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Drowsiness

MedGen UID:
4390
Concept ID:
C0013144
Finding
Synonyms: Abnormal drowsiness; Drowsiness, function; Drowsy; Mental status, drowsy; Sleepiness; Sleepy; Somnolence; Somnolence (sleepiness)
SNOMED CT: Drowsiness (79519003); Sleepiness (79519003); Drowsiness, function (79519003); Mental status, drowsy (271782001); Somnolence (sleepiness) (271782001); Sleepy (271782001); Drowsiness (271782001); Sleepiness (271782001); Drowsy (271782001)
 
HPO: HP:0002329

Definition

Abnormal feeling of sleepiness or difficulty staying awake. [from HPO]

Conditions with this feature

Hypervalinemia
MedGen UID:
120652
Concept ID:
C0268573
Disease or Syndrome
Valinemia is an inborn error of metabolism characterized clinically by vomiting, feeding difficulties, hypotonia, and developmental delay, and biochemically by high concentrations of valine in serum and urine (Wada, 1965).
Alexander disease
MedGen UID:
78724
Concept ID:
C0270726
Disease or Syndrome
Alexander disease, a progressive disorder of cerebral white matter caused by a heterozygous GFAP pathogenic variant, comprises a continuous clinical spectrum most recognizable in infants and children and a range of nonspecific neurologic manifestations in adults. This chapter discusses the spectrum of Alexander disease as four forms: neonatal, infantile, juvenile, and adult. The neonatal form begins in the first 30 days after birth with neurologic findings (e.g., hypotonia, hyperexcitability, myoclonus) and/or gastrointestinal manifestations (e.g., gastroesophageal reflux, vomiting, failure to thrive), followed by severe developmental delay and regression, seizures, megalencephaly, and typically death within two years. The infantile form is characterized by variable developmental issues: initially some have delayed or plateauing of acquisition of new skills, followed in some by a loss of gross and fine motor skills and language during in the first decade or in others a slow disease course that spans decades. Seizures, often triggered by illness, may be less frequent/severe than in the neonatal form. The juvenile form typically presents in childhood or adolescence with clinical and imaging features that overlap with the other forms. Manifestations in early childhood are milder than those in the infantile form (e.g., mild language delay may be the only developmental abnormality or, with language acquisition, hypophonia or nasal speech may alter the voice, often prior to appearance of other neurologic features). Vomiting and failure to thrive as well as scoliosis and autonomic dysfunction are common. The adult form is typically characterized by bulbar or pseudobulbar findings (palatal myoclonus, dysphagia, dysphonia, dysarthria or slurred speech), motor/gait abnormalities with pyramidal tract signs (spasticity, hyperreflexia, positive Babinski sign), or cerebellar abnormalities (ataxia, nystagmus, or dysmetria). Others may have hemiparesis or hemiplegia with a relapsing/remitting course or slowly progressive quadriparesis or quadriplegia. Other neurologic features can include sleep apnea, diplopia or disorders of extraocular motility, and autonomic dysfunction.
Leucine-induced hypoglycemia
MedGen UID:
82888
Concept ID:
C0271714
Disease or Syndrome
Migraine, familial hemiplegic, 1
MedGen UID:
331388
Concept ID:
C1832884
Disease or Syndrome
Familial hemiplegic migraine (FHM) falls within the category of migraine with aura. In migraine with aura (including FHM) the neurologic symptoms of aura are unequivocally localizable to the cerebral cortex or brain stem and include visual disturbance (most common), sensory loss (e.g., numbness or paresthesias of the face or an extremity), and dysphasia (difficulty with speech). FHM must include motor involvement, such as hemiparesis (weakness of an extremity). Hemiparesis occurs with at least one other symptom during FHM aura. Neurologic deficits with FHM attacks can be prolonged for hours to days and may outlast the associated migrainous headache. FHM is often earlier in onset than typical migraine, frequently beginning in the first or second decade; the frequency of attacks tends to decrease with age. Approximately 40%-50% of families with CACNA1A-FHM have cerebellar signs ranging from nystagmus to progressive, usually late-onset mild ataxia.
Migraine, familial hemiplegic, 2
MedGen UID:
355962
Concept ID:
C1865322
Disease or Syndrome
Familial hemiplegic migraine (FHM) falls within the category of migraine with aura. In migraine with aura (including FHM) the neurologic symptoms of aura are unequivocally localizable to the cerebral cortex or brain stem and include visual disturbance (most common), sensory loss (e.g., numbness or paresthesias of the face or an extremity), and dysphasia (difficulty with speech). FHM must include motor involvement, such as hemiparesis (weakness of an extremity). Hemiparesis occurs with at least one other symptom during FHM aura. Neurologic deficits with FHM attacks can be prolonged for hours to days and may outlast the associated migrainous headache. FHM is often earlier in onset than typical migraine, frequently beginning in the first or second decade; the frequency of attacks tends to decrease with age. Approximately 40%-50% of families with CACNA1A-FHM have cerebellar signs ranging from nystagmus to progressive, usually late-onset mild ataxia.
Congenital nongoitrous hypothryoidism 6
MedGen UID:
482447
Concept ID:
C3280817
Disease or Syndrome
Any hypothyroidism, congenital, nongoitrous in which the cause of the disease is a mutation in the THRA gene.
Epilepsy, hot water, 1
MedGen UID:
1636069
Concept ID:
C4551550
Disease or Syndrome
Mitochondrial complex 1 deficiency, nuclear type 2
MedGen UID:
1648466
Concept ID:
C4748737
Disease or Syndrome
Leukoencephalopathy, acute reversible, with increased urinary alpha-ketoglutarate
MedGen UID:
1677730
Concept ID:
C5193068
Disease or Syndrome
Acute reversible leukoencephalopathy with increased urinary alpha-ketoglutarate (ARLIAK) is an autosomal recessive disorder characterized by acute reversible neurologic deterioration in the context of a febrile illness. The disorder is associated with transient leukoencephalopathy on brain imaging concurrent with the acute episode, as well as persistently increased excretion of dicarboxylic acids, particularly alpha-ketoglutarate (summary by Dewulf et al., 2019).

