Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
Sleep Medicine Center, IRCCS Neuromed, Pozzilli, IS, Italy.
Sleep Breath. 2020 Jun;24(2):413-424. doi: 10.1007/s11325-019-01921-4. Epub 2019 Aug 23.
Excessive daytime sleepiness (EDS) and fatigue are some of the most frequent symptoms in neurological diseases and could impact on quality of life by increasing the risk of accidents and generally affecting daily life activities. In this review, we will examine the variety of causes responsible for EDS in neurological diseases, including nocturnal sleep alterations, CNS pathological abnormalities with alterations in arousal and/or REM regulation systems, circadian rhythms disorders, drugs, and comorbid psychiatric or primary sleep disorders. Among neurological diseases, epilepsy, dementia, Parkinson disease, multiple sclerosis, and myotonic dystrophies represented a model for these interactions between EDS and neurological diseases. A complete diagnostic workup in neurological patients with EDS should be undertaken since EDS can worsen many different aspects such as psychiatric symptoms, cognitive deficit, and in some cases, the severity of the neurological disease per se. Moreover, quality of life and risk of accidents are dependent on EDS. An individualized approach to this symptom in neurological patients should be considered with a focus on modifiable causes such as SDB, psychiatric comorbidities, and drugs. When considering EDS and fatigue in neurological diseases, close attention to lifestyle and sleep hygiene is advisable. A critical review of ongoing pharmacological therapy should not be overlooked. Possible diagnosis and treatment of SDB should be always considered.
白天过度嗜睡（EDS）和疲劳是一些最常见的神经系统疾病的症状，通过增加事故风险和普遍影响日常生活活动，可能会影响生活质量。在这篇综述中，我们将检查导致神经系统疾病中 EDS 的各种原因，包括夜间睡眠改变、CNS 病理异常伴觉醒和/或 REM 调节系统改变、昼夜节律紊乱、药物以及合并的精神或原发性睡眠障碍。在神经系统疾病中，癫痫、痴呆、帕金森病、多发性硬化症和肌强直性营养不良症代表了 EDS 与神经系统疾病之间这些相互作用的模型。对于 EDS 的神经科患者应进行全面的诊断评估，因为 EDS 会使许多不同方面恶化，如精神症状、认知缺陷，在某些情况下还会使神经系统疾病本身的严重程度恶化。此外，生活质量和事故风险取决于 EDS。对神经科患者的这种症状应考虑个体化的治疗方法，重点是可改变的原因，如 SDB、精神合并症和药物。在考虑神经系统疾病中的 EDS 和疲劳时，应注意生活方式和睡眠卫生。不应忽视对正在进行的药物治疗的批判性审查。应始终考虑 SDB 的可能诊断和治疗。
