Quiz: 5 questions, how much do you know about the differential diagnosis of idiopathic hypersomnia?

Hypersomnia is a central nervous system sleepiness disorder characterized by adequate sleep at night but extreme sleepiness during the day
.

Primary hypersomnia, idiopathic hypersomnia and hypersomnia all refer to a central hypersomnia
.

Hypersomnia is often accompanied by prolonged sleep at night or during the day, insufficient sleep, difficulty awakening, cognitive dysfunction, and autonomic symptoms
.

It imposes a huge burden on the quality of life of patients and is related to huge medical costs
.

An effective diagnosis is the first step in controlling this disease.
However, since it behaves similarly to other sleep disorders, the diagnosis of excessive sleep can be challenging
.

How much do you know about the differential diagnosis of excessive sleep? This article will test everyone's understanding through 5 small questions, let's try it together
.

Yimaitong compiles and organizes, please do not reprint without authorization
.

Question 1 Compared with idiopathic hypersomnia, which feature of narcolepsy is more descriptive? A.
Polysomnography (PSG)/Multiple Sleep Latency Test (MSLT) during rapid eye movement (SOREMP) without sleep onset B.
Cataplexy C.
Cerebrospinal fluid (CSF) hypothalamic secretin 1 level abnormal D.
Night View more sleep disruption slide answer ↓↓↓↓↓↓↓↓↓ [resolve] the answer and the answer: B
.

Generally speaking, excessive daytime sleepiness with a history of cataplexy and the presence of two or more SOREMPS should be able to distinguish between narcolepsy and hypersomnia
.

However, in the absence of cataplexy, it is difficult to distinguish between the two conditions, especially since it was found that 80% of patients with narcolepsy without cataplexy and 100% of patients with idiopathic hypersomnia had CSF hyposecretin 1 levels Normal
.

 Patients with hypersomnia do not have SOREMPS on PSG/MSLT, and they usually sleep longer at night with fewer interruptions compared to patients with narcolepsy
.

Question 2: How to distinguish between excessive sleep and chronic lack of sleep? A.
Ensure that the patient’s average sleep time is ≥5 hours before the diagnosis of hypersomnia.
B.
The improvement of daytime symptoms after increased sleep time indicates chronic lack of sleep, rather than hypersomnia.
C.
MSLT results are sufficient to distinguish insufficient sleep from excessive sleep D.
Increase night sleep Differential diagnosis improve sleep and excessive daytime symptoms unrelated to slide after time to see the answer and the answer ↓↓↓↓↓↓↓↓↓ [resolve] the answer: B
.

Chronic sleep deprivation (average sleep <7 hours per night) can cause daytime sleepiness, which is similar to the sleepiness reported by hypersomniacs
.

Therefore, in the differential diagnosis of hypersomnia, it is very important to carefully rule out this cause
.

Patients with hypersomnia will not improve their symptoms during the day after increasing their sleep time at night
.

 The MSLT findings are not helpful in distinguishing chronic sleep deprivation from hypersomnia
.

However, combined with clinical history, sleep records, and activity monitoring, sleep deprivation can usually be ruled out with reasonable certainty
.

Patients who are found to have insufficient sleep at night should be advised to extend their sleep time to ≥8 hours, and then reassess the resolution of sleepiness after a few weeks of treatment on the new schedule
.

Question 3 What factors can distinguish between hypersomnia and type 2 narcolepsy? A.
B.
nighttime sleep fragmentation sleep paralysis C.
PSG / MSLT with or without SOREMPD on sleep-related hallucinations slide view the answer ↓↓↓↓↓↓↓↓↓ [resolve] the answer and the answer:.
C
.

It is very challenging to distinguish between hypersomnia and type 2 narcolepsy
.

In these two diseases, there is no cataplexy
.

Sleep paralysis and sleep-related hallucinations are common in patients with type 2 narcolepsy, but they are also present in about a quarter of patients with hypersomnia
.

Therefore, the difference depends only on the presence of SOREMPS on PSG/MSLT
.

Patients with hypersomnia will have one or no SOREMP, while patients with type 2 narcolepsy will have two or more SOREMP
.

Question 4 What kind of sleep disorder is the characteristic of short α-EEG awakening that PSG finds lasting 3-14 seconds? Hypersomnia A.
B.
C.
periodic limb movement disorder on airway resistance syndrome, obstructive sleep apnea D.
View slide answer ↓↓↓↓↓↓↓↓↓ [resolve] the answer and the answer: C
.

When evaluating patients with excessive daytime sleepiness, it is necessary to conduct a complete laboratory PSG study to rule out other sleep disorders, especially sleep breathing disorders, periodic limb movement disorders, and narcolepsy
.

PSG results of short α-EEG awakening lasting 3-14 seconds were observed in patients with upper airway resistance syndrome
.

In order to confirm the presence of this syndrome, you must observe the esophageal pressure or use a respiratory flow meter to calculate the airflow
.

Therapeutic examination using continuous positive airway pressure through the nose can be used to confirm the diagnosis
.

Question 5 What considerations should be included in the differential diagnosis of hypersomnia? A.
PSG results can be used to distinguish behavior-induced insufficiency of sleep syndrome (BIISS) and hypersomnia B.
Dreaming during a daytime nap can distinguish narcolepsy and hypersomnia C.
Activity records can help rule out BIISSD.
No relief after bed rest persistent or recurrent hypersomnia distinguishable fatigue and chronic fatigue syndrome slide view answer and answer ↓↓↓↓↓↓↓↓↓ [a] answer: C
.

BIISS is characterized by chronic lack of sleep at night, and affected individuals usually sleep 2-3 hours more on weekends than workdays
.

It can be manifested as PSG/MSLT performance similar to hypersomnia, so it is important to exclude it
.

Since the patient's subjective view of sleep time is not always accurate, activity recording can help rule out BIISS
.

 Patients with hypersomnia never or rarely dream during naps during the day, as opposed to patients with narcolepsy
.

Compared with patients with narcolepsy, patients with hypersomnia have more difficulty waking up during the day and are more sleepy
.

 Persistent or recurrent fatigue that cannot be resolved by bed rest is a feature of chronic fatigue syndrome, not excessive sleep
.

The findings of PSG include reduced sleep efficiency and alpha interference on EEG
.

Yimaitong compiled from: Adrian Preda.
Fast Five Quiz: Idiopathic Hypersomnia Differential Diagnosis-Medscape-Jul 29, 2021.