Understanding and approaching excessive daytime sleepiness

Excessive daytime sleepiness (EDS) is a public health issue. However, it remains largely undervalued, scarcely diagnosed, and poorly supported. Variations in the definition of EDS and limitations in clinical assessment lead to difficulties in its epidemiological study, but the relevance of this symptom from a socioeconomic perspective is inarguable. EDS might be a consequence of several behavioural issues leading to insufficient or disrupted sleep, as well as a consequence of sleep disorders including sleep apnoea syndrome, circadian disorders, central hypersomnolence disorders (narcolepsy and idiopathic hypersomnia), other medical or psychiatric conditions, or medications. Furthermore, EDS can have implications for health as it is thought to act as a risk factor for other conditions, such as cardiovascular and neurodegenerative disorders. Because of the heterogeneous causes of EDS and the complexity of its pathophysiology, management will largely depend on the cause, with the final aim of making treatment specific to the individual using precision medicine and personalised medicine. Excessive daytime sleepiness (EDS) is a public health issue. However, it remains largely undervalued, scarcely diagnosed, and poorly supported. Variations in the definition of EDS and limitations in clinical assessment lead to difficulties in its epidemiological study, but the relevance of this symptom from a socioeconomic perspective is inarguable. EDS might be a consequence of several behavioural issues leading to insufficient or disrupted sleep, as well as a consequence of sleep disorders including sleep apnoea syndrome, circadian disorders, central hypersomnolence disorders (narcolepsy and idiopathic hypersomnia), other medical or psychiatric conditions, or medications. Furthermore, EDS can have implications for health as it is thought to act as a risk factor for other conditions, such as cardiovascular and neurodegenerative disorders. Because of the heterogeneous causes of EDS and the complexity of its pathophysiology, management will largely depend on the cause, with the final aim of making treatment specific to the individual using precision medicine and personalised medicine. Waking up to the importance of sleepFor decades, sleep and its associated disorders have been considered a Cinderella branch of medicine. The subject receives little attention in undergraduate education, training is an adjunct to other more established specialties, and funding for sleep research is woefully deficient. The reasons for such neglect are embedded in the disparate nature of the conditions grouped together under the heading of sleep disorders—ranging from sleep apnoea, dealt with by an ear, nose, and throat specialist or cardiologist, to restless legs syndrome, handled by a neurologist or primary care physician—as well as a lack of understanding of their causes and the sparsity of treatment options. Full-Text PDF Anticoagulation in patients with cerebral amyloid angiopathySurvivors of intracranial haemorrhage with atrial fibrillation are a population that have a heightened risk of future ischaemic stroke and recurrent intracranial haemorrhage.1 In the absence of definitive randomised evidence to guide antithrombotic prophylaxis in these patients, current guidelines recommend individualised decisions that weigh a patient's absolute risks of thromboembolism and recurrent haemorrhage.2 Intracranial haemorrhage can occur from different underlying causes, with different rates of disease progression and intracranial haemorrhage recurrence. Full-Text PDF Excessive daytime sleepiness in primary care – Authors' replyWe thank Joshua Kovoor for their Correspondence regarding our paper,1 which was part of the Sleep Series published across The Lancet and The Lancet Neurology. Full-Text PDF Excessive daytime sleepiness in primary careI read Pérez-Carbonell and colleagues’ Series paper on excessive daytime sleepiness with interest.1 Unfortunately, outside of recognising obstructive sleep apnoea, excessive daytime sleepiness is not part of the common parlance within primary care, where most of these patients would initially present. Full-Text PDF