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## Complete Summary

#### GUIDELINE TITLE

Practice parameters for the treatment of narcolepsy and other
hypersomnias of central origin.

#### BIBLIOGRAPHIC SOURCE(S)

Morgenthaler TI, Kapur VK, Brown T, Swick TJ, Alessi C, Aurora RN,
Boehlecke B, Chesson AL Jr, Friedman L, Maganti R, Owens J, Pancer J,
Zak R, Standards of Practice Committee of the American Academy of Sleep
Medicine. Practice parameters for the treatment of narcolepsy and other
hypersomnias of central origin. Sleep 2007 Dec 1;30(12):1705-11. \[35
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18246980)

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline is an update of a previously issued version (Standards of
Practice Committee of the American Sleep Disorders Association. Practice
parameters for the use of stimulants in the treatment of narcolepsy.
Sleep 1994;17\[4\]:348-51).

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s) for which important revised regulatory information
has been released.

-   [October 24, 2007, Provigil
    (modafinil)](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Provigil):
    Cephalon has agreed to include additional labeling revisions to the
    WARNINGS, CLINICAL PHARMACOLOGY, PRECAUTIONS, and PATIENT PACKAGE
    INSERT sections.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Hypersomnias of central origin, including:

-   Narcolepsy (with or without cataplexy, due to medical condition or
    unspecified)

-   Idiopathic hypersomnia (with or without long sleep time)

-   Recurrent hypersomnia (e.g., Klein-Levin syndrome)

-   Hypersomnia due to medical condition (e.g., Parkinson\'s disease,
    myotonic dystrophy, multiple sclerosis)

#### GUIDELINE CATEGORY

Diagnosis\
Management\
Treatment

#### CLINICAL SPECIALTY

Family Practice\
Internal Medicine\
Neurology\
Pediatrics\
Psychiatry\
Sleep Medicine

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

-   To present recommendations on therapy of hypersomnia of central
    origin

-   To update previous practice parameters for the therapy of narcolepsy
    and to serve as the first practice parameters to address treatment
    of other hypersomnias of central origin

#### TARGET POPULATION

Adults and children diagnosed with narcolepsy and other hypersomnias of
central origin

**Note**: This guideline excludes patients for whom daytime sleepiness
is the primary complaint, but the cause of this symptom is due to
disturbed nocturnal sleep or misaligned circadian rhythms.

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Diagnosis/Management**

1.  Evaluation of other possible contributing causes of excessive
    daytime sleepiness

2.  Establishment of individual treatment objectives

**Treatment**

1.  Medications:

    -   Modafinil

    -   Sodium oxybate

    -   Amphetamine, methamphetamine, dextroamphetamine, methylphenidate

    -   Selegiline

    -   Ritanserin

    -   Tricyclic antidepressants, selective serotonin reuptake
        inhibitors, venlafaxine, fluoxetine, reboxetine

    -   Methylphenidate

    -   Lithium carbonate

2.  Scheduled naps

3.  Regular follow-up

    -   Monitor response to treatment, respond to potential side effects
        of medications, and enhance the patient\'s adaptation to the
        disorder

    -   Determine adherence, assist the patient with occupational and
        social problems

#### MAJOR OUTCOMES CONSIDERED

-   Reduction in daytime sleepiness

-   Quality of life

-   Adverse effects of and tolerance to medications

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The task force developed search terms and search strategies suitable for
queries of the medical literature using Medline. Explicit inclusion and
exclusion criteria were established to guide selection of relevant
citations. Search terms included the names of each disorder and each
medication of interest. Editorials, letters to the editor, books and
book chapters, abstracts from professional meetings, review articles,
publications in languages other than English, and studies involving
non-human subjects were excluded.

Searches involving narcolepsy and cataplexy were performed for the
period from 1999 through April 26, 2006, since the search performed for
the previous treatment of narcolepsy paper in 2001 included citations
through 2000. Searches involving non-narcolepsy topics were performed on
April 28, 2006 with no date limit, since non-narcolepsy topics were not
covered in the previous papers. A second and final search using the same
search strategy was performed in October, 2006 in order to identify new
articles published after the initial search.

