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Essentials of Diagnosis

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  • • Sleepiness results from habits leading to inadequate time asleep, alterations in daily sleep patterns, primary sleep disorders, medications, or medical diseases; not all sleepiness is from sleep apnea.
  • • Taking a good history is critical to treatment of disease and appropriate sleep laboratory referral.

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General Considerations

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Hypersomnolence is defined as sleepiness or drowsiness during the day, sometimes even after a full night’s sleep. Sleepiness can lead to irritability, depression, or lack of vigilance, with resultant falling asleep when driving. Sleepiness can also impair cognitive function and lead to poor job performance. The impact of sleepiness on health and daytime functioning is underestimated and often ignored by physicians as well as the public. Accidents on the road are increasingly associated with sleepiness and are expensive. In the United States, the indirect costs of sleep-related accidents are estimated to be one hundred billion dollars per year.

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Sleepiness is common, and can be caused by poor general sleep habits as well as sleep disorders (Table 29–1). Sleepiness from inadequate hours of sleep is widespread in our society, with fewer hours of sleep time today compared to 100 years ago for the average adult. Changes in circadian rhythm in sleep, such as advanced or delayed sleep phase, may lead to enhanced sleepiness. For example, getting to bed at 4:00 am and arising at 7:00 am for school may be the most comfortable schedule for an adolescent, but results in daytime sleepiness (delayed sleep phase). There are large numbers of people doing shift work, and others with poor quality sleep or inadequate sleep due to insomnia. Daytime sleepiness is frequently a hallmark of obstructive sleep apnea, as discussed in Chapter 28: Sleep Apnea & the Upper Airway Resistance Syndrome. Sleepiness may also result from underlying medical conditions as well as primary sleep disorders such as sleep apnea, narcolepsy, or restless leg syndrome. Often, patients with sleepiness from insomnia, defined as the inability to get to sleep or stay asleep, or those with poor sleep habits are referred for sleep apnea evaluation without having had a sleep history taken by the referring physician. To evaluate sleep apnea appropriately and distinguish it from other conditions, it is important to take a good sleep history, know how common systemic diseases impact sleep, and learn how to refer appropriate patients to a sleep laboratory for diagnostic sleep apnea testing.

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Table Graphic Jump Location
Table 29–1. Diagnoses and Conditions Causing Sleepiness.

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