Professional guidelines

PubMed

Kawauchi H, Yanai K, Wang DY, Itahashi K, Okubo K
Int J Mol Sci 2019 Jan 8;20(1) doi: 10.3390/ijms20010213. PMID: 30626077Free PMC Article
Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A
Cochrane Database Syst Rev 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. PMID: 29781504Free PMC Article
Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP
Cochrane Database Syst Rev 2012 Mar 14;2012(3):CD009234. doi: 10.1002/14651858.CD009234.pub2. PMID: 22419342Free PMC Article

Recent clinical studies

Etiology

Kim M, Seol J, Sato T, Fukamizu Y, Sakurai T, Okura T
Nutrients 2022 Feb 11;14(4) doi: 10.3390/nu14040755. PMID: 35215405Free PMC Article
Głowacka K, Wiela-Hojeńska A
Int J Mol Sci 2021 May 13;22(10) doi: 10.3390/ijms22105146. PMID: 34067981Free PMC Article
Penzel T, Fietze I, Schöbel C, Veauthier C
Sleep Med Clin 2019 Dec;14(4):463-468. doi: 10.1016/j.jsmc.2019.08.004. PMID: 31640874
Rao TP, Ozeki M, Juneja LR
J Am Coll Nutr 2015;34(5):436-47. Epub 2015 Mar 11 doi: 10.1080/07315724.2014.926153. PMID: 25759004
Powell NB, Chau JK
Med Clin North Am 2010 May;94(3):531-40. doi: 10.1016/j.mcna.2010.02.002. PMID: 20451030

Diagnosis

Arnulf I, Leu-Semenescu S, Dodet P
Sleep Med Clin 2022 Sep;17(3):379-398. Epub 2022 Sep 8 doi: 10.1016/j.jsmc.2022.06.016. PMID: 36150801
Penzel T, Fietze I, Schöbel C, Veauthier C
Sleep Med Clin 2019 Dec;14(4):463-468. doi: 10.1016/j.jsmc.2019.08.004. PMID: 31640874
Saini AG, Vyas S, Singhi P
J Infect Public Health 2017 Nov-Dec;10(6):884-885. Epub 2017 Feb 21 doi: 10.1016/j.jiph.2016.11.019. PMID: 28233725
Gallup AC, Gallup GG Jr
Physiol Behav 2008 Sep 3;95(1-2):10-6. Epub 2008 May 13 doi: 10.1016/j.physbeh.2008.05.003. PMID: 18550130
Bazil CW
Semin Neurol 2002 Sep;22(3):321-7. doi: 10.1055/s-2002-36651. PMID: 12528057