A separate search was performed to query the medical literature with
regard to medication safety issues, including adverse effects, pregnancy
and breast-feeding issues, and pediatric issues. This search involved a
dual strategy in which the Physicians\' Desk Reference was used to
identify general information about the medications of interest without
regard to diagnosis. Second, the task force performed a more specific
Medline search to identify articles regarding individuals who received
the medications of interest, and the majority of these reports involved
subjects with sleep disorders. In contrast to the strategy employed for
the literature search regarding treatment a less restrictive approach
was utilized, allowing for review of case reports and articles with
small numbers of subjects. Our review also included all treatment
articles extracted above that reported adverse events. Extractions were
performed on articles that were otherwise excluded from consideration
for the regular review, including those that addressed hypersomnia and
fatigue in the setting of psychiatric illness and other medical
conditions.

The initial Medline search performed on April 26, 2006 yielded 1,073
citations. Task force members reviewed each citation by title and
abstract to ascertain whether the article was relevant and whether
inclusion or exclusion criteria were met. Additional articles were
considered for inclusion by searching the bibliographies of previously
identified articles (a process known as pearling). The task force
accepted thirty-three treatment articles for review and the remainder
were rejected because the article was deemed not relevant (did not
address issues in the Population, Intervention, Comparison, and Outcome
\[PICO\] tables) or because the article contained exclusionary features.
The task force identified 48 articles for the Safety search; this group
includes all medication-related articles from the treatment search.

#### NUMBER OF SOURCE DOCUMENTS

33

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Classification of Evidence**

**Level I**: Randomized, well-designed trials with low alpha and beta
error,\* or meta-analyses of randomized controlled trials with
homogeneity of result

**Level II**: Randomized trials with high alpha and beta error,
methodologic problems, or high quality cohort studies\*

**Level III**: Nonrandomized concurrently controlled studies
(case-control studies)

**Level IV**: Case-control or cohort studies with methodological
problems, or case series

**Level V**: Expert opinion, or studies based on physiology or bench
research

\*Alpha (type I error) refers to the probability that the null
hypothesis is rejected when in fact it is true (generally acceptable at
5% or less, or P \<0.05). Beta (Type II error) refers to the probability
that the null hypothesis is mistakenly accepted when in fact it is false
(generally, trials accept a beta error of 0.20). The estimation of Type
II error is generally the result of a power analysis. The power analysis
takes into account the variability and the effect size to determine if
sample size is adequate to find a difference in means when it is present
(power generally acceptable at 80%-90%).

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Relevant articles that met inclusion criteria were obtained by the
American Academy of Sleep Medicine (AASM) and the full length article
was made available to members of the task force using a website
directory. The task force developed data extraction forms customized for
this project and these forms were used to record and summarize key
findings from each article identified. The task force piloted the data
extraction forms on a subset of articles to identify problems with the
format or content of the forms, and appropriate revisions were made.

Review of the articles and completion of the data extraction forms were
performed in a two step process. Primary reviewers (individuals with
doctoral level education) were identified and trained by the AASM using
a standardized training module regarding use of evidence-based medicine
techniques for data extraction and evidence grading. Following the
initial review and data extraction process, members of the task force
(secondary reviewers) reviewed each citation and data extraction form,
and made corrections when necessary. Discrepancies between the primary
and secondary reviewers were discussed and resolved by the task force
chairman. This process is identical to that used by the AASM Standards
of Practice Committee and sponsored task forces for reviewing and
grading medical evidence. The task force used the Oxford Centre for
Evidence-based Medicine Levels of Evidence in order to grade the
strength of evidence for each citation (see the \"Rating Scheme for the
Strength of the Evidence\" field). Evidence grading was not performed
for those extractions used solely for assessing adverse effects of the
medications of interest.

An Evidence Table was developed to summarize key findings from each
citation. Information extracted from the safety review and general
safety information from the Physicians\' Desk Reference is provided in
the companion document (see the \"Companion Documents\" field). The
evidence tables and safety review extraction tables are available online
at [www.aasmnet.org](http://www.aasmnet.org/).

The grading of evidence was performed by an American Academy of Sleep
Medicine (AASM) Task Force of content experts. Three members of the
Standards of Practice Committee served as liaisons to facilitate
communication between the Standards of Practice Committee and the Task
Force. The Standards of Practice Committee used the evidence review of
the Task Force, the prior practice parameters on narcolepsy, and the
reviews upon which they were informed to develop these updated practice
parameters, and rated the levels (strength) of recommendations using the
AASM codification.

