Excessive Daytime Sleepiness

Abstract

Excessive daytime sleepiness is one of the most common sleep-related patient symptoms, with prevalence in the community estimated to be as high as 18%. Patients with excessive daytime sleepiness may exhibit life threatening road and work accidents, social maladjustment, decreased academic and occupational performance and have poorer health than comparable adults. Thus, excessive daytime sleepiness is a serious condition that requires investigation, diagnosis and treatment primarily. As with most medical condition, evaluation of excessive daytime sleepiness begins a precise history and various objective and subjective tools have been also developed to assess excessive daytime sleepiness. The most common causes of excessive daytime sleepiness are insufficient sleep hygiene, chronic sleep deprivation, medical and psychiatric conditions and sleep disorders, such as obstructive sleep apnea, medications, and narcolepsy. Treatment option should address underlying contributors and promote sleep quantity by ensuring good sleep hygiene

Keywords

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Gündüz Aşırı Uykululuğu

Abstract

Gündüz aşırı uykululuğu en sık görülen uyku ile ilişkili belirti olup, toplum içindeki tahmini yaygınlığı %18’e kadar çıkabilmektedir. Gündüz aşırı uykululuğu olan kişiler yaşamı tehdit eden yol veya iş kazaları, sosyal uyumsuzluk, akademik veya mesleki performansta düşme yaşayabilir ve daha düşük sağlık standartlarına sahip olabilirler. Bu yüzden gündüz aşırı uykululuk incelenmesi, tanısı ve tedavisi öncelikle yapılması gereken önemli bir durumdur. Çoğu tıbbi durumda olduğu gibi, gündüz aşırı uykululuğunun değerlendirilmesi titiz bir öyküyle başlar ve bunun için çeşitli öznel ve nesnel araçlar da geliştirilmiştir. Gündüz aşırı uykululuğunun en sık sebepleri uyku hijyenine uymama, kronik uyku yoksunluğu, ilaçlar, fiziksel ve psikiyatrik durumlar ve obstruktif uyku apnesi ve narkolepsi gibi uyku bozukluklarıdır. Tedavi seçenekleri iyi uyku hijyeni sağlayarak uyku miktarı ve kalitesini artırmayı amaçlamalıdır.

Keywords

• Gündüz aşırı uykululuk, narkolepsi, sirkadiyen ritm uyku bozuklukları

References

1. Ağargün MY, Çilli AS, Kara H, Bilici M (1999) Epworth Uykululuk Ölçeği'nin geçerliği ve güvenirliği. Turk Psikiyatri Derg, 10:261- 268.
2. Akerstedt T (1996) Wide Awake at Odd Jours. Shift Work, Time Zones and Burning the Midnight Oil. Uppsala, Swedish Council for Work Life Research.
3. Alexandre C, Andermann ML, Scammell TE (2013) Control of arousal by the orexin neurons. Curr Opin Neurobiol, 23:752–759.
4. Almeida OP, Pfaff JJ (2005) Sleep complaints among older general practice patients: association with depression. Br J Gen Pract, 55: 864-866.
5. AASM (American Academy of Sleep Medicine) (2005) International Classification of Sleep Disorders: Diagnostic and Coding Manual, 2nd ed. Westchester, Ill, American Academy of Sleep Medicine.
6. AASM (American Academy of Sleep Medicine) (2014) The International Classification of Sleep Disorders, Diagnostic and Coding Manual (3rd ed.) (ICSD-3). Darien, IL, American Academy of Sleep Medicine.
7. APA (American Psychiatric Association) (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association.
8. Armitage R, Hoffmann R, Conroy DA, Arnedt JT, Brower K.J (2012) Effects of a 3-hour sleep delay on sleep homeostasis in alcohol dependent adults. Sleep, 35:273-278.

