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Abstract Introduction Excessive daytime sleepiness (EDS) has an estimated prevalence of 10-25%. Disorders of central hypersomnolence such as narcolepsy and idiopathic hypersomnia pose a diagnostic challenge since commonly used psychotropic medications can alter REM sleep parameters on polysomnography (PSG). The American Academy of Sleep Medicine has published protocols for the multiple sleep latency test (MSLT), including a 2-week medication discontinuation period (MDP) prior to testing, however discontinuation must be carefully considered. Report of case(s) A 22-year-old female with obsessive compulsive disorder, attention deficit hyperactivity disorder, and optic nerve hypoplasia presented with episodic EDS for several years. Epworth was 14 despite amphetamine-dextromphetamine 30mg twice daily. These episodes would last for 1-2 weeks without associated hypersexuality, increased food seeking behaviors or changes in cognition. Additionally, she would experience periods of not sleeping for days at a time, but not decreased need for sleep. She denied cataplexy, sleep-related hallucinations, or sleep paralysis. No symptoms of bipolar disorder reported. Initial polysomnography showed 432 minutes of sleep, REM latency of 39.5 minutes and AHI of 0.1. MSLT showed a mean sleep latency of 11.5 minutes without sleep onset REM periods. She reported later that she was unable to complete the MDP for escitalopram. The diagnosis at that time was hypersomnolence related to a mental disorder, and referred back to psychiatry. She returned 20 months later with more persistent hypersomnolence and a MDP was attempted again, this time with confirmation. She stopped venlafaxine and stimulant per protocol. PSG was again unremarkable and MSLT showed mean sleep latency of 7 minutes across 5 naps and SOREMP in 4 naps, resulting in the diagnosis of type 2 narcolepsy. Conclusion Sleep symptoms are common in patients with comorbid psychiatric conditions, and MDP can pose safety risks or be poorly adhered to. Longitudinal follow-up, repeat testing for persistent and worsening symptoms of EDS, and careful questioning about adherence to MSLT protocol can help clarify the eventual diagnosis. Support (if any) None.
Hope et al. (Sat,) studied this question.