Bucurescu Vlad, Peter-Derex Laure, Fantini Maria Livia, Putois Benjamin
Faculty of Psychology, UniDistance Suisse, 3900 Brig, Switzerland.
Sleep Medicine and Respiratory Disease Center, Croix-Rousse Hospital, CHU of Lyon, 103 Gd Rue de la Croix-Rousse, 69000 Lyon, France.
Clocks Sleep. 2025 Aug 15;7(3):43. doi: 10.3390/clockssleep7030043.
Hypersomnia may be classified as primary or secondary, with secondary hypersomnia arising from a variety of underlying causes. Thus, according to ICSD3-TR classification, the diagnosis of idiopathic hypersomnia (IH) is established based on (1) excessive daytime sleepiness (EDS); (2) electrophysiological findings including either a mean sleep latency of less than 8 min on the Multiple Sleep Latency Test (MSLT) or increased total sleep (≥11 h) on 24 h polysomnography; and (3) systematic elimination of other potential etiologies, including sleep deprivation, substances, and medical, psychiatric (notably mood disorders), or sleep disorders. Nevertheless, the clinical heterogeneity observed in IH fuels an ongoing debate, reflecting the limited understanding of its underlying pathophysiological mechanisms. This report describes the case of a patient presenting with a clinical and polysomnographic phenotype of IH (MSLT < 8 min). A comprehensive psychopathological evaluation was performed to explore the possibility of secondary hypersomnia, which revealed features consistent with complex post-traumatic stress disorder (c-PTSD). Psychotherapy focused on c-PTSD was administered with positive and objective results in hypersomnolence/EDS. This clinical improvement suggests a potential relationship between psychological trauma and hypersomnia, a connection that is rarely described in the literature and warrants further investigation. This case highlights the need for a comprehensive assessment of secondary factors, particularly complex trauma, even in the presence of a clinical and polysomnographic phenotype consistent with IH.
发作性睡病可分为原发性或继发性,继发性发作性睡病由多种潜在原因引起。因此,根据国际睡眠障碍分类第三版(ICSD3-TR)的分类,特发性发作性睡病(IH)的诊断基于以下几点:(1)日间过度嗜睡(EDS);(2)电生理检查结果,包括多次睡眠潜伏期试验(MSLT)的平均睡眠潜伏期小于8分钟,或24小时多导睡眠图显示总睡眠时间增加(≥11小时);(3)系统排除其他潜在病因,包括睡眠剥夺、物质使用以及医学、精神(尤其是情绪障碍)或睡眠障碍。然而,IH中观察到的临床异质性引发了持续的争论,这反映出对其潜在病理生理机制的理解有限。本报告描述了一例具有IH临床和多导睡眠图表型(MSLT<8分钟)的患者。进行了全面的精神病理学评估以探究继发性发作性睡病的可能性,结果显示其特征与复杂性创伤后应激障碍(c-PTSD)一致。针对c-PTSD进行的心理治疗在改善过度嗜睡/EDS方面取得了积极且客观的效果。这种临床改善表明心理创伤与发作性睡病之间可能存在关联,这种关联在文献中鲜有描述,值得进一步研究。该病例强调,即使存在与IH一致的临床和多导睡眠图表型,也需要对继发性因素,尤其是复杂创伤进行全面评估。