9. Arnulf I, Lin L, Gadoth N, File J, Lecendreux M, Franco P et al. (2008) Kleine-Levin syndrome: a systematic study of 108 patients. Ann Neurol, 63:482–493.
10. Benedetto L, Chase MH, Torterolo P (2012) GABAergic processes within the median preoptic nucleus promote NREM sleep. Behav Brain Res, 232:60–65.
11. Billiard M (2008) Narcolepsy: current treatment options and future approaches. Neuropsychiatr Dis Treat, 4:557-566.
12. Billiard M, Besset A, Montplaisir J, Laffont F, Goldenberg, F, Weill JS et al. (1994) Modafinil: a double-blind multicentric study. Sleep, 17(8 Suppl):107-112.
13. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A (2005) Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endoc Met, 90:4510-4515.
14. Black J, Guilleminault C (2001) Medications for the treatment of narcolepsy. Expert Opin Emerg Drugs, 6:239–247.
15. Black J, Houghton WC (2006) Sodium oxybate improves excessive daytime sleepiness in narcolepsy. Sleep, 29:939–946.
16. Bonnet MH, Arand DL (2005) Impact of motivation on Multiple Sleep Latency Test and Maintenance of Wakefulness Test measurements. J Clin Sleep Med, 1:386-390.
17. Brower KJ, Hoffmann R, Conroy DA, Arnedt JT, Armitage R (2011) Sleep homeostasis in alcohol-dependent, depressed and healthy control men. Eur Arch Psych Clin Neurosci, 261:559-566.
18. Brower KJ, Perron BE (2010) Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances. Med Hypotheses, 74:928-933.
19. Carney CE, Segal ZV, Edinger JD, Krystal AD (2007) A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. J Clin Psychiatry, 68:254-260.
20. Carter ME, Brill J, Bonnavion P, Huguenard JR, Huerta R, de Lecea L (2012) Mechanism for Hypocretin-mediated sleep-to-wake transitions. Proc Natl Acad Sci USA 109:E2635–E2644.
21. Colrain IM, Campbell KB (2007) The use of evoked potentials in sleep research. Sleep Med Rev, 11:277-293.
22. Colrain IM, Turlington S, Baker FC (2009) Impact of alcoholism on sleep architecture and EEG power spectra in men and women. Sleep, 32:1341-1352.
23. Conroy DA, Arnedt JT (2014) Sleep and substance use disorders: an update. Curr Psychiatry Rep, 16:1-9.
24. Dantz B, Edgar DM, Dement WC (1994) Circadian rhythms in narcolepsy: studies on a 90 minute day. Electroencephalogr Clin Neurophysiol, 90:24–35.
25. Dauvilliers Y, Bassetti C, Lammers GJ, Arnulf I, Mayer G, Rodenbeck A et al. (2013) Pitolisant versus placebo or modafinil in patients with narcolepsy: a double-blind, randomised trial. Lancet Neurol,12:1068-1075.
26. de Lecea L (2012) Hypocretins and the neurobiology of sleep-wake mechanisms. Prog Brain Res, 198:15-24.
27. Dodson ER, Zee PC (2010) Therapeutics for circadian rhythm sleep disorders. Sleep Med Clin, 5:701-715.
28. Drakatos P, Leschziner GD. (2014) Update on hypersomnias of central origin. Curr Opin Pulm Med, 20:572-580.
29. Fava M, Graves LM, Benazzi F, Scalia MJ, Iosifescu DV, Alpert JE et al. (2006) A cross-sectional study of the prevalence of cognitive and physical symptoms during long-term antidepressant treatment. J Clin Psychiatry, 67:1754-1759.
30. Findley LJ, Levinson MP, Bonnie RJ (1992) Driving performance and automobile accidents in patients with sleep apnea. Clin Chest Med,13:427-435.
31. Fort P, Bassetti C, Luppi PH (2009) Alternating vigilance states: new insights regarding neuronal networks and mechanisms. Eur J Neurosci, 29:1741–1753.
32. Fraigne JJ, Peever JH (2013) Melanin-concentrating hormone neurons promote and stabilize sleep. Sleep, 36:1767–1768.
33. Galvao F, Sportiche S, Lambert J, Amiez M, Musa C, Nieto I et al. (2013) Clinical differences between unipolar and bipolar depression: interest of BDRS (Bipolar Depression Rating Scale).Compr Psychiatry, 54:605-610.
