Kothare Sanjeev V, Kaleyias Joseph
Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Sleep Center for Children, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Semin Pediatr Neurol. 2008 Jun;15(2):61-9. doi: 10.1016/j.spen.2008.03.003.
Excessive sleepiness is defined as sleepiness that occurs in a situation when an individual would usually be expected to be awake and alert. Hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness (EDS) or prolonged nighttime sleep, which affects the everyday life of the patient. Clinical surveys have reported that EDS is a complaint observed in up to 68% of normal high school children, with a negative impact in academic achievement and extracurricular activity. Clues toward recognizing childhood daytime sleepiness may be sleeping longer hours than expected for age, daytime naps beyond normal for age, being sleepy when other children of the same age are active and alert, and sleeping more than previously. Causes of EDS are arbitrarily divided into 3 categories: insufficient nighttime sleep, fragmented nighttime sleep, and increased drive of sleep. A list of various causes of EDS in children has been discussed. A detailed history along with examination of the upper airway is crucial in evaluating patients with EDS. Appropriate screening tools such as sleep logs, sleepiness scales, and sleep questionnaires further help in identifying and quantifying the degree of sleepiness. Confirmatory tests such as polysomnography, multiple sleep latency test, and actigraphy along with referral to a sleep physician may be necessary in appropriate cases. Details of other ancillary testing such use of cerebrospinal fluid orexin levels, HLA subtyping, and so on have also been provided.
过度嗜睡被定义为在个体通常预期清醒且警觉的情况下出现的嗜睡。发作性睡病的特征是反复出现白天过度嗜睡（EDS）或夜间睡眠延长，这会影响患者的日常生活。临床调查报道，高达68%的正常高中学生存在EDS主诉，这对学业成绩和课外活动有负面影响。识别儿童白天嗜睡的线索可能包括睡眠时间比同龄人预期的长、白天小睡超过同龄人正常水平、在同龄其他孩子活跃且警觉时感到困倦以及比以前睡得更多。EDS的原因可任意分为三类：夜间睡眠不足、夜间睡眠碎片化以及睡眠驱动力增加。已讨论了儿童EDS的各种原因列表。详细病史以及对上气道的检查对于评估EDS患者至关重要。适当的筛查工具，如睡眠日志、嗜睡量表和睡眠问卷，有助于进一步识别和量化嗜睡程度。在适当情况下，可能需要进行多导睡眠图、多次睡眠潜伏期试验和活动记录仪等确证测试，并转诊至睡眠科医生。还提供了其他辅助测试的详细信息，如脑脊液食欲素水平检测、HLA分型等。
