title: Excessive sleepiness: under-recognized and essential marker for sleep/wake disorder management.
abstract: BACKGROUND
  Research during the past few decades has provided substantial evidence indicating that excessive sleepiness (ES) and associated sleep/wake disorders can result in significant morbidity and mortality. However, symptomatology (e.g., ES) and the relationships among common morbidities (e.g., cardiovascular disease, metabolic disorders, mood impairment) and sleep/wake disorders remain under-recognized in clinical practice, particularly in primary care. Yet assessment of sleep/wakefulness and associated symptoms can often be easily conducted in the primary care setting, providing valuable information to facilitate the diagnosis and management of sleep/wake disorders.
  
  
  OBJECTIVE
  To provide a conceptual and educational framework that helps primary care physicians comprehensively assess, differentially diagnosis, and appropriately manage patients presenting with ES or ES-related sleep/wake disorders.
  
  
  METHODS
  Comprised of six sleep specialists and six primary care physicians, the Sleep/Wake Disorders Working Group (SWG) used a modified, two-round Delphi approach to create and harmonize consensus recommendations for the assessment, diagnosis, treatment, and ongoing management of patients with common sleep/wake disorders related to ES.
  
  
  RESULTS
  After a review of the relevant literature, the SWG arrived at consensus on a number of clinical recommendations for the assessment and management ES and some of the most commonly associated sleep/wake disorders. Ten consensus statements – five each for assessment/diagnosis and treatment/ongoing care – were created for ES, insomnia, obstructive sleep apnea, circadian rhythm disorders, restless legs syndrome, and narcolepsy.
  
  
  CONCLUSIONS
  ES and ES-related sleep/wake disorders are commonly encountered in the primary care setting. By providing an educational framework for primary care physicians, the SWG hopes to improve patient outcomes by emphasizing recognition, prompt diagnosis, and appropriate ongoing management of ES and associated sleep/wake disorders.
authors.affiliation: Henry Ford Hospital, Sleep Disorders Center, Detroit, MI 48202, USA. TRoth1@hfhs.org
authors.forename: T
authors.initials: T
authors.lastname: Roth
authors.forename: R K
authors.initials: RK
authors.lastname: Bogan
authors.forename: L
authors.initials: L
authors.lastname: Culpepper
authors.forename: K
authors.initials: K
authors.lastname: Doghramji
authors.forename: P
authors.initials: P
authors.lastname: Doghramji
authors.forename: C
authors.initials: C
authors.lastname: Drake
authors.forename: J H
authors.initials: JH
authors.lastname: Grauke
authors.forename: P
authors.initials: P
authors.lastname: Knoepflmacher
authors.forename: M
authors.initials: M
authors.lastname: Sateia
authors.forename: D
authors.initials: D
authors.lastname: Silvershein
authors.forename: M J
authors.initials: MJ
authors.lastname: Thorpy
mesh_terms: D015415:Biomarkers / Q000032:analysis; D032921:Consensus; D003937:Diagnosis, Differential; D006801:Humans; D008954:Models, Biological; D012890:Sleep / Q000502:physiology*; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D015415:Biomarkers