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 1,062 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Objective: To assess the continued efficacy of modafinil in the treatment of excessive daytime somnolence (EDS) of narcolepsy.Background: Modafinil has been shown to be a safe and effective treatment for the EDS presented by patients with narcolepsy. However, the duration of treatment has been relatively brief, particularly considering the chronic nature of the disease.Methods: Sixty-nine patients with narcolepsy, who completed a 6-week crossover study of modafinil continued on modafinil for 16 weeks of open-label treatment (300+/-100 mg). This was followed by 2 weeks during which patients were randomly and blindly allocated to continue modafinil (M) at the same dose (n=30), or placebo (P; n=33).Results: A mean dose of 330 mg of modafinil continued to produce a significant decrease in EDS as measured by the Maintenance of Wakefulness Test (9.7+/-7.9 for P; 16.4+/-13.7 for M; P=0.009), the Epworth Sleepiness Scale (15.4+/-5.8 for P; 13.2+/-5.7 for M; P=0.023), and the number of episodes of severe somnolence and sleep reported in patient diaries (8.2+/-7.2 for P; 4.2+/-5.2 for M; P=0.017). Modafinil had no significant effects on nocturnal sleep, blood pressure, heart rate, the electrocardiogram (ECG), weight, or mood.Conclusion: Modafinil continues to be an effective and well-tolerated drug after 16 weeks of treatment.
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PMID:A randomized trial of the long-term, continued efficacy and safety of modafinil in narcolepsy. 1076 51

Obstructive sleep apnoea syndrome is a common but underrecognised disorder with associated substantial morbidity and mortality. Excessive daytime sleepiness caused by the disorder leads to poor work performance and increases the risk of an individual having an automobile accident. The main objective of treatment for sleep apnoea is the relief of disabling daytime sleepiness and the improvement of quality of life. Conservative measures such as weight reduction and the avoidance of alcohol should be initiated when appropriate. Nasal continuous positive airway pressure devices have remained the standard treatment since it was first introduced in 1981. Oral appliances provide an alternative treatment choice in mild-to-moderate cases, whereas surgery is useful in selected cases.
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PMID:Obstructive sleep apnoea syndrome: treatment update. 1089 46

Excessive daytime sleepiness often complicates the clinical picture of epilepsy, facilitating the occurrence of seizures and aggravating cognitive disabilities and/or behavioral problems. Thus it further adversely affects social and working activities of epileptic subjects. Both unstructured and structured clinical reports documented a not negligible proportion of epilepsy patients suffering from excessive daytime sleepiness. Studies based on neurophysiological testing such as Multiple Sleep Latency Test or Maintenance Wakefulness Test revealed a degree of daytime sleepiness tendency in epilepsy patients greater than that they subjectively estimate. Antiepileptic drugs play a remarkable role in determining drowsiness in epilepsy patients and they are generally viewed as the only cause of sleepiness in these patients. However excessive daytime sleepiness has been documented in epilepsy patients before starting any drug treatment or after its discontinuation. Both clinical and neurophysiological studies have clearly documented the possible role of seizure occurrence and of co-morbidity as determinants of excessive daytime sleepiness in epilepsy patients. Nocturnal sleep fragmentation and daytime sleepiness have been reported in temporal lobe and frontal lobe epilepsy, namely nocturnal frontal lobe epilepsy. Some recent reports have stressed that obstructive sleep apnea and periodic limb movements during sleep can significantly account for sleepiness complaints in epilepsy patients; most of the antiepileptic drugs can worsen obstructive sleep apnea. To date the evaluation of daytime sleepiness of epilepsy patients in clinical practice has been based mainly or exclusively on clinical reports. To improve our understanding of this symptom in epilepsy patients, the use of standardized sleepiness scales should be encouraged. Patients with persistent daytime sleepiness without a clear cause-and-effect relationship with antiepiletic drugs treatment or in whom a coincident sleep pathology is suspected, should be investigated by means of neurophysiological testing such as Multiple Sleep Latency Test or Maintenance Wakefulness Test.
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PMID:Evaluation of sleepiness in epilepsy. 1099 63

