Abstract

Introduction

Presence of sleep onset REM episodes often raises concerns of narcolepsy. However other conditions have shown to have presence of sleep on REM episodes which include but not limited to obstructive sleep apnea, sleep wake schedule disturbance, alcoholism, neurodegenerative disorders, depression and anxiety

Report of Case

Here we present a case of 30 year old female with history of asthma, patent foraman ovale, migraine headache, and anxiety who presented with daytime sleepiness, falling asleep while at work, occasional scheduled naps, non-restorative sleep, sleep paralysis, and hypnopompic hallucination. Pertinent physical exam included; mallampati score of 4/4, retrognathia, high arched hard palate, crowded posterior oropharynx. She had a score of 16 on Epworth sleepiness scale. Patient previously had multiple sleep latency test at outside facility which revealed 4/5 SOREM, with mean sleep onset latency of 11.5 minutes. She however was diagnosed with narcolepsy and tried on modafinil which she failed to tolerate. She was tried on sertraline as well which was discontinued due to lack of benefit. She had repeat multiple sleep latency test work up which revealed 2/5 SOREM, with mean sleep onset latency was 13.1 minutes. Her overnight polysomnogram prior to repeat MSLT showed SOREM with sleep onset latency of 10 minutes. Actigraphy showed consistent sleep pattern overall with sufficient sleep time but was taking hydroxyzine and herbal medication. Patient did not meet criteria for hypersomnolence disorder and sleep disordered breathing.

Conclusion

There is possibility her medication may have played pivotal role with her daytime symptoms. We also emphasize SOREMs can be present in other disorders such as anxiety in this case and not solely in narcolepsy

中文翻译：

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1253白天过度嗜睡的中年女性多次睡眠发作REM发作–这是否自动假定为发作性睡病？

摘要

介绍

睡眠发作性REM发作的存在常常引起对发作性睡病的关注。然而，其他情况也显示出REM发作有睡眠，包括但不限于阻塞性睡眠呼吸暂停，睡眠唤醒时间表障碍，酒精中毒，神经退行性疾病，抑郁和焦虑

案件报告

在这里，我们介绍了一名30岁女性，有哮喘病史，无孔洞卵圆形偏头痛，偏头痛和焦虑症，白天表现为嗜睡，工作时入睡，偶尔打scheduled，不恢复性睡眠，睡眠麻痹和催眠幻觉。包括相关的身体检查；Mallampati评分为4/4，后吞咽，高弓形硬pa，后口口部拥挤。她在Epworth嗜睡量表上得分为16。患者先前在外部设施进行了多次睡眠潜伏期测试，显示4/5 SOREM，平均睡眠发作潜伏期为11.5分钟。然而，她被诊断患有发作性睡病，并尝试了莫达非尼，但她不能耐受。她也接受了舍曲林的治疗，由于缺乏益处而被中止。她重复进行多次睡眠潜伏期测试，发现2/5 SOREM，平均睡眠发作潜伏期为13.1分钟。在重复进行MSLT之前，她的过夜多导睡眠图显示SOREM，睡眠发作潜伏期为10分钟。书法表现出总体上具有一致的睡眠方式，并具有足够的睡眠时间，但正在服用羟嗪和草药。患者不符合过睡症和睡眠呼吸障碍的标准。

结论

她的药物有可能在白天的症状中起关键作用。我们还强调，在这种情况下，SOREM可能存在于其他疾病（例如焦虑症）中，而不仅仅是发作性睡病