Last reviewed: 6 Jul 2021
Last updated: 15 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • sleep partner complaints
  • delayed sleep onset
  • multiple or long awakenings

Other diagnostic factors

  • impairment of functioning
  • accidents
  • decreased sleep time
  • daytime napping
  • thyrotoxicosis
  • chronic pain
  • restless leg syndrome
  • enlarged tonsils or tongue
  • micrognathia and retrognathia
  • lateral narrowing of oropharynx

Risk factors

  • female sex
  • advanced age
  • chronic medical conditions
  • chronic pain (e.g., hip impairment)
  • psychiatric illness
  • alcohol or substance misuse
  • stimulant usage
  • poor sleep hygiene
  • traumatic brain injury
  • medications
  • recent travel across time zones
  • night work
  • thyroid dysregulation
  • participation in elite sport
  • sedentary behaviour

Diagnostic investigations

1st investigations to order

  • Pittsburgh Sleep Quality Index (PSQI)
  • Insomnia Severity Index (ISI)
  • Stanford Sleepiness Scale (SSS)
  • Epworth Sleepiness Scale
  • Athens Insomnia Scale (AIS)

Investigations to consider

  • polysomnography (PSG)
  • actigraphy
  • sleep diary
  • thyroid-stimulating hormone (TSH)

Treatment algorithm

Contributors

Authors

John W. Winkelman, MD, PhD

Chief, Sleep Disorders Clinical Research Program

Department of Psychiatry

Massachusetts General Hospital

Professor of Psychiatry

Harvard Medical School

Boston

MA

Disclosures

JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation.

Acknowledgements

Dr John W. Winkelman would like to gratefully acknowledge Dr Teofilo Lee-Chiong and Dr Vipin Malik, previous contributors to this topic.

Disclosures

TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnoea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.

Peer reviewers

Karl Doghramji, MD

Director

Sleep Disorders Center

Thomas Jefferson University Hospital

Philadelphia

PA

Disclosures

KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.

Chiadi U. Onyike, MD, MHS

Assistant Professor

Geriatric Psychiatry and Neuropsychiatry

The Johns Hopkins Hospital

Baltimore

MD

Disclosures

CUO declares that he has no competing interests.

Roy Goldberg, MD

Medical Director

Kings Harbor Multicare Center

Bronx

NY

Disclosures

RG declares that he has no competing interests.

Craig Sawchuk, MD

Affiliate Assistant Professor

Department of Psychiatry and Behavioral Sciences

University of Washington Medical Center

Seattle

WA

Disclosures

CS declares that he has no competing interests.

David Cunnington, MD

Director

Melbourne Sleep Disorders Centre

Melbourne

Victoria

Australia

Disclosures

DC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis.

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