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New EEG Insights Offer Window into Hypersomnia Differential Diagnosis

Researchers investigate how timing and density of EEG segments differ among patients with narcolepsy character 1, narcolepsy type 2, idiopathic hypersomnia, and oversight matters.

When providers come across patients who show signs of excessive sleepiness and frequent daytime sleep attempts, diagnostic tests like polysomnogram( PSG) and multiple sleep latency exams( MSLTs) help screen for idiopathic hypersomnia and narcolepsy. But as numerous learns and narcolepsy patient reports have shown, even MSLTs can show invalid makes that can create missed opportunities for proper diagnosis.

Given that there are still challenges in accurately diagnosing and treating patients for hypersomnia and narcolepsy, researchers like Alyssa Cairns, PhD, at SleepMed looked for new ways to parse through sleep survey data to better understand the sleep arrangement in narcolepsy and other hypersomnias. Last-place time, Cairns published research studies that looked at the microarchitecture of patient groups with differing hypersomnias. Use electroencephalogram( EEG) data, she and her colleagues found that the sleepiness symptoms narcolepsy patients presented differed from the symptoms patients with idiopathic hypersomnia showed.

Since then, she has looked further into the 200 EEG results of SleepMed’s deidentified data storehouse to see how the timing and concentration of EEG segments in hypersomnias differed among patients with narcolepsy form 1, narcolepsy type 2, idiopathic hypersomnia, and clinic restraint patients. In 2018, she co-published her survey titled, “Timing And Density Of EEG Segments In The Hypersomnias: Ramifications For Circadian And Homeostatic Control Of Sleep.”

“We took a closer look at these EEGs and focused on the aberrations we read in circadian timing and homeostatic regulation part among these different groups of patients, ” Cairns says.

Cairns and her peers found that patients with narcolepsy had elevated homeostatic regulation of REM at the beginning of the night that soon dropped off, which explains why patients with narcolepsy have a lot of instances of discontinued sleep at night. Patients with idiopathic hypersomnia appeared to have normal circadian timing of REM but adjusted homeostatic regulation that hints increased deep sleep and/ or reduced homeostatic efficiency.

The findings of this study emphasize the importance of ensuring that taking into account the robust information that PSGs can tell providers about the abnormality of the patient’s sleep regulation processes. In other terms, don’t just rely on the performance of the the MSLT to rule out narcolepsy with absolute certainty.

“Polysomnograms can reveal potential underlying mechanisms of abnormality. So for instance, if you person with relatively early timed rapid eye movement procedures on their PSG but their MSLT is normal or consistent with idiopathic hypersomnia for example, don’t just stop there but instead re-administer the MSLT, ” Cairns says.

Because the MSLT is under the responsibility of high exam unreliability, especially concerning narcolepsy type 2 and idiopathic hypersomnia, clinicians should rely on their clinical expertise to redo tests to gather more clinical correlation to get patients a most reliable, accurate diagnosis.

“Our nocturnal polysomnogram data has shown us that there are some characteristics where patients with narcolepsy cluster on demonstrating consistent abnormal REM processes and polysomnograms can corroborate abnormal REM phenomenon, ” Cairns says.

Unlike narcolepsy form 1, idiopathic hypersomnia is not quite easy to assess, and the margins of lapse of diagnosing this circumstance are massive, which builds it like “the wild, wild west that needs more investigation, ” according to Cairns.

The biggest takeaway for providers and patients is that when in doubt, consider retaking the MSLT. Given that it still takes years for narcolepsy to get a proper diagnosis from the moment of onset, it merely establishes appreciation to is not merely ignore symptoms of excess daytime sleepiness but rather gather more data that can had contributed to a more precise diagnosis.

Yoona Ha is a freelance writer and healthcare public relations professional.

Read more: sleepreviewmag.com

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