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An approach to excessive daytime sleepiness in adults
The BMJ ( IF 105.7 ) Pub Date : 2020-03-27 , DOI: 10.1136/bmj.m1047
James Brown , Himender K Makker

Differentiating excessive daytime sleepiness (EDS) from symptoms of fatigue or being “tired all the time” is key to accurate diagnosis
The Epworth Sleepiness Scale (ESS) score is a useful way to assess and classify EDS. An ESS >10 indicates EDS and >17 indicates severe EDS
Obstructive sleep apnoea, periodic limb movement syndrome, narcolepsy, and circadian rhythms are some of the commonest causes of EDS
Treating obstructive sleep apnoea reduces excessive daytime sleepiness, improves neuropsychological function, and reduces blood pressure
Refer patients with EDS for assessment, including overnight sleep study
Excessive daytime sleepiness (EDS) is best described as an urge to sleep during daytime hours. It is a common problem, occurring at least three days a week in 4-20% of the population,1 and affects quality of life, workplace performance, and has safety implications, for example, when driving. Sleep disorders that cause excessive daytime sleepiness remain underdiagnosed and are easy to miss in clinical practice.2 Insomnia is a common cause of daytime sleepiness, but other disorders are important to consider. This review discusses the different potential causes of excessive daytime sleepiness in adults and proposes an approach to management and referral in non-specialist settings, in particular how to identify disorders that require referral to secondary care.
It is important to distinguish EDS from fatigue. EDS is defined as the inability to maintain wakefulness and alertness during the major waking episodes of the day, with sleep occurring unintentionally or at inappropriate times almost daily for at least three months.3 It is used interchangeably with hypersomnia and hypersomnolence, although according to ICD-4, hypersomnolence is excessive sleepiness when wakefulness is expected, and hypersomnia is a disorder characterised by hypersomnolence.
Patients may report sleepiness as a vague symptom of fatigue or feeling “tired all the time.” When assessing a patient, it is useful …


中文翻译:

成人白天过度嗜睡的方法

白天过度嗜睡(EDS)与疲劳症状或“一直疲倦”的区别是准确诊断
的关键。Epworth嗜睡量表(ESS)评分是评估和分类EDS的有用方法。的ESS> 10表示EDS和> 17表示严重EDS
阻塞性睡眠呼吸暂停,周期性肢体运动综合征,发作性睡病和昼夜节律是一些的EDS最常见的诱因
治疗阻塞性睡眠呼吸暂停减少白天过度嗜睡,改善神经心理功能,并减少了血液压力
将EDS患者转介评估,包括过夜睡眠研究
白天过度嗜睡(EDS)最好形容为白天白天睡觉的冲动。这是一个普遍的问题,每周至少三天发生在4-20%的人口中1,并且会影响生活质量,工作场所的绩效,并且在开车时会产生安全隐患。导致白天过度嗜睡的睡眠障碍仍未得到充分诊断,在临床实践中容易遗漏。2失眠是白天嗜睡的常见原因,但其他疾病也需要考虑。这篇综述讨论了成年人白天过度嗜睡的不同潜在原因,并提出了在非专家环境中进行管理和转诊的方法,尤其是如何确定需要转诊至二级保健的疾病。
区分EDS和疲劳很重要。EDS被定义为在一天的主要清醒事件中无法保持清醒和警觉,几乎无意地或在不适当的时间几乎每天都发生睡眠至少三个月。3尽管与ICD-4一致,高睡眠觉醒是指过度嗜睡,但预计会导致清醒,而高睡眠血症是一种以高睡眠障碍为特征的疾病。
患者可能会报告困倦是模糊的疲劳症状或“一直疲倦”。在评估患者时,它很有用……
更新日期:2020-03-27
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