Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline

Abstract

Introduction: This guideline establishes clinical practice recommendations for the treatment of central disorders of hypersomnolence in adults and children. Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths to each recommendation, based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force provided a summary of the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations. Recommendations: The following recommendations are intended to guide clinicians in choosing a specific treatment for central disorders of hypersomnolence in adults and children. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend … ") is one that clinicians should follow under most circumstances. A "conditional" recommendation (ie, "We suggest … ") is one that requires that the clinician use clinical knowledge and experience and strongly consider the individual patient's values and preferences to determine the best course of action. Under each disorder, strong recommendations are listed in alphabetical order followed by the conditional recommendations in alphabetical order. The section on adult patients with hypersomnia because of medical conditions is categorized based on the clinical and pathological subtypes identified in ICSD-3. The interventions in all the recommendation statements were compared to no treatment. Adult patients with narcolepsy 1. We recommend that clinicians use modafinil for the treatment of narcolepsy in adults. (STRONG) 2. We recommend that clinicians use pitolisant for the treatment of narcolepsy in adults. (STRONG) 3. We recommend that clinicians use sodium oxybate for the treatment of narcolepsy in adults. (STRONG) 4. We recommend that clinicians use solriamfetol for the treatment of narcolepsy in adults. (STRONG) 5. We suggest that clinicians use armodafinil for the treatment of narcolepsy in adults. (CONDITIONAL) 6. We suggest that clinicians use dextroamphetamine for the treatment of narcolepsy in adults. (CONDITIONAL) 7. We suggest that clinicians use methylphenidate for the treatment of narcolepsy in adults. (CONDITIONAL) Adult patients with idiopathic hypersomnia 8. We recommend that clinicians use modafinil for the treatment of idiopathic hypersomnia in adults. (STRONG) 9. We suggest that clinicians use clarithromycin for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL) 10. We suggest that clinicians use methylphenidate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL) 11. We suggest that clinicians use pitolisant for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL) 12. We suggest that clinicians use sodium oxybate for the treatment of idiopathi...

Emerging Treatments for Disorders of Consciousness in Paediatric Age

“…Complementary to the stimulation of consciousness, the promotion of sleep restructuring and circadian alternation are concurrently addressed in paediatric DoC, using a largely overlapping pool of pharmacological interventions and a timed approach. No specific recommendations exist for the management of circadian re-organisation in children with DoC; however, recent guidelines on the management of sleep in neurological diseases, and severe brain injury in particular, can give precious indications [ 59 , 60 , 61 ].…”

Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update

“…Oral appliances may be suggested for mild to moderate OSA and surgery to correct anatomic obstructions ( 66 ). b The treatment of central hypersomnias and secondary narcolepsy should include cognitive behavioral therapy (CBT) and approved stimulants (i.e., modafinil, pitolisant, solriamfetol, and sodium oxybate) ( 67 ). c Sleep hygiene, CBT, and short-term pharmacologic approach should be considered for insomnia and CRSWD ( 68 ).…”

Calcium, Magnesium, Potassium, and Sodium Oxybates Oral Solution: A Lower-Sodium Alternative for Cataplexy or Excessive Daytime Sleepiness Associated with Narcolepsy

“…SXB was given a strong recommendation for its use in narcolepsy in adults, based on the findings that treatment with SXB led to clinically significant improvements in cataplexy, EDS, and overall disease severity. 1 , 97 SXB was also given a conditional recommendation for the treatment of pediatric narcolepsy due to its demonstrated clinical improvements in EDS, cataplexy, and disease severity, but the quality of the evidence was downgraded in accordance with the GRADE framework, as fewer than 100 patients were analyzed in the clinical trial of SXB in pediatric participants with narcolepsy. SXB was also given a conditional recommendation for its use in other disorders of central hypersomnolence (idiopathic hypersomnia and hypersomnia secondary to alpha synucleinopathies [Parkinson’s disease]), reflecting its potential for the treatment of EDS outside of narcolepsy.…”

“…Sodium oxybate (SXB), first developed in the 1960s, is a central nervous system depressant recommended by the American Academy of Sleep Medicine, European guidelines, and expert statements for the treatment of excessive daytime sleepiness (EDS) and cataplexy in narcolepsy. 1 , 2 SXB was first approved to treat cataplexy in patients with narcolepsy in the United States (2002) and in Europe (2006). 3–6 SXB is currently approved in the United States for the treatment of cataplexy or EDS in patients 7 years of age and older with narcolepsy and in Europe for the treatment of narcolepsy with cataplexy in patients 7 years of age and older.…”