Operationalisierung der Idiopathischen Hypersomnie anhand einer retrospektiven Studie durch klinische und polysomnographische Daten sowie Hypocretinwerten aus dem Liquor cerebrospinalis

Excessive daytime sleepiness is the leading symptom of many sleep disorders. Various sleep disorders are summarized in the ICSD 3; This work deals in particular with hypersomnolences of central nervous origin. In the current version of the classification unit, there were some innovations which take into account the latest research results. The focus of the work is on the IHS in contrast to NT 2. The IHS has a very low prevalence with 0.002-0.01% (7, 119), but those affected have a high suffering. Clinically, the IHS is characterized by an excessive sleepiness of the day, the night sleep usually not being impaired or only fragmented, nocturnal wax phases are not typical (110). The aim of this thesis was to work out similarities and significant differences between the IHS and NT 2 using retrospective data. For further delineation, the results were compared with a NT-1 and an OSAS collective. Anthropometric data, results from the ESS, PSG and MSLT as well as hypocretins from the cerebrospinal fluid were analyzed. The collected data were analyzed both in the four collectives: NT 1, NT 2, IHS and OSAS, as well as with results from previous studies. In the statistical evaluation of the anthropometric data, it should be emphasized that the mean BMI is pathologically increased in the IHS cohort of this study. It was found that the results of the ESS are very similar in the collectives of NT 1, NT 2 and IHS and only the mean score of the ESS of NT-1 patients was significantly higher than in the OSAS collective. The analysis of the PSG with respect to the REML corresponded to the results previously described in the literature. The mean REML in the NT-1 and NT-2 groups was significantly shorter than in the IHS collective (86, 114), with a mean REML in the NT-2 cohort being shorter than in the NT-1 group and a shorter mean REML in the OSAS group than in the IHS collective. Remarkable is that the mean SE was significantly higher in the IHS group than in the NT-1 and OSAS group, but lower than in the NT-2 cohort. This is in contrast to the results described in the literature so far (53, 57, 86). The results of the PSG parameters: PLMI, WASO, SE and the number of number of awakening show similarities in the IHS and NT-2 cohorts. In contrast, the mean REML and mean SL of the NT-1 and NT-2 cohorts are significantly different from the results of the IHS collective. In the analysis of the mean sleep-latency in the MSLT, the IHS cohort shows a shorter mean sleep-time than in the NT-1 group, but a longer latency than in the NT-2 cohort. The most SOREMP originating from N1 were found in NT-2 patients. The analysis of the hypocretin values ​​is very interesting because it shows that there are no significant differences between the IHS and NT-2 cohorts. In both cohorts, values ​​in the intermediate range of 110-200 pg /ml can be found, in the IHS cohort 37.5% and in the NT-2 cohort 50%. In summary, the results of this work are inhomogeneous and this support theories that the IHS and NT 2 are not to be considered as independent diseases, but rather as subgroups of another entity. This is underlined by the hypocretin results, so that a partial hypocretinal deficiency can be assumed. It is of particular importance to closely examine patients with excessive daytime sleepiness, and to reevaluate the diagnosis by means of objective studies.