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Excessive daytime sleepiness in primary care – Authors' reply

2023; Elsevier BV; Volume: 402; Issue: 10411 Linguagem: Inglês

10.1016/s0140-6736(23)01505-2

1474-547X

Laura Pérez‐Carbonell, Emmanuel Mignot, Guy Leschziner, Yves Dauvilliers,

Sleep and Work-Related Fatigue

We thank Joshua Kovoor for their Correspondence regarding our paper,1Pérez-Carbonell L Mignot E Leschziner G Dauvilliers Y Understanding and approaching excessive daytime sleepiness.Lancet. 2022; 400: 1033-1046Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar which was part of the Sleep Series published across The Lancet and The Lancet Neurology. We are aware that there is little training in sleep medicine; this is the case not only for primary care doctors, but also within medical specialties frequently confronted with sleep disorders, such as neurology, respiratory medicine, or psychiatry. Indeed, even at the level of medical school, medical students receive little formal education in sleep and its disorders. Furthermore, in many countries, sleep medicine remains unrecognised as a stand-alone specialty. Although the interdisciplinary nature of sleep medicine brings to the field an enriched variety of physicians from different specialties and backgrounds, the lack of recognition as a distinct specialty prevents standardised training and creates a tendency for clinicians to view sleep through the prism of their own subspecialty. This tendency has been reinforced in the USA, where clinical and research sleep programmes have been split by departments or reintegrated into a single departmental structure, with little understanding of the multispecialty aspect of the discipline. We also agree that people who have sleep disturbances, including people with hypersomnolence, will probably consult their primary care doctor first. For this reason, we highlighted the need to recognise and differentiate symptoms of hypersomnolence, namely excessive daytime sleepiness and hypersomnia, from fatigue and apathy. Hypersomnolence is still under-recognised, and understudied, and often associated with frequent use of health-care services, poor quality of life, and thus a substantial socioeconomic burden. Hypersomnolence might be a consequence of behavioural issues leading to insufficient or disrupted sleep but can also be the consequence of sleep disorders (eg, obstructive sleep apnoea, circadian disorders, narcolepsy, and idiopathic hypersomnia), medications, or other medical or psychiatric conditions. These disorders also commonly co-occur. Accordingly, the assessment of hypersomnolence requires a rigorous clinical approach, completed by use of self-reported questionnaires and neurophysiological measures, depending on clinical context.2Lammers GJ Bassetti CLA Dolenc-Groselj L et al.Diagnosis of central disorders of hypersomnolence: a reappraisal by European experts.Sleep Med Rev. 2020; 52101306Crossref Scopus (86) Google Scholar This thorough assessment ensures proper diagnosis and personalised therapy. However, the mean and median diagnostic delay of patients with narcolepsy in different European countries over the past three decades was about 9·7 and 5·3 years, respectively.3Zhang Z Dauvilliers Y Plazzi G et al.Idling for decades: a European study on risk factors associated with the delay before a narcolepsy diagnosis.Nat Sci Sleep. 2022; 14: 1031-1047Crossref PubMed Scopus (11) Google Scholar We also concur in the need for joint work between sleep medicine specialists and primary care doctors for a comprehensive and successful identification, assessment, and management of these patients. The aim of the Sleep Series was to bring to attention to the wider clinical audience some of the most common issues within sleep medicine encountered in routine clinical practice. Hopefully, by increasing the awareness of the nature and impact of sleep conditions, medical training and continued professional development programmes will be shaped to provide appropriate understanding of sleep medicine among physicians, with the goal to deliver the best possible quality of care (including diagnosis and management) to patients. LP-C reports personal fees from Jazz Pharmaceuticals, outside the submitted work. YD reports personal fees and honoraria from Jazz Pharmaceuticals, Bioprojet, Takeda, Union Chimique Belge, Orexia, Idorsia, and Avadel; grants or contracts from Jazz Pharmaceuticals and Idorsia; support for attending meetings from Jazz Pharmaceuticals, Bioprojet, and Avadel; and participation on a data safety monitoring board or advisory board for Idorsia. All other authors report no competing interests. Understanding and approaching excessive daytime sleepinessExcessive 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. Full-Text PDF