Table 5.
Therapeutic strategies for excessive daytime sleepiness with fragmented sleep in adolescents.
| Causes | Therapeutic strategies | Approved interventions for adolescents | |
|---|---|---|---|
| Obstructive sleep apnoea syndrome | Adolescents with enlarged tonsils and/or adenoids | • First-line treatment: Adenotonsillectomy | Yes |
| • Second-line treatment: Continuous positive airway pressure if failure or contraindication to adenotonsillectomy | Yes | ||
| • Complementary treatments: Weight loss strategies | Yes | ||
| Adolescents with obesity, craniofacial abnormalities and neuromuscular disorders | • First-line treatment: Continuous positive airway pressure | Yes | |
| • Complementary treatments: Weight loss strategies | Yes | ||
| Adolescents with malocclusion and retrognathia | • Alternative treatment: Orthodontic mandibular advancement | Yes | |
| • Complementary treatments: Weight loss strategies | Yes | ||
| Restless legs syndrome alone or combined to periodic limb movements during sleep | Mild severity | • First-line treatments: Adequate sleep hygiene and avoidance of aggravating factors | Yes |
| • Complementary treatment: Iron supplementation if serum ferritin <50 mcg/L | No (off-label prescription) | ||
| Moderate to severe severity | • First-line treatments: Dopaminergic agents | No (off-label prescription) | |
| • Second-line treatments: Benzodiazepines, anticonvulsants, alpha-receptor agonists or minor opioids | No (off-label prescription) | ||
| • Complementary treatments: Adequate sleep hygiene, avoidance of aggravating factors and iron supplementation if serum ferritin <50 mcg/L | No (off-label prescription for iron supplementation) | ||
| Parasomnias | Sporadic episodes without dangerous behaviour | • First-line treatments: Psychoeducation and adequate sleep hygiene | Yes |
| • Complementary treatment: Therapy of scheduled awakenings | Yes | ||
| Persistent episodes or episodes associated with dangerous behaviours | • First-line treatments: Benzodiazepines (clonazapam) | No (off-label prescription) | |
| • Second-line treatments: Serotonergic agents | No (off-label prescription) | ||
| • Alternative treatment: L-5-hydroxytryptophan | No (off-label prescription) | ||
| • Complementary treatments: Psychoeducation and adequate sleep hygiene | Yes | ||
| Somatic pathologies | • Establishment of targeted management for these specific aetiologies | Yes | |
| Environmental causes | • Adequate sleep environment | Yes |