Hypersomnolence in focus: a white paper of the 6th Think Tank World Sleep Forum.

Mauro Manconi, Wendy Troxel, Tina Sundelin, Sophia Schiza, Göran Hajak, Luigi Ferini Strambi, Matteo Bradicich, Alessandro Silvani, Poul Jennum, Giuseppe Plazzi, Fabio Pizza, Richard Dodel, Sogol Javaheri, Jean-Louis Pepin, Gert Jan Lammers, Jan Hedner, Claudio Bassetti, Winfried Randerath, David T Plante, Joan Santamaria, Ramin Khatami, Ulf Kallweit, Raphael Heinzer

Journal: Sleep medicine 2025;133():106607

PMID: 40505170

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Abstract

An international expert group (European Sleep Foundation Think Tank) convened in 2022 to discuss the state of the evidence in the domain of hypersomnolence. The expert group considered the current state of knowledge based on the most relevant recent publications, discussed the current challenges in the field and identified future priorities. The purpose of this white paper is to summarize the definition, diagnosis, and pathophysiology of hypersomnolence, the epidemiology, phenotype, and management of hypersomnolence in obstructive sleep apnea and in neurological and psychiatric disorders, and the impact of hypersomnolence on daily activities, workability and health-related quality of life. The key results of the discussion were that: a) hypersomnolence is both prevalent and heterogeneous in its manifestations in a wide variety of pathological conditions encompassing obstructive sleep apnea and neurological and psychiatric disorders; and b) while multiple pathophysiological pathways are potentially involved in hypersomnolence, knowledge of the specific causal factors in individual patients remains undefined, and the specific factors responsible for excessive daytime sleepiness vs. excessive need for sleep remain largely unclear. The clinical implications of these results are the occurrence of important limitations to the development of personalized approaches to diagnosis, prognosis, and management of hypersomnolence, which is essential considering the high societal and personal costs of hypersomnolence, and its substantial adverse impact on quality of life. Research priorities should address these limitations with improved quantification of hypersomnolence and with an evidence base on the costs and benefit of hypersomnolence management in patients with respiratory, neurologic, and psychiatric disorders.

Address: Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. Electronic address: [email protected].; Dept of Neurology, Inselspital, University of Bern, Bern, Switzerland.; Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.; Dept of Geriatric Medicine, University of Duisburg-Essen, Germany.; Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy.; Munich Psychiatry Outpatient Clinic, Munich, Germany; University of Regensburg, Germany.; Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgranska Academy, University of Gothenburg, Gothenburg, Sweden.; Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.; Danish Center for Sleep Medicine, Dept of Clinical Neurophysiology, University of Copenhagen and Danish Technical University, Copenhagen, Denmark.; Professorship for Narcolepsy and Hypersomnolence Research, Faculty of Health, University Witten/Herdecke, Witten, Germany.; Dept of Neurology, Inselspital, University of Bern, Bern, Switzerland; Centre of Sleep Medicine and Sleep Research, Klinik Barmelweid AG, Barmelweid, Switzerland.; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.; University Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, HP2 Laboratory, Grenoble, France.; Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.; Dept of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.; IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.; Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.; Sleep Unit, Dept of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.; Dept of Respiratory and Sleep Medicine, School of Medicine, University of Crete, Greece.; Dept of Psychology, Stockholm University, Stockholm, Sweden; Dept of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.; Division of Social and Economic Wellbeing, RAND, Pittsburgh, PA, USA.; Sleep Medicine Unit, Neurocenter of Italian Switzerland, Civic Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.

DOI: 10.1016/j.sleep.2025.106607

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MeSH Terms: Humans, Disorders of Excessive Somnolence, Quality of Life, Sleep Apnea, Obstructive, Mental Disorders