34. Gögenur I, Middleton B, Burgdorf S, Rasmussen LS, Skene DJ, Rosenberg J (2007) Impact of sleep and circadian disturbances in urinary 6‐sulphatoxymelatonin levels, on cognitive function after major surgery.J Pineal Res, 43:179-184.
35. Guilleminault C, Brooks SN (2001) Excessive daytime sleepiness, a challenge for the practising neurologist. Brain, 124:1482-1491.
36. Gulec M, Ozcan H, Oral E, Selvi Y, Aydin A (2012) The relationship between insomnia and major depressive disorder: a chicken and egg situation? Journal of Mood Disorders, 2:28-33.
37. Gvilia I, Xu F, McGinty D, Szymusiak R (2006) Homeostatic regulation of sleep: a role for preoptic area neurons. J Neurosci, 26:9426–9433.
38. Hara J, Sakurai T (2011) Interaction between sleep mechanisms and orexin neurons. Sleep Biol Rhythms, 9:38–43.
39. Hassani OK, Henny P, Lee MG, Jones BE (2010) GABAergic neurons intermingled with orexin and MCH neurons in the lateral hypothalamus discharge maximally during sleep. Eur J Neurosci, 32:448–457.
40. Hassani OK, Lee MG, Jones BE (2009) Melanin-concentrating hormone neurons discharge in a reciprocal manner to orexin neurons across the sleep-wake cycle. Proc Natl Acad Sci U S A, 106:2418–2422.
41. Hayley AC, Williams LJ, Kennedy GA, Berk M, Brennan SL, Pasco JA (2014) Excessive daytime sleepiness and body composition: a population-based study of adults. PLoS One, 9:e112238.
42. Hayley AC, Williams LJ, Kennedy GA, Berk M, Brennan SL, Pasco JA (2015) Excessive daytime sleepiness and metabolic syndrome: a cross-sectional study. Metabolism, 64: 244-252.
43. Hoddes E, Dement W, Zarcone V (1972) The development and use of the Stanford Sleepiness Scale. Psychophysiology, 9:150.
44. Houghton WC, Scammell TE, Thorpy M (2004) Pharmacotherapy for cataplexy. Sleep Med Rev, 8:355–366.
45. Husain AM, Yancy WS, Carwile ST, Miller PP, Westman EC (2004) Diet therapy for narcolepsy. Neurology, 62:2300-2302.
46. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH (2015) The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev, 2:23-36
47. Jego S, Glasgow SD, Herrera CG, Ekstrand M, Reed SJ, Boyce R et al. (2013) Optogenetic identification of a rapid eye movement sleep modulatory circuit in the hypothalamus. Nat Neurosci, 16:1637–1643.
48. Johanson CE, Roehrs T, Schuh K, Warbasse L (1999) The effects of cocaine on mood and sleep in cocaine-dependent males. Exp Clin Psychopharmacol, 7(4), 338.
49. Johnson E (1999) Omnibus Sleep in American Poll. Washington DC, National Sleep Foundation.
50. Johnson EO, Roehrs T, Roth T, Breslau N (1998) Epidemiology of alcohol and medication as aids to sleep in early adulthood. Sleep, 21:178-186.
51. Karadeniz D, Ondze B, Besset A, Billiard M (2000) Are periodic leg movements during sleep (UPHB) responsible for sleep disruption in insomnia patients? Eur J Neurol, 54:502.
52. Kaynak H, Gözükırmızı E, Damcı D, Akıncı T, Denktaş H (1995) The prevalance of insomnia and excessive sleepiness in Turkey. In Reports of a WHO meeting: Neurology and Public Health, 1st ed (Eds D Kirbac, L Matilde):164-169. İstanbul, Bitam Publications.
53. Klink M, Quan SF (1987) Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest, 91:540-546.
54. Konadhode RR, Pelluru D, Blanco-Centurion C, Zayachkivsky A, Liu M, Uhde T et al. (2013) Optogenetic stimulation of MCH neurons increases sleep. J Neurosci, 33:10257–10263.
55. Langdon N, Lock C, Welsh K, Vergani D, Dorow R, Wachtel H et al. (1985) Immune factors in narcolepsy. Sleep, 9:143-148.
56. Lewis G, Wessely S (1992) The epidemiology of fatigue: more questions than answers. J Epidemiol Commun Health, 46:92-97.
