Hypersomnolence in focus: a white paper of the 6th Think Tank World Sleep Forum

doi:10.1016/j.sleep.2025.106607

Review

. 2025 Sep:133:106607.

doi: 10.1016/j.sleep.2025.106607. Epub 2025 Jun 6.

Hypersomnolence in focus: a white paper of the 6th Think Tank World Sleep Forum

Alessandro Silvani¹, Claudio Bassetti², Matteo Bradicich³, Richard Dodel⁴, Luigi Ferini Strambi⁵, Göran Hajak⁶, Jan Hedner⁷, Raphael Heinzer⁸, Sogol Javaheri⁹, Poul Jennum¹⁰, Ulf Kallweit¹¹, Ramin Khatami¹², Gert Jan Lammers¹³, Jean-Louis Pepin¹⁴, Fabio Pizza¹⁵, David T Plante¹⁶, Giuseppe Plazzi¹⁷, Winfried Randerath¹⁸, Joan Santamaria¹⁹, Sophia Schiza²⁰, Tina Sundelin²¹, Wendy Troxel²², Mauro Manconi²³

Affiliations

¹ Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. Electronic address: alessandro.silvani3@unibo.it.
² Dept of Neurology, Inselspital, University of Bern, Bern, Switzerland.
³ Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
⁴ Dept of Geriatric Medicine, University of Duisburg-Essen, Germany.
⁵ Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy.
⁶ Munich Psychiatry Outpatient Clinic, Munich, Germany; University of Regensburg, Germany.
⁷ Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgranska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.
⁹ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Danish Center for Sleep Medicine, Dept of Clinical Neurophysiology, University of Copenhagen and Danish Technical University, Copenhagen, Denmark.
¹¹ Professorship for Narcolepsy and Hypersomnolence Research, Faculty of Health, University Witten/Herdecke, Witten, Germany.
¹² Dept of Neurology, Inselspital, University of Bern, Bern, Switzerland; Centre of Sleep Medicine and Sleep Research, Klinik Barmelweid AG, Barmelweid, Switzerland.
¹³ Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.
¹⁴ University Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, HP2 Laboratory, Grenoble, France.
¹⁵ Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹⁶ Dept of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.
¹⁷ IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹⁸ Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
¹⁹ Sleep Unit, Dept of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.
²⁰ Dept of Respiratory and Sleep Medicine, School of Medicine, University of Crete, Greece.
²¹ Dept of Psychology, Stockholm University, Stockholm, Sweden; Dept of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
²² Division of Social and Economic Wellbeing, RAND, Pittsburgh, PA, USA.
²³ Sleep Medicine Unit, Neurocenter of Italian Switzerland, Civic Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.

PMID: 40505170
DOI: 10.1016/j.sleep.2025.106607

Free article

Review

Hypersomnolence in focus: a white paper of the 6th Think Tank World Sleep Forum

Alessandro Silvani et al. Sleep Med. 2025 Sep.

Free article

. 2025 Sep:133:106607.

doi: 10.1016/j.sleep.2025.106607. Epub 2025 Jun 6.

Authors

Affiliations

¹ Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. Electronic address: alessandro.silvani3@unibo.it.
² Dept of Neurology, Inselspital, University of Bern, Bern, Switzerland.
³ Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
⁴ Dept of Geriatric Medicine, University of Duisburg-Essen, Germany.
⁵ Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy.
⁶ Munich Psychiatry Outpatient Clinic, Munich, Germany; University of Regensburg, Germany.
⁷ Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgranska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Centre for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Lausanne, Switzerland.
⁹ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Danish Center for Sleep Medicine, Dept of Clinical Neurophysiology, University of Copenhagen and Danish Technical University, Copenhagen, Denmark.
¹¹ Professorship for Narcolepsy and Hypersomnolence Research, Faculty of Health, University Witten/Herdecke, Witten, Germany.
¹² Dept of Neurology, Inselspital, University of Bern, Bern, Switzerland; Centre of Sleep Medicine and Sleep Research, Klinik Barmelweid AG, Barmelweid, Switzerland.
¹³ Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.
¹⁴ University Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, HP2 Laboratory, Grenoble, France.
¹⁵ Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹⁶ Dept of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.
¹⁷ IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹⁸ Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
¹⁹ Sleep Unit, Dept of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain.
²⁰ Dept of Respiratory and Sleep Medicine, School of Medicine, University of Crete, Greece.
²¹ Dept of Psychology, Stockholm University, Stockholm, Sweden; Dept of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
²² Division of Social and Economic Wellbeing, RAND, Pittsburgh, PA, USA.
²³ Sleep Medicine Unit, Neurocenter of Italian Switzerland, Civic Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.

