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Update on hypersomnias of central origin

Drakatos, Panagisa; Leschziner, Guy D.a,b,c

Current Opinion in Pulmonary Medicine: November 2014 - Volume 20 - Issue 6 - p 572–580
doi: 10.1097/MCP.0000000000000098
SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee K. Brown and Adrian Williams

Purpose of review To describe the multiple clinical aspects of hypersomnias of central origin. Emphasis is given to the new pathophysiological pathways and treatment options described in the current literature.

Recent findings Narcolepsy is the most recognized of the hypersomnias of central origin. Hypocretin deficiency appears to underlie narcolepsy with cataplexy, and infections and vaccinations have been associated with disease onset. Targeted therapeutic approaches are currently underway. A putative naturally occurring constituent in the cerebrospinal fluid of patients with non-narcoleptic primary hypersomnias, able to stimulate γ-aminobutyric acid alpha receptors and induce sleep, has recently been postulated. Neuroimaging has also provided more insight into the pathophysiology of Kleine–Levin syndrome. Sleep deprivation is currently recognized as a major differential diagnosis.

Summary Excessive daytime sleepiness is the cardinal symptom of the hypersomnias of central origin, with major impact on the quality of life. It is important that clinicians be able to recognize these conditions, so that appropriate management or onward referral is expedited.

aSleep Disorders Centre

bDepartment of Neurology, Guy's and St Thomas’ NHS Foundation Trust

cDepartment of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, UK

Correspondence to Guy D. Leschziner, PhD, FRCP, Department of Neurology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Tel: +44 207 188 4100; fax: +44 207 188 0939; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins