title: French consensus. Management of patients with hypersomnia: Which strategy?
abstract: Central hypersomnias principally involves type 1 narcolepsy (NT1), type 2 narcolepsy (NT2) and idiopathic hypersomnia (IH). Despite great progress made in understanding the physiopathology of NT1 with low cerebrospinal fluid hypocretin-1 levels, current treatment remains symptomatic. The same applies to NT2 and IH, for which the physiopathology is still largely unknown. Controlling excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis and disturbed night-time sleep are key therapeutic targets in NT1. For IH and NT2, reducing EDS is the main objective. Based on European and American directives for the treatment of narcolepsy, we propose French recommendations for managing central hypersomnias as well as strategies in the case of drug-resistance. Stimulating treatments target EDS, and Modafinil is the first-line treatment. Other stimulants such as methylphenidate, pitolisant, and exceptionally dextro-amphetamine can be prescribed. Selective serotonin and noradrenaline reuptake inhibitor antidepressants are effective for the management of cataplexy in NT1. Sodium oxybate is an effective treatment for several symptoms, including EDS, cataplexy and disturbed night-time sleep. Treatment of central hypersomnia must also take into consideration frequent cardiovascular, metabolic and psychiatric comorbidities, particularly in NT1. New therapies are currently under study with the development of new stimulants and anti-cataplectics. The next few years will see innovative emerging therapies, based on a physiopathological approach, aiming to restore hypocretinergic transmission or to interrupt the autoimmune processes causing the loss of hypocretin neurons.
authors.affiliation: Centre de référence nationale narcolepsie et hypersomnie idiopathique, 34295 Montpellier cedex 5, France; Unité des troubles du sommeil et de l'éveil, hôpital Gui-De-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1061, 34295 Montpellier, France.
authors.forename: R
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Centre de référence nationale narcolepsie et hypersomnie idiopathique, 34295 Montpellier cedex 5, France; Service des pathologies du sommeil, département R3S, hôpital Pitié-Salpêtrière/Charles-Foix, 75013 Paris, France; Centre de recherche, institut du cerveau et de la moelle épinière, UPMC-Paris 6, Inserm U 1127, CNRS UMR 722, 75013 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Arnulf
authors.affiliation: Service de neurophysiologie clinique, CHU de Poitiers, 86000 Poitiers, France.
authors.forename: X
authors.initials: X
authors.lastname: Drouot
authors.affiliation: Centre de référence nationale narcolepsie et hypersomnie idiopathique, 34295 Montpellier cedex 5, France; Centre du sommeil pédiatrique, CHU Robert-Debré, 75019 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Lecendreux
authors.affiliation: Centre de référence nationale narcolepsie et hypersomnie idiopathique, 34295 Montpellier cedex 5, France; Unité des troubles du sommeil et de l'éveil, hôpital Gui-De-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Inserm U1061, 34295 Montpellier, France. Electronic address: ydauvilliers@yahoo.fr.
authors.forename: Y
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D003943:Diagnostic Techniques, Neurological; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005602:France / Q000453:epidemiology; D006801:Humans; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D012720:Severity of Illness Index
keywords: Antidepressants; Cataplexy; Excessive daytime sleepiness; Idiopathic hypersomnia; Narcolepsy; Sodium oxybate; Stimulant; Treatment