SLEEP 2026 | Improving the diagnosis of central disorders of hypersomnolence

There was a lot of discussion at the meeting, about the central disorders of hypersomnolence. We discussed the orexin agonists and the DUET study data. I’d definitely like to call out the fact that there’s also a lot of scientific interest now and progress being made on the diagnostic side. We recognize that the tests we currently do have challenges. We recognize that patients cannot often taper off medications that can confound the Multiple Sleep Latency Test, and this may be one of the main reasons why we have delayed diagnoses in many of our patients. So for example, 50% of patients with idiopathic hypersomnia don’t meet the cut point for an abnormal MSLT. If we’re also not collecting actigraphy data that can demonstrate long sleep time, or recording an overnight polysomnogram long enough, which can be as long as 24 hours to record the 11 hours of sleep required for idiopathic hypersomnia with long sleep time, then we may have a negative evaluation. Some of these patients likely get turned away or are told that they may not have this disorder and perhaps have depression or something else, and this can lead to long diagnostic delays. So there’s a lot of focus now on not only figuring out how we can better diagnose these patients, but how we can diagnose these patients sooner by recognizing typical cataplexy in narcolepsy type 1, and also for the other disorders, working on expanding our diagnostics, particularly in the United States, to reduce the false-negative outcomes that can happen in people, particularly those with narcolepsy type 2 and, even more so, idiopathic hypersomnia.

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