0596 Overlap of Psychiatric Disorders with Central Hypersomnia

Abstract

Introduction In sleep clinics, hypersomnia is a frequently encountered condition. While narcolepsy and idiopathic hypersomnia are discrete diagnoses that typically do not have co-existing psychiatric co-morbidities, sleep practitioners often have to address mental illness and/or psychotropic medication needs in these patients with hypersomnia. The reasons for co-occurrence of idiopathic hypersomnia and narcolepsy with psychiatric disorders is not well understood. This study aimed to assess the degree of overlap between psychiatric diagnoses with central hypersomnias and the temporal relationship between the development of hypersomnia and psychiatric conditions. Methods Using the University of Utah EPIC database, patients with diagnoses of idiopathic hypersomnia or narcolepsy encountered over the last decade were identified. Out of the 307 available medical records, only those that met strict criteria for diagnosis of narcolepsy and idiopathic hypersomnia were included. Medical records were reviewed for the presence of psychiatric disorders and psychotropic medication use, and to assess the prevalence of mental illness with central hypersomnia. Results Out of 119 patients that met ICSD-2 criteria for central hypersomnia, 37 were diagnosed with narcolepsy type 1 (T1N), 59 with narcolepsy type 2 (T2N) and 23 with idiopathic hypersomnia (IH). There were 69/119 (58%) patients with central hypersomnia that had psychiatric comorbidities with 23/37 (62%) of T1N, 32/59 (54%) of T2N and 14/23 (60%) of IH experiencing psychiatric problems. Approximately 45% were prescribed antidepressants or a mood stabilizer either before, during or after diagnosis of a central hypersomnia. 46% of patients on stimulants alone vs. 23% of patients on sodium oxybate had a concurrent psychiatric diagnoses or psychotropic medication use. Conclusion Given the degree of overlap between psychiatric disorders and central hypersomnias, further research is necessary to understand whether this overlap is a result of common neurological substrates driving these disorders or whether the hypersomnia is from comorbid psychiatric disorder or psychotropic medication use. The highest prevalence of psychiatric illness was seen with T1N. Patients with hypersomnia on sodium oxybate had lower rates of psychiatric co-morbidities. Whether these findings point to more optimal diagnosis and treatment of underlying hypersomnia with reduced need for psychotropic medication needs to be understood. Support (if any) None