1501 Sleepy Teens: A Case Series of Diagnostic Dilemmas in Pathological Excessive Daytime Sleepiness (EDS)
Abstract
Central disorders for hypersomnolence (CDH) consist of idiopathic hypersomnia (IH), narcolepsy type 1 and type 2. These are difficult to differentiate due to confounding social issues and mood disorders commonly encountered in pediatric clinical settings, which may contribute to the delay in diagnosis. These diagnostic dilemmas arise in patients who have significant sleepiness, but do not meet diagnostic criteria. Here, a case series of five patients with EDS, and their confounders will be presented.
An eleven-year-old early teen with an Epworth Sleepiness Scale (ESS) of 17, who has undergone polysomnograms (PSG) and multiple sleep latency tests (MSLT) demonstrating 1-2 sleep onset rapid eye movement periods (SOREMP), and mean sleep-onset latency (MSL) of 8.7 minutes and 9 minutes. Genetic testing and cerebrospinal fluid orexin levels were normal. A twenty-year-old (ESS 13) with unrefreshing naps without cataplexy, underwent a PSG/MSLT demonstrating 3 SOREMPs and MSL of 3.3 minutes while on sertraline and trazodone, but 6.3 hours of sleep and AHI of 3.0/hr with normal genetic testing and orexin levels. An eighteen-year-old with hypersomnia (ESS 16) and snoring had no SOREMPs, but an MSL of 7.5 minutes and normal orexin levels with an AHI of 3.9/hr, while an eighteen-year-old with ESS of 20, cataplexy and hypnogogic hallucinations had no SOREMPs and an MSL of 14.3 minutes. Lastly, a 21-year-old with sleep paralysis had no SOREMPs and an MSL of 9.5 minutes on fluoxetine, with…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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