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Semin Neurol 2021; 41(06): 781-794
DOI: 10.1055/s-0041-1726364
Review Article

Approach to Common Sleep Disorders

Yujie Wang 
1   Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Rachel Marie E. Salas
1   Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Sleep disorders are highly relevant in clinical practice given their prevalence as well as their impact on health outcomes and quality of life. The most common concerns are excessive daytime sleepiness, insomnia, disordered breathing, and abnormal movements or behaviors during sleep. A detailed but targeted history is vital, particularly from the sleep partner/witness. In-laboratory sleep testing (polysomnography and multiple sleep latency test) remains vital in the diagnosis of certain sleep disorders (such as sleep-disordered breathing and central hypersomnia) and in specific populations (such as in children and individuals with comorbid medical disorders). Advances in technology have allowed for a variety of methods in assessing a patient's sleep, from compact devices to evaluate for sleep apnea, wrist actigraphy, and mobile device-based applications. As the pathophysiology of various sleep disorders becomes better elucidated, disease-specific medications have been developed for these conditions. Nonetheless, a multidisciplinary approach to management is necessary, including improving sleep hygiene and cognitive behavioral therapy.

Keywords

sleep disorders - obstructive sleep apnea - narcolepsy - restless legs syndrome - insomnia


Publication History

Article published online:
26 November 2021

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  • References

  • 1 Institute of Medicine (US) Committee on Sleep Medicine and Research. Colten HR, Altevogt BM. eds. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: National Academies Press; 2006. . Accessed January 13, 2020 at: http://www.ncbi.nlm.nih.gov/books/NBK19960/
    Google Scholar
  • 2 Salas RME, Strowd RE, Ali I. et al. Incorporating sleep medicine content into medical school through neuroscience core curricula. Neurology 2018; 91 (13) 597-610
    CrossrefPubMedGoogle Scholar
  • 3 Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep 2017; 9: 151-161
    CrossrefPubMedGoogle Scholar
  • 4 Choi SJ, Suh S, Ong J, Joo EY. Sleep misperception in chronic insomnia patients with obstructive sleep apnea syndrome: implications for clinical assessment. J Clin Sleep Med 2016; 12 (11) 1517-1525
    CrossrefPubMedGoogle Scholar
  • 5 Roehrs TA, Roth T. Sleep disturbance in substance use disorders. Psychiatr Clin North Am 2015; 38 (04) 793-803
    CrossrefPubMedGoogle Scholar
  • 6 Baran AS, Chervin RD. Approach to the patient with sleep complaints. Semin Neurol 2009; 29 (04) 297-304
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Silber MH. Diagnostic approach and investigation in sleep medicine. Contin Minneap Minn 2017; 23 (4, Sleep Neurology): 973-988
    PubMedGoogle Scholar
  • 8 Epstein LJ, Kristo D, Strollo Jr PJ. et al; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5 (03) 263-276
    CrossrefPubMedGoogle Scholar
  • 9 Khurshid KA. Comorbid insomnia and psychiatric disorders: an update. Innov Clin Neurosci 2018; 15 (3-4): 28-32
    PubMedGoogle Scholar
  • 10 Williams NJ, Grandne MA, Snipes A. et al. Racial/ethnic disparities in sleep health and health care: importance of the sociocultural context. Sleep Health 2015; 1 (01) 28-35
    CrossrefPubMedGoogle Scholar