Therapy

Wang L, Hong PJ, May C, Rehman Y, Oparin Y, Hong CJ, Hong BY, AminiLari M, Gallo L, Kaushal A, Craigie S, Couban RJ, Kum E, Shanthanna H, Price I, Upadhye S, Ware MA, Campbell F, Buchbinder R, Agoritsas T, Busse JW
BMJ 2021 Sep 8;374:n1034. doi: 10.1136/bmj.n1034. PMID: 34497047
Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A
Cochrane Database Syst Rev 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. PMID: 29781504Free PMC Article
Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M
Cochrane Database Syst Rev 2015 Jul 30;2015(7):CD001751. doi: 10.1002/14651858.CD001751.pub3. PMID: 26224322Free PMC Article
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J
JAMA 2015 Jun 23-30;313(24):2456-73. doi: 10.1001/jama.2015.6358. PMID: 26103030
Rao TP, Ozeki M, Juneja LR
J Am Coll Nutr 2015;34(5):436-47. Epub 2015 Mar 11 doi: 10.1080/07315724.2014.926153. PMID: 25759004

Prognosis

Schwarz C, Gaspar J, Yousefian R
Traffic Inj Prev 2023;24(sup1):S100-S104. doi: 10.1080/15389588.2023.2164839. PMID: 37267009
Corbett MA, Newman DG
Aerosp Med Hum Perform 2022 Apr 1;93(4):354-361. doi: 10.3357/AMHP.5275.2022. PMID: 35354514
Cai AWT, Manousakis JE, Lo TYT, Horne JA, Howard ME, Anderson C
Sleep Med Rev 2021 Dec;60:101533. Epub 2021 Aug 4 doi: 10.1016/j.smrv.2021.101533. PMID: 34461582
Ordóñez Gallego A, González Barón M, Espinosa Arranz E
Clin Transl Oncol 2007 May;9(5):298-307. doi: 10.1007/s12094-007-0057-9. PMID: 17525040
Leonard JV, Morris AA
Semin Neonatol 2002 Feb;7(1):27-35. doi: 10.1053/siny.2001.0085. PMID: 12069536

Clinical prediction guides

Corbett MA, Newman DG
Aerosp Med Hum Perform 2022 Apr 1;93(4):354-361. doi: 10.3357/AMHP.5275.2022. PMID: 35354514
Kim M, Seol J, Sato T, Fukamizu Y, Sakurai T, Okura T
Nutrients 2022 Feb 11;14(4) doi: 10.3390/nu14040755. PMID: 35215405Free PMC Article
Han Y, Li P, Miao M, Tao Y, Kang X, Zhang J
BMC Anesthesiol 2022 Feb 16;22(1):49. doi: 10.1186/s12871-022-01588-7. PMID: 35172727Free PMC Article
Jacobé de Naurois C, Bourdin C, Stratulat A, Diaz E, Vercher JL
Accid Anal Prev 2019 May;126:95-104. Epub 2017 Dec 6 doi: 10.1016/j.aap.2017.11.038. PMID: 29203032
Pyszora A, Budzyński J, Wójcik A, Prokop A, Krajnik M
Support Care Cancer 2017 Sep;25(9):2899-2908. Epub 2017 May 16 doi: 10.1007/s00520-017-3742-4. PMID: 28508278Free PMC Article

Recent systematic reviews

Fiore JF Jr, El-Kefraoui C, Chay MA, Nguyen-Powanda P, Do U, Olleik G, Rajabiyazdi F, Kouyoumdjian A, Derksen A, Landry T, Amar-Zifkin A, Bergeron A, Ramanakumar AV, Martel M, Lee L, Baldini G, Feldman LS
Lancet 2022 Jun 18;399(10343):2280-2293. doi: 10.1016/S0140-6736(22)00582-7. PMID: 35717988
Ball NS, Knable BM, Relich TA, Smathers AN, Gionfriddo MR, Nemecek BD, Montepara CA, Guarascio AJ, Covvey JR, Zimmerman DE
Clin Toxicol (Phila) 2022 Aug;60(8):892-901. Epub 2022 Apr 20 doi: 10.1080/15563650.2022.2063135. PMID: 35442125
Wang L, Hong PJ, May C, Rehman Y, Oparin Y, Hong CJ, Hong BY, AminiLari M, Gallo L, Kaushal A, Craigie S, Couban RJ, Kum E, Shanthanna H, Price I, Upadhye S, Ware MA, Campbell F, Buchbinder R, Agoritsas T, Busse JW
BMJ 2021 Sep 8;374:n1034. doi: 10.1136/bmj.n1034. PMID: 34497047
Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A
Cochrane Database Syst Rev 2018 May 21;5(5):CD000331. doi: 10.1002/14651858.CD000331.pub4. PMID: 29781504Free PMC Article
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J
JAMA 2015 Jun 23-30;313(24):2456-73. doi: 10.1001/jama.2015.6358. PMID: 26103030

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