Initial experience and establishment of a hypersomnia board: A multidisciplinary approach to complex hypersomnia cases
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 hypers...
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| Published in: | Sleep medicine Vol. 134; p. 106735 |
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| Format: | Journal Article |
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01.10.2025
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| Abstract | 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.
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.
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.
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.
•Diagnosis and management of central disorders of hypersomnolence require a multidisciplinary approach that may not be readily available.•Multidisciplinary boards (MDB) may provide a feasible model to care for these patients.•Our preliminary experience showed that hypersomnia-MDB can improve diagnosis and care of these patients.•We need to determine feasibility, cost, and value in care of patients with central disorders of hypersomnolence.
Diagnosis and management of narcolepsy and other central disorders of hypersomnolence pose a significant challenge and require multi-disciplinary approach. We implemented a multispecialty board to improve diagnosis and management of patients referred to our sleep center for central disorders of hypersomnolence. The board consisted of specialist in sleep medicine, psychiatry, neurology, clinical psychology, and clinical pharmacy, as well as fellows in training. Our preliminary experience suggests that such an approach results in improved diagnosis, additional referral, additional testing and change in pharmacotherapy. |
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| AbstractList | 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.
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.
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.
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.
•Diagnosis and management of central disorders of hypersomnolence require a multidisciplinary approach that may not be readily available.•Multidisciplinary boards (MDB) may provide a feasible model to care for these patients.•Our preliminary experience showed that hypersomnia-MDB can improve diagnosis and care of these patients.•We need to determine feasibility, cost, and value in care of patients with central disorders of hypersomnolence.
Diagnosis and management of narcolepsy and other central disorders of hypersomnolence pose a significant challenge and require multi-disciplinary approach. We implemented a multispecialty board to improve diagnosis and management of patients referred to our sleep center for central disorders of hypersomnolence. The board consisted of specialist in sleep medicine, psychiatry, neurology, clinical psychology, and clinical pharmacy, as well as fellows in training. Our preliminary experience suggests that such an approach results in improved diagnosis, additional referral, additional testing and change in pharmacotherapy. 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.BACKGROUNDHypersomnia 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.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.METHODSWe 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.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.RESULTSOver 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.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.CONCLUSIONSEstablishing 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. 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. 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. 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. 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. |
| ArticleNumber | 106735 |
| Author | Velamuri, Kanta Sharafkhaneh, Amir Mallampalli, Antara Agrawal, Ritwick Thomas, Tara Singh, Supriya Dang, Lequan Moghtader, Shahram |
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| Cites_doi | 10.1002/jclp.21958 10.1378/chest.14-1304 10.1200/OP.22.00503 10.3390/brainsci13091327 10.1016/j.smrv.2022.101669 10.5664/jcsm.3808 |
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| References_xml | – volume: 65 year: Oct 2022 ident: bib6 article-title: Narcolepsy: comorbidities, complexities and future directions publication-title: Sleep Med Rev – volume: 148 start-page: 262 year: Jul 2015 end-page: 273 ident: bib1 article-title: Central disorders of hypersomnolence: focus on the narcolepsies and idiopathic hypersomnia publication-title: Chest – volume: 10 start-page: 342 year: Jun 2024 end-page: 347 ident: bib5 article-title: Multidisciplinary providers' perceptions of care delivery for sleep disorders: a qualitative case study publication-title: Sleep Health – volume: 69 start-page: 1066 year: Oct 2013 end-page: 1077 ident: bib3 article-title: The more the merrier? Working towards multidisciplinary management of obstructive sleep apnea and comorbid insomnia publication-title: J Clin Psychol – volume: 18 start-page: 691 year: Oct 2022 end-page: 693 ident: bib2 article-title: Virtual tumor board: benefits, problems, and finding balance in a postpandemic future publication-title: JCO Oncol Pract – volume: 10 start-page: 693 year: Jun 15 2014 end-page: 697 ident: bib4 article-title: Multidisciplinary sleep centers: strategies to improve care of sleep disorders patients publication-title: J Clin Sleep Med – volume: 13 year: Sep 15 2023 ident: bib7 article-title: Focus on multidisciplinary aspects of sleep medicine publication-title: Brain Sci – volume: 69 start-page: 1066 issue: 10 year: 2013 ident: 10.1016/j.sleep.2025.106735_bib3 article-title: The more the merrier? Working towards multidisciplinary management of obstructive sleep apnea and comorbid insomnia publication-title: J Clin Psychol doi: 10.1002/jclp.21958 – volume: 148 start-page: 262 issue: 1 year: 2015 ident: 10.1016/j.sleep.2025.106735_bib1 article-title: Central disorders of hypersomnolence: focus on the narcolepsies and idiopathic hypersomnia publication-title: Chest doi: 10.1378/chest.14-1304 – volume: 18 start-page: 691 issue: 10 year: 2022 ident: 10.1016/j.sleep.2025.106735_bib2 article-title: Virtual tumor board: benefits, problems, and finding balance in a postpandemic future publication-title: JCO Oncol Pract doi: 10.1200/OP.22.00503 – volume: 10 start-page: 342 issue: 3 year: 2024 ident: 10.1016/j.sleep.2025.106735_bib5 article-title: Multidisciplinary providers' perceptions of care delivery for sleep disorders: a qualitative case study publication-title: Sleep Health – volume: 13 issue: 9 year: 2023 ident: 10.1016/j.sleep.2025.106735_bib7 article-title: Focus on multidisciplinary aspects of sleep medicine publication-title: Brain Sci doi: 10.3390/brainsci13091327 – volume: 65 year: 2022 ident: 10.1016/j.sleep.2025.106735_bib6 article-title: Narcolepsy: comorbidities, complexities and future directions publication-title: Sleep Med Rev doi: 10.1016/j.smrv.2022.101669 – volume: 10 start-page: 693 issue: 6 year: 2014 ident: 10.1016/j.sleep.2025.106735_bib4 article-title: Multidisciplinary sleep centers: strategies to improve care of sleep disorders patients publication-title: J Clin Sleep Med doi: 10.5664/jcsm.3808 |
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| SubjectTerms | Adult Disorders of Excessive Somnolence - diagnosis Disorders of Excessive Somnolence - therapy Excessive daytime sleepiness Female Humans Male Middle Aged Multidisciplinary board Narcolepsy Narcolepsy - diagnosis Narcolepsy - therapy Patient Care Team - organization & administration |
| Title | Initial experience and establishment of a hypersomnia board: A multidisciplinary approach to complex hypersomnia cases |
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