  • 11 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (06) 540-545
    CrossrefPubMedGoogle Scholar
  • 12 Tietjens JR, Claman D, Kezirian EJ. et al. Obstructive sleep apnea in cardiovascular disease: a review of the literature and proposed multidisciplinary clinical management strategy. J Am Heart Assoc 2019; 8 (01) e010440
    CrossrefPubMedGoogle Scholar
  • 13 Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42 (05) 487-490
    CrossrefPubMedGoogle Scholar
  • 14 Friedman M, Salapatas AM, Bonzelaar LB. Updated Friedman staging system for obstructive sleep apnea. Adv Otorhinolaryngol 2017; 80: 41-48
    PubMedGoogle Scholar
  • 15 Friedman M, Hamilton C, Samuelson CG, Lundgren ME, Pott T. Diagnostic value of the Friedman tongue position and Mallampati classification for obstructive sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg 2013; 148 (04) 540-547
    CrossrefPubMedGoogle Scholar
  • 16 Dahlqvist J, Dahlqvist A, Marklund M, Berggren D, Stenlund H, Franklin KA. Physical findings in the upper airways related to obstructive sleep apnea in men and women. Acta Otolaryngol 2007; 127 (06) 623-630
    CrossrefPubMedGoogle Scholar
  • 17 Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax 1992; 47 (02) 101-105
    CrossrefPubMedGoogle Scholar
  • 18 Ho AW, Moul DE, Krishna J. Neck circumference-height ratio as a predictor of sleep related breathing disorder in children and adults. J Clin Sleep Med 2016; 12 (03) 311-317
    CrossrefPubMedGoogle Scholar
  • 19 Claassen DO, Josephs KA, Ahlskog JE, Silber MH, Tippmann-Peikert M, Boeve BF. REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology 2010; 75 (06) 494-499
    CrossrefPubMedGoogle Scholar
  • 20 Dauvilliers Y, Barateau L. Narcolepsy and other central hypersomnias. Contin Minneap Minn 2017; 23 (4, Sleep Neurology) 989-1004
    PubMedGoogle Scholar
  • 21 Ruoff C, Rye D. The ICSD-3 and DSM-5 guidelines for diagnosing narcolepsy: clinical relevance and practicality. Curr Med Res Opin 2016; 32 (10) 1611-1622
    CrossrefPubMedGoogle Scholar
  • 22 Kirk V, Baughn J, D'Andrea L. et al. American Academy of Sleep Medicine position paper for the use of a home sleep apnea test for the diagnosis of OSA in children. J Clin Sleep Med 2017; 13 (10) 1199-1203
    Google Scholar
  • 23 Levendowski DJ, Ferini-Strambi L, Gamaldo C, Cetel M, Rosenberg R, Westbrook PR. The accuracy, night-to-night variability, and stability of frontopolar sleep electroencephalography biomarkers. J Clin Sleep Med 2017; 13 (06) 791-803
    CrossrefPubMedGoogle Scholar
  • 24 Smith MT, McCrae CS, Cheung J. et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2018; 14 (07) 1231-1237
    Google Scholar
  • 25 Le HH, Salas RME, Gamaldo A. et al. The utility and feasibility of assessing sleep disruption in a men's health clinic using a mobile health platform device: a pilot study. Int J Clin Pract 2018; 72 (01) DOI: 10.1111/ijcp.12999.
    CrossrefPubMedGoogle Scholar
  • 26 Doshi A, Gamaldo CE, Dziedzic P. et al. Finding time for sleep: identifying sleep concerns in non-sleep specialty clinics using the MySleepScript App. J Mob Technol Med 2017; 6 (02) 19-27
    CrossrefPubMedGoogle Scholar
  • 27 Foldvary-Schaefer NR, Waters TE. Sleep-disordered breathing. Contin Minneap Minn 2017; 23 (4, Sleep Neurology): 1093-1116
    PubMedGoogle Scholar
  • 28 Senaratna CV, Perret JL, Lodge CJ. et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017; 34: 70-81
    CrossrefPubMedGoogle Scholar