57. Lindberg E, Carter N, Gislason T, Janson C (2001) Role of snoring and daytime sleepiness in occupational accidents. Am J Respir Crit Care Med, 164:2031-2035.
58. Luppi PH, Fort P (2011) What are the mechanisms activating the sleep-active neurons located in the preoptic area? Sleep Biol Rhythms, 9:59–64.
59. McCarley RW (1999) Sleep neurophysiology; basic mechanisms underlying control of wakefulness and sleep. In Sleep Disorders Medicine: Basic Science, Technical Consideration and Clinical Aspects, 2nd ed (Ed S Chokroverty):21-50. Boston, Butterworth- Heinemann.
60. Miller DD (2004) Atypical antipsychotics: sleep, sedation, and efficacy. J Clin Psychiatry, 6(Suppl 2):3-7.
61. Mitler MM, Shafor R, Hajdukovich R, Timms RM, Browman CP (1985) Treatment of narcolepsy: objective studies on methylphenidate, pemoline, and protriptyline. Sleep, 9:260-264.
62. Modafinil in Narcolepsy Multicenter Study Group (2000) Randomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy. Neurology, 54:1166-1175.
63. Montplaisir J, Baucher S, Poirier G (1996) Clinical polisomnographic and genetic characteristics of Restless Leg Syndrome: a study of 133 patients diagnosed with new standart criteria. Mov.Disord, 12:61-65.
64. Morgenthaler T, Lee-Chiong T, Alessi, C, Friedman L, Aurora N, Boehlecke B et al. (2007) Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. Sleep, 30:1445-1459.
65. Morrish E, King MA, Smith IE, Shneerson JM (2004) Factors associated with a delay in the diagnosis of narcolepsy. Sleep Med, 5:37–41.
66. Ohayon MM, Roth T (2002) Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res, 53:547-554.
67. Oliveira MM, Conti C, Saconato H, Fernades do Prado G (2009) Pharmacologic treatment for Klein-Levin syndrome. Cochrane Database Syst Rev, 15:CD006685.
68. Ondo WG, He Y, Rajasekaran S, Le WD (2000) Clinical correlates of 6- hydroxyl dopamine injections into A11 dopaminergic neurons in rats: a possible model for restless legs syndrome. Mov Disord, 15 154-158.
69. Özdemir PG, Aydın A, Selvi Y (2013) Farklı klinik semptomlarla ortaya çıkan narkolepsi olguları. Klinik Psikiyatri Dergisi, 16:244- 248.
70. Özdemir PG, Selvi Y, Güleç TÇ, Güleç M (2014) Narkolepsinin fizyopatolojisi, klinik görünümü ve tedavi yaklaşımları. Psikiyatride Güncel Yaklaşımlar, 6:271-283.
71. Pagel JF (2009) Excessive daytime sleepiness. Am Family Physician, 79:391-396.
72. Palagini L, Baglioni C, Ciapparelli A, Gemignani A, Riemann D (2013) REM sleep dysregulation in depression: state of the art. Sleep Med Rev, 17:377-390.
73. Paul MA, Gray GW, Lieberman HR, Love RJ, Miller JC, Trouborst M et al. (2011) Phase advance with separate and combined melatonin and light treatment. Psychopharmacology (Berl), 214: 515-523.
74. Roehrs T, Roth T (2012) Insomnia pharmacotherapy. Neurotherapeutics, 9:728-738.
75. Roehrs T, Roth T (2001) Sleep, sleepiness, and alcohol use. Alcohol Res Health, 25:101-109.
76. Rogers AE, Aldrich MS, Lin X (2001) A comparison of three different sleep schedules for reducing daytime sleepiness in narcolepsy. Sleep, 24:385-391.
77. Sakurai T (2007) The neural circuit of orexin (hypocretin): maintaining sleep and wakefulness. Nat Rev Neurosci, 8:171–181.
78. Saper CB, Fuller PM, Pedersen NP, Lu J, Scammell TE (2010) Sleep state switching. Neuron, 68:1023–1042.
79. Sapin E, Bérod A, Léger L, Herman PA, Luppi P-H, Peyron C (2010) A very large number of GABAergic neurons are activated in the tuberal hypothalamus during paradoxical (REM) sleep hypersomnia. PLoS One, 5:e11766.
80. Sarı H, Tekin M, Özdamar O İ, Yakut H, Acar G (2011) Obstrüktif uyku apne sendromlu hastalarda vücut kitle indeksi ve boyun çevresi ölçümlerinin apne hipopne indeksiyle korelasyonu. Türk Otolarengoloji Arşivi, 49(4):67-73.
