Which diagnosis best fits duration, episodicity, and exclusions?
A
Obstructive sleep apnoea-hypopnoea
Evidence by polysomnography of ≥5 obstructive apnoeas/hypopnoeas per hour of sleep + ≥1 of: nocturnal breathing disturbances (snoring, snorting, gasping, breathing pauses); daytime sleepiness/fatigue/unrefreshing sleep not explained by another disorder; OR ≥15 obstructive apnoeas/hypopnoeas per hour of sleep regardless of accompanying symptoms
Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)
AA. Evidence by polysomnography of ≥5 obstructive apnoeas/hypopnoeas per hour of sleep + ≥1 of: nocturnal breathing disturbances (snoring, snorting, gasping, breathing pauses); daytime sleepiness/fatigue/unrefreshing sleep not explained by another disorder; OR ≥15 obstructive apnoeas/hypopnoeas per hour of sleep regardless of accompanying symptoms
BA. Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)
Common specifiers
AMild; Moderate; Severe
BNarcolepsy Type 1; Narcolepsy Type 2; Narcolepsy due to another medical condition; Mild
Differential flags
ACentral sleep apnoea (different respiratory events; different mechanism); Primary insomnia (no respiratory events; no excessive daytime sleepiness); Hypersomnolence disorder (no respiratory events on PSG)
BHypersomnolence disorder (no cataplexy; normal hypocretin; no MSLT SOREMP pattern); Seizure disorder (cataplexy-like episodes - EEG; no emotional trigger); REM sleep behaviour disorder (acting out dreams, not cataplexy)