  • 29 Garvey JF, Pengo MF, Drakatos P, Kent BD. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis 2015; 7 (05) 920-929
    PubMedGoogle Scholar
  • 30 Dudley KA, Patel SR. Disparities and genetic risk factors in obstructive sleep apnea. Sleep Med 2016; 18: 96-102
    CrossrefPubMedGoogle Scholar
  • 31 Kapur VK, Auckley DH, Chowdhuri S. et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13 (03) 479-504
    Google Scholar
  • 32 Kushida CA, Littner MR, Morgenthaler T. et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28 (04) 499-521
    CrossrefPubMedGoogle Scholar
  • 33 Collop NA, Anderson WM, Boehlecke B. et al; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007; 3 (07) 737-747
    CrossrefPubMedGoogle Scholar
  • 34 Carter KA, Hathaway NE, Lettieri CF. Common sleep disorders in children. Am Fam Physician 2014; 89 (05) 368-377
    PubMedGoogle Scholar
  • 35 Ramar K, Dort LC, Katz SG. et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015; 11 (07) 773-827
    CrossrefPubMedGoogle Scholar
  • 36 Eckert DJ, Jordan AS, Merchia P, Malhotra A. Central sleep apnea: pathophysiology and treatment. Chest 2007; 131 (02) 595-607
    CrossrefPubMedGoogle Scholar
  • 37 Böing S, Randerath WJ. Chronic hypoventilation syndromes and sleep-related hypoventilation. J Thorac Dis 2015; 7 (08) 1273-1285
    CrossrefPubMedGoogle Scholar
  • 38 Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med 2007; 3 (5, Suppl): S7-S10
    CrossrefPubMedGoogle Scholar
  • 39 Avidan AY, Neubauer DN. Chronic insomnia disorder. Contin Minneap Minn 2017; 23 (4, Sleep Neurology): 1064-1092
    PubMedGoogle Scholar
  • 40 Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13 (02) 307-349
    Google Scholar
  • 41 Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA 2001; 285 (14) 1856-1864
    CrossrefPubMedGoogle Scholar
  • 42 Rosenberg R, Murphy P, Zammit G. et al. Comparison of lemborexant with placebo and zolpidem tartrate extended release for the treatment of older adults with insomnia disorder: a phase 3 randomized clinical trial. JAMA Netw Open 2020; 3 (04) e206497
    CrossrefPubMedGoogle Scholar
  • 43 Anderson SL, Vande Griend JP. Quetiapine for insomnia: a review of the literature. Am J Health Syst Pharm 2014; 71 (05) 394-402
    CrossrefPubMedGoogle Scholar
  • 44 Pavlova M. Circadian rhythm sleep-wake disorders. Contin Minneap Minn 2017; 23 (4, Sleep Neurology): 1051-1063
    PubMedGoogle Scholar
  • 45 Barion A, Zee PC. A clinical approach to circadian rhythm sleep disorders. Sleep Med 2007; 8 (06) 566-577
    CrossrefPubMedGoogle Scholar
  • 46 Zhdanova IV, Tucci V. Melatonin, circadian rhythms, and sleep. Curr Treat Options Neurol 2003; 5 (03) 225-229
    CrossrefPubMedGoogle Scholar
  • 47 Longstreth Jr WT, Koepsell TD, Ton TG, Hendrickson AF, van Belle G. The epidemiology of narcolepsy. Sleep 2007; 30 (01) 13-26
    CrossrefPubMedGoogle Scholar
  • 48 Alshaikh MK, Tricco AC, Tashkandi M, Mamdani M, Straus SE, BaHammam AS. Sodium oxybate for narcolepsy with cataplexy: systematic review and meta-analysis. J Clin Sleep Med 2012; 8 (04) 451-458
    CrossrefPubMedGoogle Scholar
  • 49 St Louis EK, Boeve BF. REM sleep behavior disorder: diagnosis, clinical implications, and future directions. Mayo Clin Proc 2017; 92 (11) 1723-1736
    CrossrefPubMedGoogle Scholar
  • 50 Aurora RN, Zak RS, Maganti RK. et al; Standards of Practice Committee, American Academy of Sleep Medicine. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med 2010; 6 (01) 85-95
    CrossrefPubMedGoogle Scholar
