title: Resolution of hypersomnia following identification and treatment of vitamin d deficiency.
abstract: A 28-year-old woman was evaluated for 4 months of excessive daytime sleepiness (EDS), after an overnight polysomnogram (PSG) revealed neither sleep disordered breathing nor a sleep related movement disorder. A full sleep evaluation revealed the presence of heavy daytime napping and pervasive fatigue. Epworth Sleepiness Scale (ESS) Score was 10/24. No features characteristic for depression or narcolepsy were present. Chronic pain in the low back and thighs, as well as chronic daily headaches were identified as potential sleep-disrupting forces. Risk factors for hypovitaminosis D included limited natural sun exposure, dark skin tone, and obesity. A 25-hydroxyvitamin D level was low, at 5.9 ng/mL. Vitamin D supplementation was initiated at a dose of 50,000 IU once weekly, and EDS improved within 2 weeks. One week later, a PSG with next-day multiple sleep latency testing (MSLT) failed to show significant pathology. At follow-up, she reported resolution of thigh pain and headaches, with a significant improvement in her low back pain syndrome. EDS had resolved, and her ESS score was 1/24. Follow-up 25-hydroxyvitamin D level was normal at 39 ng/mL. Mechanisms for her clinical improvement could include enhanced sleep quality due to resolution of hypovitaminosis D-associated noninflammatory myopathy, or a possible immunomodulatory effect of vitamin D decreasing central nervous system (CNS) homeostatic sleep pressure via its effects on tumor necrosis factor-alpha (TNF-α) and/or prostaglandin D2. More research is needed to determine if patients presenting with EDS should be more broadly screened for vitamin D deficiency.
authors.affiliation: Sleep Medicine Program, Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA. dmcca1@lsuhsc.edu
authors.forename: David E
authors.initials: DE
authors.lastname: McCarty
mesh_terms: D000328:Adult; D001774:Blood Chemical Analysis; D003937:Diagnosis, Differential; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017286:Polysomnography / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage*; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D014807:Vitamin D