swine flu connection provides clues about narcolepsy.

• Vogel G.
• Science (New York, N.Y.).Science.2013 Dec 20;342(6165):1430. doi: 10.1126/science.342.6165.1430.
• PMID 24357283

• Alzheimer's disease, sleep apnea, and positive pressure therapy.

• Bliwise DL.Author information Department of Neurology, Emory University School of Medicine, Wesley Woods Center, 1841 Clifton Road, Room 509, Atlanta, GA, 30329, USA, dbliwis@emory.edu.AbstractOPINION STATEMENT: Numerous lines of evidence converge in suggesting that sleep apnea may play a causal role in severe cognitive impairment, most likely Alzheimer's Disease (AD) but also including vascular dementia. Until recently, most of these studies have been based on small samples of clinic patients or population-based, descriptive studies of sleep apnea and cognition. Although randomized clinical trials have been completed for treating sleep apnea in middle-aged cognitively intact patients with sleep apnea using continuous positive airway pressure (CPAP), systematic intervention studies in well-characterized AD patients are very rare and have been published from only a single research group. Results suggest some very modest improvement in selected aspects of cognition over a very limited period of time. There is, thus, a lack of conclusive evidence that treating sleep apnea in AD is likely to have a major impact on dementia, although it may benefit daytime hypersomnolence, excessive napping, and lethargy so common in many dementia patients. In addition, anecdotal evidence suggests that in some selected cases, treatment can have relatively dramatic effects. At this point in time, the best indications for pursuing treatment for sleep apnea with nasal CPAP in AD patients would be factors promoting adherence, such as presence of a caregiver/family member invested in treatment, and a realistic appraisal of what goals of intervention should be expected (eg, increasing daytime functionality by enhancing alertness) over a reasonable window of time. Speculative factors implicating a potentially causal role for sleep apnea in dementing illness would be comorbid diseases well-established to be associated with both sleep apnea and dementia (cardiovascular disease, diabetes) and presence of the Apolipoprotein-E4 genotype. None of these factors have been shown conclusively to influence CPAP efficacy in dementia, but to the extent that they lie on a putative causal pathway for sleep apnea and dementia (either as moderators or mediators of CPAP efficacy), their presence might be expected to enhance, rather than mitigate, a more favorable response in the domain of cognition.
• Current treatment options in neurology.Curr Treat Options Neurol.2013 Dec;15(6):669-76. doi: 10.1007/s11940-013-0262-5.
• OPINION STATEMENT: Numerous lines of evidence converge in suggesting that sleep apnea may play a causal role in severe cognitive impairment, most likely Alzheimer's Disease (AD) but also including vascular dementia. Until recently, most of these studies have been based on small samples of clinic pat
• PMID 24198176

Japanese Journal

• DSM-5における過眠障害 (特集 睡眠障害の臨床)

• 伊東 若子,井上 雄一
• 臨床精神医学 43(7), 981-988, 2014-07
• NAID 40020146351

• 治療により過眠症状の改善が得られたナルコレプシー患者における主観的眠気と客観的眠気の相違

• 和田 大和,黒田 健治,澤田 将幸 [他]
• 臨床精神医学 41(2), 195-200, 2012-02
• NAID 40019192702

• Effect of an oral branched chain amino acid-enriched snack in cirrhotic patients with sleep disturbance

• ICHIKAWA Tatsuki,NAOTA Taura,MIYAAKI Hisamitsu,MIUMA Satoshi,ISOMOTO Hajime,TAKESHIMA Fuminao,NAKAO Kazuhiko
• Hepatology research : the official journal of the Japan Society of Hepatology 40(10), 971-978, 2010-10-01
• … We used the Epworth Sleepiness Scale (ESS) for the evaluation of daytime hypersomnolence. …
• NAID 10027821149

Related Links

• Hypersomnolence | Define Hypersomnolence at Dictionary.com

somnolent / ˈsɒm nə lənt / Show Spelled [som-n uh-l uh nt] Show IPA adjective 1. sleepy; drowsy. 2. tending to cause sleep. Origin: 1425–75; late Middle English sompnolent Old French Latin somnolentus, derivative of somnus sleep; see ...

• Hypersomnolence - definition of Hypersomnolence in the ...

hypersomnolence /hy·per·som·no·lence/ (-som´no-lens) hypersomnia. Hypersomnolence Excessive sleeping hypersomnia [hi″per-som´ne-ah] excessive sleeping or sleepiness, as in any of a group of sleep disorders. primary ...

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★リンクテーブル★

リンク元	「hypersomnia」「disorder of excessive somnolence」「睡眠過剰」「傾眠過剰」
拡張検索	「idiopathic hypersomnolence」

「hypersomnia」

　　[★]

• n.

• 過眠症、過眠

関

disorder of excessive somnolence、hypersomnolence、narcolepsy、narcoleptic

　

「disorder of excessive somnolence」

　　[★]

傾眠症、傾眠過剰症、昼間過眠症

関

hypersomnia、hypersomnolence

「睡眠過剰」

　　[★]

英

hypersomnolence

関

過眠症、傾眠過剰症、傾眠過剰

「傾眠過剰」

　　[★]

英

hypersomnolence

関

睡眠過剰

「idiopathic hypersomnolence」

　　[★]

特発性過眠症

関

idiopathic hypersomnia