Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline
- PMID: 34743789
- PMCID: PMC8636351
- DOI: 10.5664/jcsm.9328
Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline
Abstract
Introduction: This guideline establishes clinical practice recommendations for the treatment of central disorders of hypersomnolence in adults and children.
Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths to each recommendation, based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force provided a summary of the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.
Recommendations: The following recommendations are intended to guide clinicians in choosing a specific treatment for central disorders of hypersomnolence in adults and children. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "conditional" recommendation (ie, "We suggest…") is one that requires that the clinician use clinical knowledge and experience and strongly consider the individual patient's values and preferences to determine the best course of action. Under each disorder, strong recommendations are listed in alphabetical order followed by the conditional recommendations in alphabetical order. The section on adult patients with hypersomnia because of medical conditions is categorized based on the clinical and pathological subtypes identified in ICSD-3. The interventions in all the recommendation statements were compared to no treatment.
1: We recommend that clinicians use modafinil for the treatment of narcolepsy in adults. (STRONG).
2: We recommend that clinicians use pitolisant for the treatment of narcolepsy in adults. (STRONG).
3: We recommend that clinicians use sodium oxybate for the treatment of narcolepsy in adults. (STRONG).
4: We recommend that clinicians use solriamfetol for the treatment of narcolepsy in adults. (STRONG).
5: We suggest that clinicians use armodafinil for the treatment of narcolepsy in adults. (CONDITIONAL).
6: We suggest that clinicians use dextroamphetamine for the treatment of narcolepsy in adults. (CONDITIONAL).
7: We suggest that clinicians use methylphenidate for the treatment of narcolepsy in adults. (CONDITIONAL).
8: We recommend that clinicians use modafinil for the treatment of idiopathic hypersomnia in adults. (STRONG).
9: We suggest that clinicians use clarithromycin for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).
10: We suggest that clinicians use methylphenidate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).
11: We suggest that clinicians use pitolisant for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).
12: We suggest that clinicians use sodium oxybate for the treatment of idiopathic hypersomnia in adults. (CONDITIONAL).
13: We suggest that clinicians use lithium for the treatment of Kleine-Levin syndrome in adults. (CONDITIONAL).
14: We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to dementia with Lewy bodies in adults. (CONDITIONAL).
15: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL).
16: We suggest that clinicians use sodium oxybate for the treatment of hypersomnia secondary to Parkinson's disease in adults. (CONDITIONAL).
17: We suggest that clinicians use armodafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL).
18: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to traumatic brain injury in adults. (CONDITIONAL).
19: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to myotonic dystrophy in adults. (CONDITIONAL).
20: We suggest that clinicians use modafinil for the treatment of hypersomnia secondary to multiple sclerosis in adults. (CONDITIONAL).
21: We suggest that clinicians use modafinil for the treatment of narcolepsy in pediatric patients. (CONDITIONAL).
22: We suggest that clinicians use sodium oxybate for the treatment of narcolepsy in pediatric patients. (CONDITIONAL).
Citation: Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(9):1881-1893.
Keywords: Kleine-Levin syndrome; Parkinson’s disease; dementia with lewy bodies; hypersomnia; idiopathic hypersomnia; multiple sclerosis; myotonic dystrophy; narcolepsy; traumatic brain injury; treatment.
© 2021 American Academy of Sleep Medicine.
Conflict of interest statement
All authors have seen and approved the article. The development of this article was funded by the American Academy of Sleep Medicine. Dr. Rowley and Dr. Trotti serve on the AASM Board of Directors. Ms. Hashmi is employed by the American Academy of Sleep Medicine. Dr. Maski has research funding from the National Institute of Neurological Disorders and Stroke (K23 NS104267-01A1) and a Jazz Pharmaceuticals investigator-initiated grant and was a site Principal Investigator for a pediatric narcolepsy sodium oxybate clinical trial sponsored by Jazz Pharmaceuticals; has been a consultant for Harmony Biosciences (March 2018–March 2019), Jazz Pharmaceuticals (June 2017–August 2020 and January 2021), Roche Pharmaceuticals (November 2017), and Alkermes (May 2020 and January 2021); and was a speaker for a continuing medical education program funded by Harmony Biosciences entitled “Patient, Provider, and Caregiver Connection: A Patient’s Journey Living with Narcolepsy” on February 23, 2021. Because of her conflicts, Dr. Maski did not participate in developing or voting on final recommendations for sodium oxybate, solriamfetol, and pitolisant. Dr. Watson was a consultant for Harmony Biosciences (September 2018–December 2020) and Jazz Pharmaceuticals (October 2018–April 2019). Dr. Trotti has research funding from the American Academy of Sleep Medicine Foundation and is a Principal Investigator for the National Institute of Neurological Disorders (R01 NS111280). The other authors do not report any conflicts of interest.
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