Semin Neurol 2009; 29(4): 297-304
DOI: 10.1055/s-0029-1237116
© Thieme Medical Publishers

Approach to the Patient with Sleep Complaints

Alp Sinan Baran1 , Ronald D. Chervin2
  • 1Sleep Disorders Center, University of Mississippi Medical Center, Jackson, Mississippi
  • 2University of Michigan Sleep Disorders Center, Ann Arbor, Michigan
Further Information

Publication History

Publication Date:
09 September 2009 (online)

ABSTRACT

Sleep disorders are both common and consequential, but too often remain undiagnosed. The insidious, chronic course of most sleep disorders and lack of patient awareness of signs and symptoms during sleep can complicate the clinical evaluation. Typical chief complaints include snoring, excessive daytime sleepiness, insomnia, and behaviors during sleep. Sleep disorders can be primary or secondary to medical, neurologic, or psychiatric conditions, so a multidisciplinary approach is often desirable. Family members can be a critical source of information as they may have observed nocturnal or daytime symptoms unrecognized by the patient. Objective testing plays an important role in assessment for obstructive sleep apnea, parasomnias, and other specific sleep disorders, and can be used most effectively in combination with a thorough clinical evaluation. Nonsleep specialists should consider obtaining assistance from sleep clinicians for more challenging presentations or management of sleep disorders unfamiliar to them.

REFERENCES

  • 1 Mindell J A, Moline M L, Zendell S M, Brown L W, Fry J M. Pediatricians and sleep disorders: training and practice.  Pediatrics. 1994;  94(2 Pt 1) 194-200
  • 2 Chervin R D. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea.  Chest. 2000;  118(2) 372-379
  • 3 Shaheen N J, Madanick R D, Alattar M et al.. Gastroesophageal reflux disease as an etiology of sleep disturbance in subjects with insomnia and minimal reflux symptoms: a pilot study of prevalence and response to therapy.  Dig Dis Sci. 2008;  53(6) 1493-1499
  • 4 Parish J M, Lyng P J. Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure.  Chest. 2003;  124(3) 942-947
  • 5 Valerio T D, Fisk H L, Chervin R D, Zallek S N. Rating subjective fatigue greater than sleepiness predicts sleep apnea over narcolepsy; greater sleepiness is not predictive.  Sleep. 2005;  28 A206
  • 6 Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness. The upper airway resistance syndrome.  Chest. 1993;  104(3) 781-787
  • 7 Chervin R D, Aldrich M S. Characteristics of apneas and hypopneas during sleep and relation to excessive daytime sleepiness.  Sleep. 1998;  21(8) 799-806
  • 8 Pavlova M K, Duffy J F, Shea S A. Polysomnographic respiratory abnormalities in asymptomatic individuals.  Sleep. 2008;  31(2) 241-248
  • 9 Friberg D. Heavy snorer's disease: a progressive local neuropathy.  Acta Otolaryngol. 1999;  119(8) 925-933
  • 10 Bourke S C, Gibson G J. Sleep and breathing in neuromuscular disease.  Eur Respir J. 2002;  19(6) 1194-1201
  • 11 Mignot E, Lammers G J, Ripley B et al.. The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias.  Arch Neurol. 2002;  59(10) 1553-1562
  • 12 Gupta N, Ahmed K, Kulig J. A sleepy, hungry teenager.  Adolesc Med. 1996;  7(3) 369-377
  • 13 Orr W C, Goodrich S, Fernström P, Hasselgren G. Occurrence of nighttime gastroesophageal reflux in disturbed and normal sleepers.  Clin Gastroenterol Hepatol. 2008;  6(10) 1099-1104
  • 14 Bassetti C, Aldrich M S. Narcolepsy.  Neurol Clin. 1996;  14(3) 545-571
  • 15 American Academy of Sleep Medicine .International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, IL; American Academy of Sleep Medicine 2005
  • 16 Roland M M, Baran A S, Richert A C. Sleep-related laryngospasm caused by gastroesophageal reflux.  Sleep Med. 2008;  9(4) 451-453
  • 17 Ekbom K A. Restless legs syndrome.  Neurology. 1960;  10 868-873
  • 18 Ford D E, Kamerow D B. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?.  JAMA. 1989;  262(11) 1479-1484
  • 19 Roehrs T, Roth T. Sleep and pain: interaction of two vital functions.  Semin Neurol. 2005;  25(1) 106-116
  • 20 Sateia M J, Nowell P D. Insomnia.  Lancet. 2004;  364(9449) 1959-1973
  • 21 Mahowald M W, Schenck C H. Diagnosis and management of parasomnias.  Clin Cornerstone. 2000;  2(5) 48-57
  • 22 Schenck C H, Mahowald M W. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP.  Sleep. 2002;  25(2) 120-138
  • 23 Gagnon J F, Postuma R B, Mazza S, Doyon J, Montplaisir J. Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases.  Lancet Neurol. 2006;  5(5) 424-432
  • 24 Provini F, Plazzi G, Montagna P, Lugaresi E. The wide clinical spectrum of nocturnal frontal lobe epilepsy.  Sleep Med Rev. 2000;  4(4) 375-386

Alp Sinan BaranM.D. 

Director, Sleep Disorders Center, University of Mississippi Medical Center

2500 North State Street, Jackson, MS 39216

Email: abaran@psychiatry.umsmed.edu