初步经验和建立嗜睡症委员会：复杂嗜睡症病例的多学科方法

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine Pub Date : 2025-08-07 DOI:10.1016/j.sleep.2025.106735

Antara Mallampalli , Ritwick Agrawal , Supriya Singh , Lequan Dang , Shahram Moghtader , Kanta Velamuri , Tara Thomas , Amir Sharafkhaneh

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引用次数: 0

摘要

背景：嗜睡症的诊断和治疗都很复杂。复杂的医疗条件受益于多学科委员会。我们描述了一个嗜睡MDB的结构、实施和初步结果，该MDB旨在改善复杂嗜睡病例的诊断和管理。方法我们在一家大型退伍军人医疗中心实施了每月一次的虚拟病例会议，包括来自睡眠医学、精神病学、神经病学、临床心理学和药学的临床医生。选择有中枢性嗜睡障碍、诊断不确定或管理挑战的患者进行讨论。介绍提供者总结了病人的病史、诊断和治疗问题。一个多学科小组审查了每个病例，并将共识建议记录在电子健康记录中。结果在2年多的时间里，33例独特的患者出现。最终诊断为1型发作性睡病（9/33）、2型发作性睡病（9/33）、特发性嗜睡症（6/33）和原发性阻塞性睡眠呼吸暂停（6/33）。共病精神疾病（例如15/33的抑郁症，9/33的创伤后应激障碍或PTSD）和阻塞性睡眠呼吸暂停（18/33）很常见。委员会建议对8/33名患者进行药物治疗，对5/33名患者进行心理健康转诊，对8/33名患者进行进一步诊断测试。临床医生的反馈表明，提高了诊断清晰度，加强了合作，并有教育效益，特别是对睡眠医学学员。结论建立嗜睡症MDB是可行的，可促进协同护理，提高对复杂嗜睡症患者的诊断准确性和治疗方案，并加强培训生教育。未来的方向包括衡量治疗结果，评估护理障碍，跟踪临床反应，并扩展到更大规模的操作。

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Initial experience and establishment of a hypersomnia board: A multidisciplinary approach to complex hypersomnia cases

Background

Hypersomnia disorders are complex both diagnostically and management wise. Complex medical conditions benefit from multidisciplinary board (MDB). We describe the structure, implementation, and preliminary outcomes of a hypersomnia MDB established to improve diagnosis and management of complex hypersomnia cases.

Methods

We implemented a monthly virtual case-based conference at a large VA medical center, involving clinicians from sleep medicine, psychiatry, neurology, clinical psychology, and pharmacy. Patients with central hypersomnia disorders, diagnostic uncertainty, or management challenges were selected for discussion. Presenting providers summarized patient histories, diagnostics, and treatment concerns. A multidisciplinary group reviewed each case, and consensus recommendations were documented in the electronic health record.

Results

Over two years, 33 unique patients were presented. Final diagnoses included narcolepsy type 1 (9/33), narcolepsy type 2 (9/33), idiopathic hypersomnia (6/33), and primary obstructive sleep apnea (6/33). Comorbid mental illness (e.g., depression in 15/33, post-traumatic stress disorder or PTSD in 9/33) and obstructive sleep apnea (18/33) were common. The board recommended medication changes in 8/33 patients, mental health referrals in 5/33, and further diagnostic testing in 8/33. Clinician feedback indicated improved diagnostic clarity, enhanced collaboration, and educational benefit, especially for sleep medicine trainees.

Conclusions

Establishing a hypersomnia MDB is feasible and promotes collaborative care, improves diagnostic accuracy and treatment plans for patients with complex hypersomnia, and enhances trainee education. Future directions include measuring treatment outcomes, assessing care barriers, tracking clinical responses over time, and expanding to larger scale operations.

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来源期刊

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.