ETIOLOGIES AND SEQUELAE OF EXCESSIVE DAYTIME SLEEPINESS

Excessive daytime sleepiness (EDS), the primary complaint of patients seen in sleep clinics, affects up to 12% of the general population. Th e effects of EDS can be debilitating and even life threatening. Patien ts with EDS may exhibit psychosocial distress, decreased work or schoo l performance, and increased risk for accidents. The differential diag nosis of EDS requires objective assessments, such as polysomnography a nd the Multiple Sleep Latency Test. There are four major causes of EDS : (1) central nervous system (CNS) pathologic abnormalities, such as n arcolepsy and idiopathic CNS hypersomnia; (2) qualitative or quantitat ive sleep deficiencies, such as sleep apnea and insufficient nocturnal sleep; (3) misalignments of the body's circadian pacemaker with the e nvironment (eg, jet lag or shift work); and (4) drugs, which can incre ase sleepiness either therapeutically or as a side effect. Depending o n etiology, management strategies for EDS include extension of time in bed, naps, surgery, various medical devices (eg, oral appliances, con tinuous positive airway pressure), and pharmacotherapy. Pharmacotherap y is generally achieved with stimulants, such as amphetamine sulfate, methylphenidate, and pemoline or newer, safer compounds like modafinil .