The Standards of Practice Committee (SPC) developed a list of specific
questions and issues to be addressed in the review. This resulted in
creation of Population, Intervention, Comparison, and Outcome (PICO)
tables, which were used to guide the task force and to focus the review
process on clinically relevant issues. The PICO tables for this project
are available on the American Academy of Sleep Medicine (AASM) website
directory at [www.aasmnet.org](http://www.aasmnet.org/). The task force
reviewed prior AASM publications relevant to this topic.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The Standards of Practice Committee used the evidence review of the Task
Force, the prior practice parameters on narcolepsy, and the reviews upon
which they were informed to develop these updated practice parameters,
and rated the levels (strength) of recommendations using the American
Association of Sleep Medicine (AASM) codification (see the \"Rating
Scheme for the Strength of the Recommendations\" field).

When scientific data were absent, insufficient or inconclusive,
committee consensus was used to develop recommendations at an \"Option\"
level.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Levels of Recommendation**

**Standard**: This is a generally accepted patient-care strategy which
reflects a high degree of clinical certainty. The term standard
generally implies the use of Level I Evidence, which directly addresses
the clinical issue, or overwhelming Level II Evidence.

**Guideline**: This is a patient-care strategy which reflects a moderate
degree of clinical certainty. The term guideline implies the use of
Level II Evidence or a consensus of Level III Evidence.

**Option**: This is a patient-care strategy which reflects uncertain
clinical use. The term option implies either inconclusive or conflicting
evidence or conflicting expert opinion.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

The Board of Directors of the American Academy of Sleep Medicine
approved these recommendations.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The levels of evidence (**I-V**) and levels of recommendation
(**standard, guideline, option**) are defined at the end of the \"Major
Recommendations\" field.

1.  An accurate diagnosis of a specific hypersomnia disorder of central
    origin should be established. This evaluation should include a
    thorough evaluation of other possible contributing causes of
    excessive daytime sleepiness. **(Standard)**

2.  Treatment objectives should include control of sleepiness and other
    sleep related symptoms when present. **(Standard)**

3.  The following are treatment options for narcolepsy.

    a.  Modafinil is effective for treatment of daytime sleepiness due
        to narcolepsy **(Standard)**.

    b.  Sodium oxybate is effective for treatment of cataplexy, daytime
        sleepiness, and disrupted sleep due to narcolepsy.
        **(Standard)** Sodium oxybate may be effective for treatment of
        hypnagogic hallucinations and sleep paralysis. **(Option)**

    c.  Amphetamine, methamphetamine, dextroamphetamine, and
        methylphenidate are effective for treatment of daytime
        sleepiness due to narcolepsy. **(Guideline)**

    d.  Selegiline may be an effective treatment for cataplexy and
        daytime sleepiness. **(Option)**

    e.  Ritanserin may be effective treatment of daytime sleepiness due
        to narcolepsy. **(Option)**

    f.  Scheduled naps can be beneficial to combat sleepiness but seldom
        suffice as primary therapy for narcolepsy. **(Guideline)**

    g.  Pemoline has rare but potentially lethal liver toxicity, is no
        longer available in the United States, and is no longer
        recommended for treatment of narcolepsy. **(Option)**

    h.  Tricyclic antidepressants, selective serotonin reuptake
        inhibitors (SSRIs), venlafaxine, and reboxetine may be effective
        treatment for cataplexy. **(Guideline)**

    i.  Tricyclic antidepressants, selective serotonin reuptake
        inhibitors (SSRIs), and venlafaxine may be effective treatment
        for treatment of sleep paralysis and hypnagogic hallucinations.
        **(Option)**

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4.  Modafinil may be effective for treatment of daytime sleepiness due
    to idiopathic hypersomnia. **(Option)**

5.  The following medications may be effective treatments for specific
    types of hypersomnia due to a medical condition.

    a.  Modafinil may be effective for treatment of daytime sleepiness
        due to Parkinson\'s disease. **(Option)**

    b.  Modafinil may be effective for treatment of daytime sleepiness
        due to myotonic dystrophy. **(Option)**

    c.  Methylphenidate may be effective for treatment of daytime
        sleepiness due to myotonic dystrophy. **(Option)**