Excessive daytime sleepiness is a common symptom of obstructive sleep apnea syndrome (OSAS) and can be a cause of traffic accidents, creating a problem of particular importance for professional drivers given the associated death, disability and professional repercussions. We assessed whether the Epworth sleepiness scale (ESS), which is a subjective measure of daytime sleepiness, correlates well with multiple sleep latency (MSL) testing, which gives an objective measure of daytime sleepiness. We also compared each method with the results of polysomnography (apnea-hypopnea index, arousal index and minimum oxygen saturation). We studied 55 professional drivers suspected of OSAS. All answered the ESS questionnaire and underwent polysomnographic and MSL testing. We found a significant, though not relevant, correlation between the degree of excessive daytime sleepiness estimated by the ESS and by MSL testing (r = -0.41; p = 0.002). A significant, though weak, correlation was found between the ESS score and the arousal index (r = 0.26; p < 0.05). Our results do not clarify which method is best for measuring excessive daytime sleepiness in professional drivers suspected of OSAS.
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PMID:[Assessment of excessive day-time sleepiness in professional drivers with suspected obstructive sleep apnea syndrome]. 1100 84

Excessive daytime sleepiness (EDS) is a frequent symptom of patients with obstructive sleep apnoea (OSA). EDS is a high-risk factor for accidents at work and on the road. Thirty untreated patients with different levels of severity of OSA were studied concerning night sleep and EDS. The criterion for severity was the respiratory disturbance index (RDI): 15 patients were classified as 'moderately' apnoeic (RDI < 40), 15 as 'severely' apnoeic (RDI > 40). Following night-time polysomnography, objective and subjective aspects of EDS were studied. To assess objective EDS the Maintenance of Wakefulness Test (MWT) and a computer-based vigilance performance test were used. Subjective EDS was determined using the Stanford Sleepiness Scale (SSS), the Epworth Sleepiness Scale (ESS) and the Visual Analogue Scales for Performance (VAS-P) and Tiredness (VAS-T). Well-being was assessed using the Scale of Well-Being by von Zerssen (Bf-S/Bf-S'). Severe apnoea patients spent more time in stage 1 and less in slow-wave sleep. MWT latencies tended to be shorter in the severe apnoea group. Vigilance testing revealed no group differences. Patients with moderate apnoea described themselves as more impaired in all subjective scales, but only SSS scores reached statistical significance. Our results suggest that there is no simple correlation between polysomnographic and respiratory sleep variables at night on the one hand, and the extent of EDS on the other hand. Furthermore, subjective and objective evaluation of EDS does not yield the same results. New approaches which allow a more detailed analysis of night sleep and daytime function are required to identify high-risked patients.
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PMID:Excessive daytime sleepiness in patients suffering from different levels of obstructive sleep apnoea syndrome. 1101 70

Narcolepsy syndrome is a common, although often misdiagnosed, neurological disorder, whose clinical features are excessive daytime somnolence with sleep attacks, caplexy, sleep paralysis and hypnagogic hallucinations. The clinical manifestation have been interpreted as the expression of a sudden intrusion of dissociated REM phenomena in wakefulness. Sometimes the clinical manifestations may include only some of the symptoms: in particular, the cases in which the only symptom is excessive daytime somnolence may be difficult to diagnose. The etiopathogenesis of narcolepsy syndrome is still poorly understood. Recent experimental evidences suggest that a protein, called "orexin", which is supposed to play a role in the control mechanisms of both sleep and eating behaviour, is involved in its pathogenesis. The treatment of narcolepsy has been, up to now, exclusively symptomatic, and in some way empirical and unsatisfactory, especially regarding to daytime sleepiness. Recently, new pharmacological agents, acting on the serotoninergic and/or noradrenergic systems, allow a better control of the cataplectic attacks. The recent development of modafinil, a central nervous system stimulant, devoid of the serious side effects of amphetamines and other compounds, allows to hope in a better control of daytime somnolence and sleep attacks. The aim of the paper is to describe the recent advances in the diagnosis and treatment of narcolepsy.
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PMID:[New perspectives in the diagnosis and therapy of narcolepsy]. 1114 20