  • 51 Högl B, Iranzo A. Rapid eye movement sleep behavior disorder and other rapid eye movement sleep parasomnias. Contin Minneap Minn 2017; 23 (4, Sleep Neurology): 1017-1034
    PubMedGoogle Scholar
  • 52 Irfan M, Schenck CH, Howell MJ. Non-rapid eye movement sleep and overlap parasomnias. Contin Minneap Minn 2017; 23 (4, Sleep Neurology): 1035-1050
    PubMedGoogle Scholar
  • 53 Pressman MR, Bornemann MC. The ICSD-3 NREM parasomnia section is evidence based resulting from international collaboration, consensus and best practices. J Clin Sleep Med 2015; 11 (02) 187-188
    CrossrefPubMedGoogle Scholar
  • 54 Ohayon MM, O'Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 2012; 16 (04) 283-295
    CrossrefPubMedGoogle Scholar
  • 55 Hening W, Allen RP, Tenzer P, Winkelman JW. Restless legs syndrome: demographics, presentation, and differential diagnosis. Geriatrics 2007; 62 (09) 26-29
    PubMedGoogle Scholar
  • 56 Trotti LM. Restless legs syndrome and sleep-related movement disorders. Contin Minneap Minn 2017; 23 (4, Sleep Neurology): 1005-1016
    PubMedGoogle Scholar
  • 57 Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev 2019; 1: CD007834
    PubMedGoogle Scholar
  • 58 Facheris MF, Hicks AA, Pramstaller PP, Pichler I. Update on the management of restless legs syndrome: existing and emerging treatment options. Nat Sci Sleep 2010; 2: 199-212
    PubMedGoogle Scholar
  • 59 Burbank F, Buchfuhrer MJ, Kopjar B. Sleep improvement for restless legs syndrome patients. Part I: pooled analysis of two prospective, double-blind, sham-controlled, multi-center, randomized clinical studies of the effects of vibrating pads on RLS symptoms. Res Rev Parkinsonism 2013; 3: 1-10
    PubMedGoogle Scholar
  • 60 Rozeman AD, Ottolini T, Grootendorst DC, Vogels OJM, Rijsman RM. Effect of sensory stimuli on restless legs syndrome: a randomized crossover study. J Clin Sleep Med 2014; 10 (08) 893-896
    CrossrefPubMedGoogle Scholar
  • 61 Roth T, Zammit G, Kushida C. et al. A new questionnaire to detect sleep disorders. Sleep Med 2002; 3 (02) 99-108
    CrossrefPubMedGoogle Scholar
  • 62 Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 2016; 149 (03) 631-638
    CrossrefPubMedGoogle Scholar
  • 63 Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28 (02) 193-213
    CrossrefPubMedGoogle Scholar
  • 64 Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep (Basel) 2011; 34 (05) 601-608
    CrossrefPubMedGoogle Scholar
  • 65 Hublin C, Kaprio J, Partinen M, Koskenvuo M, Heikkilä K. The Ullanlinna Narcolepsy Scale: validation of a measure of symptoms in the narcoleptic syndrome. J Sleep Res 1994; 3 (01) 52-59
    CrossrefPubMedGoogle Scholar
  • 66 Walters AS, LeBrocq C, Dhar A. et al; International Restless Legs Syndrome Study Group. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003; 4 (02) 121-132
    CrossrefPubMedGoogle Scholar
  • 67 Leong WB, Arora T, Jenkinson D. et al. The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity. J Clin Sleep Med 2013; 9 (09) 853-858
    CrossrefPubMedGoogle Scholar
  • 68 Sutherland K, Keenan BT, Bittencourt L. et al; SAGIC Investigators. A global comparison of anatomic risk factors and their relationship to obstructive sleep apnea severity in clinical samples. J Clin Sleep Med 2019; 15 (04) 629-639
    CrossrefPubMedGoogle Scholar
  • 69 Wise MS, Arand DL, Auger RR, Brooks SN, Watson NF. American Academy of Sleep Medicine. Treatment of narcolepsy and other hypersomnias of central origin. Sleep 2007; 30 (12) 1712-1727
    CrossrefPubMedGoogle Scholar