    d.  Modafinil may be effective for treatment of daytime sleepiness
        due to multiple sclerosis. **(Guideline)**

```{=html}
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6.  Lithium carbonate may be effective for treatment of recurrent
    hypersomnia and behavioral symptoms due to Kleine-Levin syndrome.
    **(Option)**

7.  The following medications may be effective for treatment of daytime
    sleepiness in idiopathic hypersomnia (with and without long sleep
    time), recurrent hypersomnia, and hypersomnia due to a medical
    condition: amphetamine, methamphetamine, dextroamphetamine,
    methylphenidate, and modafinil. **(Option)**

8.  The following are treatment recommendations previously applied to
    narcolepsy only. Their application is now extended to the
    hypersomnias of central origin covered by this practice parameter
    paper by committee consensus.

    a.  Combinations of long- and short-acting forms of stimulants may
        be indicated and effective for some patients. **(Option)**

    b.  Treatment of hypersomnias of central origin with methylphenidate
        or modafinil in children between the ages of 6 and 15 appears to
        be relatively safe. **(Option)**

    c.  Regular follow-up of patients with hypersomnia of central origin
        is necessary to monitor response to treatment, to respond to
        potential side effects of medications, and to enhance the
        patient\'s adaptation to the disorder. **(Standard)**

        i.  A patient previously stabilized on stimulant medication
            should be seen regularly by a health care provider at least
            once per year, and preferably once every 6 months, to assess
            the development of medication side effects, including sleep
            disturbances, mood changes, and cardiovascular or metabolic
            abnormalities.

        ii. Follow-up is necessary to determine adherence and response
            to treatment; to monitor for the safety of medications in
            individual patients; and to assist the patient with
            occupational and social problems.

        iii. Patients with severe sleepiness should be advised to avoid
             potentially dangerous activities at home and at work, and
             should not operate a motor vehicle until sleepiness is
             appropriately controlled by stimulant medications.

        iv. Of the stimulants used to treat hypersomnia of central
            origin, amphetamines, especially at high doses, are the most
            likely to result in the development of tolerance.

        v.  Patients who fail to respond to adequate doses of stimulant
            medication should be carefully assessed for other sleep
            disorders that may contribute to excessive sleepiness such
            as insufficient sleep, inadequate sleep hygiene, circadian
            rhythm disorders, obstructive sleep apnea syndrome, or
            periodic limb movement disorder.

        vi. For side effects, dosage ranges, use in pregnancy and by
            nursing mothers, and contraindications, see Tables 6 and 7
            in the companion guideline document (see the \"Companion
            Documents\" field).

        vii. Health care providers should assist the patient with
             occupational and social accommodation for disabilities due
             to hypersomnia of central origin.

        viii. Polysomnographic re-evaluation of patients should be
              considered if symptoms of sleepiness increase
              significantly or if specific symptoms develop that suggest
              new or increased sleep abnormalities that might occur in
              disorders such as sleep apnea or periodic limb movement
              disorder.

**[Definitions]{.underline}**:

**Classification of Evidence**

**Level I**: Randomized, well-designed trials with low alpha and beta
error,\* or meta-analyses of randomized controlled trials with
homogeneity of result

**Level II**: Randomized trials with high alpha and beta error,
methodologic problems, or high quality cohort studies\*

**Level III**: Nonrandomized concurrently controlled studies
(case-control studies)

**Level IV**: Case-control or cohort studies with methodological
problems, or case series

**Level V**: Expert opinion, or studies based on physiology or bench
research

\*Alpha (type I error) refers to the probability that the null
hypothesis is rejected when in fact it is true (generally acceptable at
5% or less, or P \<0.05). Beta (Type II error) refers to the probability
that the null hypothesis is mistakenly accepted when in fact it is false
(generally, trials accept a beta error of 0.20). The estimation of Type
II error is generally the result of a power analysis. The power analysis
takes into account the variability and the effect size to determine if
sample size is adequate to find a difference in means when it is present
(power generally acceptable at 80% to 90%).

**Levels of Recommendation**

**Standard**: This is a generally accepted patient-care strategy that
reflects a high degree of clinical certainty. The term standard
generally implies the use of Level I Evidence, which directly addresses
the clinical issue, or overwhelming Level II Evidence.

**Guideline**: This is a patient-care strategy that reflects a moderate
degree of clinical certainty. The term guideline implies the use of
Level II Evidence or a consensus of Level III Evidence.

**Option**: This is a patient-care strategy that reflects uncertain
clinical use. The term option implies either inconclusive or conflicting