The authors conducted an open-label trial of modafinil for excessive daytime sleepiness in myotonic dystrophy. Eleven patients were evaluated: two were not treated because of obstructive sleep apnea, and nine received 200 to 400 mg modafinil/day for an average of 16.4 weeks. There were no major side effects. Average sleep latency as measured by the Multiple Sleep Latency Test increased from 7.3 to 22.7 minutes ( p = 0.00013), and average Epworth Sleepiness Scale score decreased from 13.25 to 7.75 (p = 0.01028). Modafinil shows evidence of effectiveness for excessive daytime somnolence in myotonic dystrophy and should be investigated further.
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PMID:Modafinil for excessive daytime sleepiness in myotonic dystrophy. 1127 21

Excessive daytime sleepiness is a serious medical problem. It appears against patient will, when he performs normal day activities. It significantly disturbes daily functioning and may be a cause of a serious accidents. Approximately 5% of the general population suffers from excessive daytime sleepiness. The most common cause of daytime sleepiness is sleep deprivation. It is also a symptom of many disorders and may be an effect of taking many drugs, especially sedative ones. Investigation continued in the seventies by W. Dement and M. Carscadon resulted in preparation of MSLT which became the most widely used, objective method of the assessment of excessive sleepiness. It has been quickly used in diagnosis of narcolepsy, obstructive sleep apnea, idiopathic hypersomnia, periodic limb movements, circadian rhythms disorders, insomnia investigations, clinical assessment of many drugs. However equipment requirements are not that complicated, but investigator knowledge and experience are the limitations of the method. We described the protocol of the test including EEG procedures, patient preparation, interpretation of the results and normal values. Indications for MSLT in the diagnosis of sleep disorders were outlined with the special emphasis on narcolepsy.
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PMID:[MSLT: an objective method of assessment of excessive sleepiness]. 1176 Apr 60

Seizures and antiepileptic drugs (AEDs) affect sleep macroarchitecture and may produce excessive daytime sleepiness (EDS) in patients with epilepsy. Sleep is a potent activator of seizures and epileptiform discharges. In some patients, seizures occur exclusively or predominately in sleep. Benign focal epilepsy of childhood with centrotemporal spikes (BECTS), supplementary sensorimotor area epilepsy (SSMA) and Lennox Gastaut syndrome are a few of the more common epilepsy syndromes characterized by nocturnal seizures. Excessive daytime sleepiness is a common complaint of patients with epilepsy. Causes of EDS include seizures, AEDs, poor sleep hygiene, and coexisting sleep disorders. Pharmacologic therapy is aimed at identifying the single most effective drug for a given seizure type or epilepsy syndrome. Polytherapy is associated with a higher likelihood of adverse effects--most notably, EDS. Poor sleep hygiene leads to sleep fragmentation that can exacerbate seizures and EDS. Primary sleep disorders should be suspected in patients with EDS, particularly those treated with monotherapy at low serum drug concentrations and well controlled seizures. Treatment of sleep disorders may lead to better seizure control.
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PMID:Sleep and Epilepsy. 1182 45

Excessive daytime sleepiness (EDS) is an important indicator when diagnosing sleep-disordered breathing and evaluating its treatment results. However, there appears to be some confusion as to what exactly is sleepiness; Dorland's Illustrated Medical Dictionary does not help. The medical literature was reviewed in order to assemble a schematic model that would suggest a definition of sleepiness and how it can be measured. The derived model is entitled the troika of consciousness cycle (TCC). It assumes that the presence of wakefulness, nonrapid eye movement sleep (NREMS), and rapid eye movement sleep (REMS) is determined by the interactions of four drives: two promoting wakefulness and one each for the two sleep states. The TCC illustrates that inadequate sleep results in sleep debt, but that sleepiness is determined solely by the nearness of the secondary wake drive line to the NREMS drive line. Contact of these lines indicates dozing, a change in consciousness state, an observable event. The probability of this event may be defined as objective sleepiness; this is what the Epworth sleepiness scale (ESS) attempts to measure. Studies indicate that the ESS can determine EDS with greater sensitivity and selectivity than either the multiple sleep latency test or the maintenance of wakefulness test.
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PMID:Sleepiness, troika of consciousness cycle, and the Epworth sleepiness scale. 1186 58


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