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Karen C. Patterson, MD; Babak Mokhlesi, MD, FCCP
Author and Funding Information

From the Pulmonary, Allergy, & Critical Care Division (Dr Patterson), The University of Philadelphia; and Section of Pulmonary and Critical Care (Dr Mokhlesi) and The University of Chicago Sleep Disorders Center (Dr Mokhlesi), The University of Chicago.

Correspondence to: Karen C. Patterson, MD, University of Philadelphia, Pulmonary, Allergy, & Critical Care Division, 828 Gates Bldg, 3600 Spruce St, Philadelphia, PA 19104; e-mail: karen.patterson@uphs.upenn.edu.


Financial/nonfinancial disclosures: The authors have reported to CHEST the following disclosures: Dr Mokhlesi has received monies from Philips Respironics as a consultant and speaker. Dr Patterson has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1977. doi:10.1378/chest.13-2041
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To the Editor:

We thank Dr Lower and colleagues for their comments and their interest in our study.1 In their study, they demonstrated that treatment with the stimulant armodafinil was associated with a reduction in fatigue in patients with sarcoidosis.2 A subset of their patients had coexisting fatigue and hypersomnolence, although improvements in fatigue were observed in patients with and without hypersomnolence.

In our study of patients referred for polysomnogram testing, we found that excessive daytime sleepiness, or hypersomnolence, was more common in patients with sarcoidosis compared with control subjects.1 As we did not measure fatigue, we were not positioned to comment on the relationship between fatigue and sleepiness in our cohort. We agree, though, that these are distinct clinical conditions. Even as they may coexist or have overlapping features, distinguishing between fatigue and excessive daytime sleepiness is clinically relevant. While treatment with stimulants may be beneficial in both, patients with fatigue also warrant an evaluation for comorbidities, which may be targeted for other primary interventions.2-4

References

Patterson KC, Huang F, Oldham JM, Bhardwaj N, Hogarth DK, Mokhlesi B. Excessive daytime sleepiness and obstructive sleep apnea in patients with sarcoidosis. Chest. 2013;143(6):1562-1568. [CrossRef] [PubMed]
 
Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for sarcoidosis-associated fatigue: a double-blind, placebo-controlled, crossover trial. J Pain Sympt Manage. 2013;45(2):159-169. [CrossRef]
 
Bogan RK. Armodafinil in the treatment of excessive sleepiness. Expert Opin Pharmacother. 2010;11(6):993-1002. [CrossRef] [PubMed]
 
Pigeon WR, Sateia MJ, Ferguson RJ. Distinguishing between excessive daytime sleepiness and fatigue: toward improved detection and treatment. J Psychosom Res. 2003;54(1):61-69. [CrossRef] [PubMed]
 

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References

Patterson KC, Huang F, Oldham JM, Bhardwaj N, Hogarth DK, Mokhlesi B. Excessive daytime sleepiness and obstructive sleep apnea in patients with sarcoidosis. Chest. 2013;143(6):1562-1568. [CrossRef] [PubMed]
 
Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for sarcoidosis-associated fatigue: a double-blind, placebo-controlled, crossover trial. J Pain Sympt Manage. 2013;45(2):159-169. [CrossRef]
 
Bogan RK. Armodafinil in the treatment of excessive sleepiness. Expert Opin Pharmacother. 2010;11(6):993-1002. [CrossRef] [PubMed]
 
Pigeon WR, Sateia MJ, Ferguson RJ. Distinguishing between excessive daytime sleepiness and fatigue: toward improved detection and treatment. J Psychosom Res. 2003;54(1):61-69. [CrossRef] [PubMed]
 
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