(Excessive Daytime Sleepiness)

.
- .
- Research Fellow in Sleep Medicine
Rush-Presbyterian-St lukes Medical Center
Chicago U.S.A.

Epworth Sleepiness Scale ( 1)
12 24

(insomnia)
(behavioral abnormalities) (respiratory
disorders)


(excessive
daytime sleepiness)

(insomnia) (underlying cause)

1 Epworth sleepiness seale

(
) 0 = 1 = 2 = 3 =

....................
....................
....................
....................
....................
....................
....................
.................... 2-3
70


5

,


(shift workers)

-
obstructive
sleep apnea (OSA) periodic limb
movements in sleep (PLMS)
Obstructive sleep apnea (OSA)
(upper airway
obstruction)

(arousals)

OSA
(excessive sleepiness) (snoring)
(apneic episodes)
(choking or gasping in
sleep) (nocturia)
(tiredness upon
awakening)
Periodic limb movements in sleep (PLMS)

1.5-2.5

Babinski response extension
ankle dorsiflexion knee
hip flexion
(cluster)
15-40

(arousals)

Circadian rhythm disorders
circadian rhythm
-
circadian rhythm
circadian rhythm

Sleep deprivation







circadian (circadian rhythm
disorders) -
delayed
sleep phase syndrome (DSPS)
0500-1300 . advanced sleep
phase syndrome (ASPS)
1800-0200 .
sleep deprivation
DSPS
0800 .
Sleep fragmentation

sleep fragmentation
-

71

biological clock

suprachiasmatic
nucleus (SCN) hypothalamus
24


circadian rhythm
circadian rhythm disorders
delayed sleep phase syndrome (DSPS), advanced
sleep phase syndrome (ASPS), jet lag, shift work
- (irregular
sleep-wake patterns)

time zone time zone

Drugs

(sedative effect) opiate
analgesics alcohol

Neurological disorders rapid eye
movement sleep - related disorders

rapid
eye movement sleep-related disorders

-

-
sleep
attack


, ,

- Motor control muscle atonia

REM
cataplexy


REM
muscle atonia sleep
paralysis

rapid eye movement sleep-related disorders

narcolepsy

sleep attack active

cataplexy /
sleep paralysis
Systemic disorders

Psychiatric disorders

(1)

sleep apnea endocrine disorder neurological
disorders
- sleep-wake patterns

72

 alcohol

sleep hygiene
-




OSA, PLMS
hypothyroidism

1 excessive daytime sleepiness (EDS)

- events during sleep

sleep
paralysis
- events on awakening

carbondioxide
retention hypoventilation

- daytime activities


-

( 2)

73

 sedate
benzodiazepine, alcohol CNS
stimulant (underlying
cause)
CNS stimulant

-

-
-
-
-
CNS stimulant
methylphenidate Ritalin caffeine
first-line
mild CNS stimulant

1. Chokroverty S. Sleep disorders medicine. Basic science,

technical considerations, and clinical aspects. ButterworthHeinemann ; 1995: 369-380.
2. Guilleminault C, Brooks SN. Excessive daytime sleepiness
: a challenge for the practicing neurologist. Brain 2001; 124
(Pt8) : 1482-1491.
3. Pigcon WR, Sateia MJ, Ferguson RJ. Distingnish between
excessive daytime sleepiness and fatigue : toward improved
detection and treatment. J Psychosom Res 2003; 54(1) : 6169.
4. Reite M, Ruddy J, Nagel K, Concise guide to evaluation
and management of sleep disorders, 2nd edition, Washington,
DC: American Psychiatric Press; 1997 : 113-152.
5. Ruggle SK, Hansman N. Evaluation of excessive daytime
sleepiness. WMJ 2003; 102(1) : 21-4.
6. Shneerson JM. Handbook of sleep medicine. Blackwell
Science; 2000 : 110-135.
7. Stenenson JE. Diagnosis of sleep apnea. WMJ. 2003; 102(1)
: 25-27.
8. Takahashi M. The role of prescribed napping in sleep
medicine. Sleep Med Rev. 2003; 7(3) : 227-235.

(excessive daytime
sleepiness)

74


1. 50




A. Narcolepsy
B. Sleep apnea
C. Kleine - Levin syndrome
D. Restless leg syndrome
E. Periodic limb movements in sleep

4.
(shift work)
A. Sleep deprivation
B. Sleep fragmentation
C. Neurological disorders
D. Psychiatric disorders
E. Circadian rhythm disorder
5. first-line mild CNS stimulant
for EDS
A. Nicotine
B. Caffeine
C. Dexamphetamine
D. Methyphenidate
E. Modafinil

2. 25

3-4




A. Narcolepsy
B. Sleep apnea
C. Kleine-Levin syndrome
D. Restless leg syndrome
E. Periodic limb movements in sleep
3. circadian rhythm
disorder
A. Jet lag
B. Sleep apnea
C. Hypothyroidism
D. Sleep deprivation
E. Periodic limb movements in sleep
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(Excessive Daytime Sleepiness)

1.
2.
3.

Multiple choice-one best answer 5 3

CME 1
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3-21-606-9500-0405
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A B C D E

ANSWER
1

(Excessive Daytime Sleepiness)

3
4

3-21-606-9500-0405

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