Daytime sleepiness: when is it normal? When to refer?

Most disorders that cause daytime sleepiness can and should be identified and treated. Physicians should recognize that excessive daytime sleepiness is a symptom with serious consequences, including higher risk of accidents and, in the case of obstructive sleep apnea, hypertension, stroke, myocardial infarction, and death. An algorithm for office-based evaluation, indications for further testing, and sleep lab testing methods are described.