PMID: 40505170
DOI: 10.1016/j.sleep.2025.106607

Abstract

An international expert group (European Sleep Foundation Think Tank) convened in 2022 to discuss the state of the evidence in the domain of hypersomnolence. The expert group considered the current state of knowledge based on the most relevant recent publications, discussed the current challenges in the field and identified future priorities. The purpose of this white paper is to summarize the definition, diagnosis, and pathophysiology of hypersomnolence, the epidemiology, phenotype, and management of hypersomnolence in obstructive sleep apnea and in neurological and psychiatric disorders, and the impact of hypersomnolence on daily activities, workability and health-related quality of life. The key results of the discussion were that: a) hypersomnolence is both prevalent and heterogeneous in its manifestations in a wide variety of pathological conditions encompassing obstructive sleep apnea and neurological and psychiatric disorders; and b) while multiple pathophysiological pathways are potentially involved in hypersomnolence, knowledge of the specific causal factors in individual patients remains undefined, and the specific factors responsible for excessive daytime sleepiness vs. excessive need for sleep remain largely unclear. The clinical implications of these results are the occurrence of important limitations to the development of personalized approaches to diagnosis, prognosis, and management of hypersomnolence, which is essential considering the high societal and personal costs of hypersomnolence, and its substantial adverse impact on quality of life. Research priorities should address these limitations with improved quantification of hypersomnolence and with an evidence base on the costs and benefit of hypersomnolence management in patients with respiratory, neurologic, and psychiatric disorders.

Keywords: Excessive daytime sleepiness; Excessive need for sleep; Hypersomnia; Hypersomnolence; Mechanisms; Obstructive sleep apnea; Quality of life.

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Conflict of interest statement

Declaration of competing interest The authors include the Sleep Medicine Editor-in-Chief (WR), as well as Field Editors (LFS, UK, and SS), Associate Editors (CB and JH) and members of the Editorial Board (GP). Given his role as Editor-in-Chief, WR had no involvement in the peer review of this article and had no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to another journal editor. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. MB was the Early Career Member Representative of European Respiratory Society (ERS) Assembly 4 at the time of the Think Tank. RD has participated in industry-sponsored research projects from Lilly, Roche, Lundbeck Foundation, EAN; served as a consultant for Lilly, Roche, Eisai, Novo Nordisk; received honoraria for scientific presentations from AbbVie, Bayer Vital, Lilly, Eisai, Schwabe, Roche; received publication royalties from Kohlhammer and Thieme; and is an inventor on patents from Philipps University Marburg for immunization in neurodegenerative diseases. LFS received speaker fees and served as Advisory Board Member for Bioprojet, Idorsia, Italfarmaco, Lundbeck, Fidia, Bruno Farmaceutici, Italfarmaco, Altais, Sanofi. GH received speaker and/or consultant fees from Amgen, Astra-Zeneca, Bioevents, Biotest, Boehringer Ingelheim, Bristol-Meyers Squibb, Culture-Thinking & People, DerCompass, EuMeCom, FEO, FOMF, Gedeon Richter, Heel, Hennig, Hexal, Hikma, Idorsia, Janssen-Cilag, Jazz, Johnson & Johnson, Lundbeck, Medfora, Medical Tribune, Medice, MedScape, MedTrix, Mermentor, Neuraxpharm, Pfizer, Prosomno, Recordati, Repha, Rovi, Schwabe, Servier, Takeda, WEBMD, and Zeller and received research grants from Janssen-Cliag. JH received travel support from Astra Zeneca, Jazz Pharmaceuticals, Bayer Pharma, ResMed; served in Data Safety Monitoring Board from Respicardia Inc.; received Joint ESADA project funding from Phillips-Respironics; received institutional receipt of equipment, materials for testing and evaluation from Itamar Medical and Res Med; is a licensor of a patent related to therapy in sleep disordered breathing. RH received speaker or consultant fees paid to his institution from Resmed, Philips, Inspire, Bioprojet, Philips, Merck, Medtronic, Nestlé, Löwenstein, and Nyxoah. UK received consulting/advisory and speaker fees from Takeda, Jazz Pharma, Bioprojet Pharma and Pharmanovia. RK has been consultant/advisory board member for Takeda and Idorsia; received speaker honoraria from Esai, Bioprojet. GJL has been advisory board member and consultant for Jazz Pharmaceuticals, Takeda, Bioprojet, Alkermes, and Daiichi Sankyo. JLP received lecture fees or conference traveling grants from ResMed, Philips, Jazz Pharmaceuticals, Agiradom, Bastide, and Bioprojet. DTP has been consultant/advisory board member for Jazz, Takeda, Alkermes, Centessa, Harmony Biosciences and has been consultant for Teva (Australia) and Aditum Bio, LLC. GP has been advisory board member for Jazz, Takeda, Bioprojet, Alkermes, Idorsia, and Centessa. AS received speaker fees from Idorsia and is an inventor of patent WO2024003128A1 (dual orexin receptor agonist). WT has served on the advisory board for National Sleep Foundation and OneCare Media.

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Hypersomnolence in focus: a white paper of the 6th Think Tank World Sleep Forum

Affiliations

Hypersomnolence in focus: a white paper of the 6th Think Tank World Sleep Forum

Authors

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Abstract

Conflict of interest statement

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