32 Tobacco consumption withdrawal in a heavy cigarette smoker was reported to provoke Epacadostat in vitro excessive daytime sleepiness with an impairment of work performance, which was successfully treated with modafinil.33 Hypersomnia associated with psychiatric disorders In contrast to insomnia, excessive daytime sleepiness is rarely associated with psychiatric disorders such as major depression or major mood disorders.34 However, no specific sleep disturbance can be evidenced and no substance can be blamed for it. In addition, MSLT is mostly normal; therefore, the diagnosis of hypersomnia in these conditions is

still subject to controversy with a more probable diagnosis of fatigue. In the northern countries of the northern Inhibitors,research,lifescience,medical hemisphere, seasonal affective disorders associate hypersomnia with anxiety, irritability, sadness, sugar bulimia, and increase in body weight.35 Hypersomnia associated Inhibitors,research,lifescience,medical with neurological disorders A number of neurological affections may be accompanied by excessive daytime sleepiness. Brain tumors36 or stroke37 that provoke lesions or a dysfunction of the thalamus, hypothalamus,

and brain stem can cause hypersomnia. For example, cases of symptomatic narcolepsy have been described as being associated with such lesions. Neurodegenerative conditions, Alzheimer’s disease, Parkinson’s disease, or multisystem atrophies will often provoke hypersomnia.36 Inhibitors,research,lifescience,medical In such associations, the main causes of hypersomnia, such as sleep apnea syndromes, medications, and periodic leg movements, should be explored. Neuromuscular diseases may provoke breathing disorders Inhibitors,research,lifescience,medical and predispose to abnormal sleepiness. Myotonic dystrophy is of particular interest, and is often associated with hypersomnia with SOREMP.38

Inhibitors,research,lifescience,medical Posttraumatic hypersomnia Abnormal sleepiness may be observed within 6 to 18 months of head trauma. Clinically related to idiopathic hypersomnia, it may be associated with headaches, memory loss, and lack of concentration.39 Its course depends on the location and the extent of the initial lesions. Infection and hypersomnia Although the initial description of von Economo’s lethargic encephalitis in patients who suffered from pharyngitis dates back to 1917,40 the influence of bacterial agents on sleep was revealed 20 to 30 years ago, Thalidomide when the pyrogenic and hypnogenic actions of muramyl peptides and endotoxin (bacterial lipopolysaccharides) were described.41,42 The hypnogenic effect was recently extended to the viral envelope glycoproteins. This action may be mediated by host immune reactions. Several cytokines are pyrogenic and somnogenic, such as tumor necrosis factor-α, interferon-p, and interleukin-β. However, sleep has rarely been analyzed in infectious patients, due to the general emergency aspects of diseases such as meningitis or severe viral infection.