Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • excessive daytime sleepiness
  • cataplexy
  • hypnagogic/hypnopompic hallucinations
  • sleep paralysis

Other diagnostic factors

  • chronic fatigue or tiredness
  • poor performance at work
  • poor memory and concentration
  • car accidents
  • slurred speech
  • blurred vision
  • irregular breathing pattern
  • sleep attacks
  • fragmented nocturnal sleep
  • symptoms of other sleep disorders
  • obesity
  • status cataplecticus
  • hepatomegaly
  • paresis

Risk factors

  • HLA-II DQA1*0102-DQB1*0602
  • Prader-Willi syndrome
  • Niemann-Pick disease type C
  • low cerebrospinal fluid hypocretin
  • linkage to 4p13-q21
  • genes on chromosome 6 or chromosome 21
  • hypothalamic tumours
  • hypothalamic infarct/haemorrhage
  • head trauma
  • CNS infection
  • CNS arteriovenous malformations
  • multiple sclerosis

Diagnostic investigations

1st investigations to order

  • actigraphy and sleep diary
  • overnight polysomnography
  • multiple sleep latency test (MSLT)
Full details

Investigations to consider

  • HLA typing
  • cerebrospinal fluid hypocretin-1 level
  • maintenance of wakefulness test
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Octavian C. Ioachimescu

Associate Professor

Emory University

Atlanta VA Medical Center

Atlanta

GA

Disclosures

OCI is a principal investigator in studies sponsored by companies such as GSK, AstraZeneca, and Portola that leads to organizational income.

Peer reviewers VIEW ALL

Medical Doctor

Sleep Disorders Center

Department of Psychiatry

Cleveland Clinic

Cleveland

OH

Disclosures

KB declares that he has no competing interests.

Associate Professor

Psychiatry and Behavioral Science

Stanford University School of Medicine

Stanford

CA

Disclosures

SN declares that he has no competing interests.

Professor of Medicine

Director

Center for Sleep Disorders Research

Professor of Anatomy

Department of Medicine

Case Western Reserve University

Cleveland

OH

Disclosures

KPS declares that he has no competing interests.

Consultant Neurologist

James Cook University Hospital

Middlesbrough

UK

Disclosures

PR declares that he has no competing interests.

Use of this content is subject to our disclaimer