evidence or conflicting expert opinion.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each
recommendation (see the \"Major Recommendations\" field).

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

The appropriate treatment of patients with narcolepsy may reduce daytime
sleepiness, improve daytime alertness, allow return to normal
functioning, improve quality of life, and minimize adverse effects of
medication.

#### POTENTIAL HARMS

Side effects of medications, including sleep disturbances, mood changes,
cardiovascular or metabolic abnormalities, or potential for abuse

**Subgroups Most Likely to Be Harmed**

Information regarding the dangers to pregnant or breastfeeding women may
be found in the Physicians\' Desk Reference (PDR).

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

-   Amphetamine (Adderall) is not recommended for children with known
    structural cardiac defects; contraindicated in patients with
    advanced arteriosclerosis, symptomatic cardiovascular (CV) disease,
    moderate to severe hypertension, hyperthyroidism, h/o drug abuse,
    during or within 14 days of administration of monoamine oxidase
    (MAO) inhibitors

-   Methylphenidate (Ritalin)

-   Venlafaxine co-administration with MAO inhibitors is contraindicated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

These practice parameters define principles of practice that should meet
the needs of most patients in most situations. These guidelines should
not, however, be considered inclusive of all proper methods of care or
exclusive of other methods of care reasonably directed toward obtaining
the same results. The ultimate judgment regarding the propriety of any
specific care must be made by health care providers in light of the
individual circumstances presented by the patient, available diagnostic
tools, accessible treatment options, and resources.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Morgenthaler TI, Kapur VK, Brown T, Swick TJ, Alessi C, Aurora RN,
Boehlecke B, Chesson AL Jr, Friedman L, Maganti R, Owens J, Pancer J,
Zak R, Standards of Practice Committee of the American Academy of Sleep
Medicine. Practice parameters for the treatment of narcolepsy and other
hypersomnias of central origin. Sleep 2007 Dec 1;30(12):1705-11. \[35
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18246980)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1994 (revised 2007 Dec)

#### GUIDELINE DEVELOPER(S)

American Academy of Sleep Medicine - Professional Association

#### SOURCE(S) OF FUNDING

American Academy of Sleep Medicine (AASM)

#### GUIDELINE COMMITTEE

Standards of Practice Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Members*: Michael Littner MD; Stephen F. Johnson MD; W. Vaughn McCall
MD, MS; W. McDowell Anderson MD; David Davila MD; Kristyna Hartse PhD;
Clete A. Kushida MD, PhD; Merrill S. Wise MD; Max Hirshkowitz PhD; B.
Tucker Woodson MD, FACS

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The authors have indicated no financial conflicts of interest.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline is an update of a previously issued version (Standards of
Practice Committee of the American Sleep Disorders Association. Practice
parameters for the use of stimulants in the treatment of narcolepsy.
Sleep 1994;17\[4\]:348-51).

#### GUIDELINE AVAILABILITY

Electronic copies: Available (in Portable Document Format \[PDF\]) from
the [American Academy of Sleep Medicine Web
site](http://www.aasmnet.org/Resources/PracticeParameters/PP_Narcolepsy.pdf).

Print copies: Available from the Standards of Practice Committee,
American Academy of Sleep Medicine, One Westbrook Corporate Center,
Suite 920, Westchester, IL 60154; Web site:
[www.aasmnet.org](http://www.aasmnet.org/).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   Wise MS, Arand DL, Auger RR, et al. Treatment of narcolepsy and
    other hypersomnias of central origin. Sleep 2007;30(12):1712-27.

Electronic copies: Available in Portable document Format (PDF) from the
[American Academy of Sleep Medicine Web
site](http://www.aasmnet.org/Resources/PracticeParameters/Review_Narcolepsy.pdf).

Print copies: Available from the Standards of Practice Committee,
American Academy of Sleep Medicine, One Westbrook Corporate Center,
Suite 920, Westchester, IL 60154; Web site:
[www.aasmnet.org](http://www.aasmnet.org/).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on April 25, 1999. The information
was verified by the guideline developer on May 24, 1999. This summary
was updated by ECRI on October 22, 2001. The update information was
verified by the guideline developer as of November 21, 2001. This
summary was updated by ECRI on February 11, 2005, following the release
of a public health advisory from the U.S. Food and Drug Administration
regarding Adderall and related products. This summary was updated by
ECRI on November 18, 2005, following the release of a public health
advisory from the U.S. Food and Drug Administration regarding Cylert.
This summary was updated by ECRI on August 28, 2006 following the
updated U.S. Food and Drug Administration advisory on Adderall. This
summary was updated by ECRI on September 7, 2006 following the updated
U.S. Food and Drug Administration advisory on Dexedrine. This summary
was updated by ECRI Institute on April 11, 2008.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
American Academy of Sleep Medicine for information regarding
reproduction of American Academy of Sleep Medicine guidelines.

### DISCLAIMER

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Date Modified: 11/10/2008