1157 The Sabbath Sleep-in: an adolescent female with delayed sleep phase disorder, hypersomnolence, and a problematic multiple sleep latency test

Abstract

Introduction: Delayed sleep phase circadian rhythm disorder is common in the adolescent population with an incidence of 7?16%. We report a case of overlapping hypersomnolence and delayed phase circadian rhythm disorder in a 15 year old female with a confounding multiple sleep latency test result. This case highlights the importance of interpreting PSG and MSLT data in the context of the patient's known wake/sleep schedule. Report of Case: A 15 year old female presented with history of worsening daytime sleepiness (Epworth Sleepiness Scale score 19/24) and drop in grades in the background of difficult sleep initiation. She reported daily sleep inertia and long weekend sleep times with concern for idiopathic hypersomnia. Actigraphy showed a delayed sleep pattern as well as a profound pattern of borderline sufficient sleep on school nights of around 7 hours and an exaggerated long time in bed up to 20 hours on Saturday, her Sabbath. Overnight sleep testing demonstrated no sleep disordered breathing with an overnight sleep latency of 46.5 minutes and a prolonged waking in the 1st half of the sleep period resulting in a total sleep time of only 352 minutes. Despite the insufficient sleep, the technician performed multiple sleep latency testing (MSLT) which showed sleep onset REM periods in the first 2 of 4 nap (no 5th nap offered), but a mean sleep latency of 13 min. Conclusion(s): Given the patient's delayed sleep phase, the MSLT with 2 sleep onset REM periods together with borderline sleep the night of the PSG likely represents a "false positive" feature of narcolepsy. Repeat PSG/MSLT can be reconsidered if her sleep pattern is regularized, pending persistence of her symptoms.