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Excessive Daytime Sleepiness in Japanese-American Male

History of Present Illness
Patient is a 22-year-old Asian-American male born in the U.S. Patient presents with symptoms of excessive daytime sleepiness (EDS), which have been present for three years, Patient states that he nearly had an automobile accident, and has difficulties at work because of symptoms. He experiences varying levels of alertness during daytime hours, occasionally falls asleep at work, and has difficulties participating in family or social activities. He also experiences disrupted nighttime sleep.

Patient’s Japanese mother, and his younger sister also experience mild degree of sleep disorder symptoms.

Medical History
No other known medical issues

Social history
Patient resides with both parents and teenage sister in a single-family home. He works full-time in a mid-level business management role.

Questions
What presenting symptoms makes you lean towards a narcolepsy diagnosis?
What would be your treatment plan for this patient?

  • from Pulmonologist Connect 1 week 3 days
    Narcolepsy would be on top of my differential. Start with a PSG and MSLT
  • from Doctor Unite 2 weeks 6 days
    Age and symptoms could indicate narcolepsy , I would ask about cataplexy, hypnagogic hallucinations and sleep paralysis .i Would get a sleep study and consider provigil.
  • from Doctor Unite 3 weeks 2 days
    I would first refer for an overnight polysomnogram. Consider a daytime stimulant pending the results of the sleep study ie: Provigil
  • 3 weeks 2 days
    Sleep study would be helpful
  • from Doctor Unite 3 weeks 2 days
    OSA is a much more common and under diagnosed issue. As many others have suggested, the very first thing I would advise is a formal sleep study.
  • from Doctor Unite 3 weeks 2 days
    Sleep study to determine sleep pattern and if sleep apnea is present.
  • from Doctor Unite 3 weeks 2 days
    Would consider narcolepsy, obstructive sleep apnea and possible psychiatric disorder. Needs sleep study, genetic test for narcolepsy.
  • from Doctor Unite 3 weeks 2 days
    Japanese descent,family history and young age favor diagnosis of Narcolepsy but would rule out OSA.
    Suggest MSLT and NPSG.Once Narcolepsy is confirmed treatment with Xywav or Xyrem would be appropriate.
  • from Neurologist Connect 3 weeks 2 days
    The patient’s presenting complaints of excessive daytime sleepiness and disrupted sleep are important features of both narcolepsy and obstructive sleep apnea. Although there is an increased prevalence of narcolepsy in Asian populations, it doesn’t reach the prevalence of sleep-disordered breathing. The patient needs a polysomnogram. If significant sleep-disordered is not present, an MSLT should be performed the following day. Xyrem or Xywav should not be prescribed unless sleep-disordered breathing is ruled out.
  • from Doctor Unite 3 weeks 3 days
    While narcolepsy is a strong possibility, I think obstructive sleep apnea is also on the differential. I agree with getting a polysomnogram. He may be a good candidate for CPAP.
  • from Pulmonologist Connect 3 weeks 3 days
    I think he age, history of EDS, history of disrupted sleep and family history all would point me in the direction of narcolepsy. My first evaluation after history and physical would be a PSG followed by MSLT. Untreated OSA also can present with symptoms that mimic narcolepsy
  • from Doctor Unite 3 weeks 3 days
    His age, family history, and presentation definitely suggests narcolepsy. Other considers also include generalized anxiety and/or PTSD from the MVA. A sleep study is certainly warranted. Therapy, if this is narcolepsy, can include Xywav or Xyrem.
  • from Doctor Unite 3 weeks 3 days
    Sleep study first. Is he normal weight or obese? may need provigil or something similar
  • from Doctor Unite 3 weeks 3 days
    The patient's symptoms of excessive daytime sleepiness, falling asleep at work, and nearly having an automobile accident points towards narcolepsy. I would refer for sleep study. Treatment plan would also include medications such as Xywav or Xyrem. Dosing for Xywav is more flexible vs. Xyrem.
  • from Doctor Unite 3 weeks 3 days
    Age,family history, and daytime patterns especially to the point of near-miss MVC.

    After sleep study would consider provigil to begin
  • from Doctor Unite 3 weeks 3 days
    Narcolepsy is a strong consideration in this patient with the daytime sleepiness and falling asleep at work as well as disruptive sleep patterns. I would recommend a sleep study and consider medication for the patient
  • from Pulmonologist Connect 3 weeks 3 days
    Young
    Japanese mother
    Family history

    Treatment plan:
    Npsg followed by MSLT to confirm diagnosis

    - xyrem for sleep consolidation
    -stimulant for EDS