81. Kryger MH, Roth T, Dement WC (2010) Principles and Practice of Sleep Medicine, 5th edition. Philadelphia, Saunders.
82. Sforza E, de Saint Hilaire Z, Pelissolo A, Rochat T, Ibanez V (2002) Personality, anxiety and mood traits in patients with sleep- related breathing disorders: effect of reduced day time alertness. Sleep Med, 3:139-145.
83. Sharma R, Bradshaw K, Sahota P, Thakkar MM (2014a) Acute binge alcohol administration reverses sleep‐wake cycle in sprague dawley rats.alcoholism. Clin Exp Res, 38:1941-1946.
84. Sharma R, Sahota P, Thakkar MM (2014b) Role of adenosine and the orexinergic perifornical hypothalamus in sleep-promoting effects of ethanol. Sleep, 37: 525-533.
85. Steier J, Jolley CJ, Seymour J, Roughton M, Polkey MI, Moxham J (2009) Neural respiratory drive in obesity. Thorax, 64:719-725.
86. Szymusiak R, McGinty D (2008) Hypothalamic regulation of sleep and arousal. Ann N Y Acad Sci, 1129:275–286.
87. Thakkar MM, Sharma R, Sahota P (2014) Alcohol disrupts sleep homeostasis. Alcohol, 49:299-310.
88. Theorell-Haglöw J, Åkerstedt T, Schwarz J, Lindberg E (2015) Predictors for development of excessive daytime sleepiness in women-a population-based 10-year follow-up. Sleep, 38:1995-2003..
89. Tsunematsu T, Ueno T, Tabuchi S, Inutsuka A, Tanaka KF, Hasuwa H et al. (2014) Optogenetic manipulation of activity and temporally controlled cell-specific ablation reveal a role for MCH neurons in sleep/wake regulation. J Neurosci, 34:6896–6909.
90. Tsuno N, Besset A, Ritchie K (2005) Sleep and depression. J Clin Psychiatry, 66:1254-1269.
91. Van Dongen H, Maislin G, Mullington JM, Dinges DF (2003) The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26:117- 126.
92. Vgontzas AN, Bixler EO, Kales A, Criley C, Vela-Bueno A (2000) Differences in nocturnal and daytime sleep between primary and psychiatric hypersomnia: diagnostic and treatment implications. Psychosomatic Med, 62:220-226.
93. Vgontzas AN, Bixler EO, Wittman AM, Zachman K, Lin HM, Vela-Bueno A et al. (2001) Middle-aged men show higher sensitivity of sleep to the arousing effects of corticotropin-releasing hormone than young men: clinical implications. J Clin Endocrinol Metab, 86:1489-1495.
94. Vgontzas AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, Chrousos GP (2004) Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-α antagonist. J Clin Endocrinol Metab, 89:4409-4413.
95. Walker J, Farney R, Rhondeau S, Boyle K, Valentine K, Cloward T et al. (2007) Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. J Clin Sleep Med, 3:455–461.
96. Wilhelm B, Bittner E, Hofmann A, Koerner A, Peters T, Lüdtke H et al. (2015) Short‐term reproducibility and variability of the pupillographic sleepiness test. Am J Human Biol, 27:862-866.
97. WHO (2011) Obesity and Overweight. Fact Sheet 311. Geneva, World Health Organization.
98. Yazaki M, Shirakawa S, Okawa M, Takahashi K (1999) Demography of sleep disturbances associated with circadian rhythm disorders in Japan. Psychiatry Clin Neurosci, 53:267–268.
99. Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle- aged men and women. Sleep, 20:705-706.
100. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med, 165:1217-1239.
101. Zee PC, Attarian H, Videnovic A (2013) Circadian Rhythm Abnormalities. Continuum (Minneap Minn), 19(1):132–147.
102. Zoltoski RZ, Cabeza R, Gillin JC (1999) Biochemical pharmacology of sleep. In Sleep Disorders Medicine: Basic Science, Technical Consideration and Clinical Aspects, 2nd ed. (Ed S Chokroverty):63-94. Boston, Butterworth-Heinemann. Yavuz Selvi, Doç.Dr., Selçuk Üniversitesi, Konya; Ali Kandeğer, Arş.Gör., Selçuk Üniversitesi, Konya; Ayça Asena Sayın, Arş.Gör., Selçuk Üniversitesi, Konya.