Frequencies and Associations of Narcolepsy-Related Symptoms: A Cross-Sectional Study

Abstract

Objectives: Narcolepsy is a disabling disease with a delayed diagnosis. At least 3 years before the disorder identifi cation, several comorbidities can be observed in patients with narcolepsy. The early recognition of narcolepsy symptoms may improve long-term prognosis of the patients. Thus, we aimed to investigate the prevalence of the symptoms associated with narcolepsy and its social and psychological association in a sample of Sao Paulo city inhabitants. Methods: We performed a cross-sectional evaluation with 1,008 individuals from the Sao Paulo Epidemiologic Sleep Study (EPISONO). Excessive daytime sleepiness (EDS) was assessed by the Epworth Sleepiness Scale. Volunteers were also asked about the occurrence of cataplectic-like, hypnagogic or hypnopompic hallucinations, and sleep paralysis symptoms. The participants underwent a full-night polysomnography and completed questionnaires about psychological, demographic, and quality of life parameters. Results: We observed a prevalence of 39.2% of EDS, 15.0% of cataplectic-like symptom, 9.2% of hypnagogic or hypnopompic hallucinations, and 14.9% of sleep paralysis in Sao Paulo city inhabitants. A frequency of 6.9% was observed when EDS and cataplectic-like symptoms were grouped. The other associations were EDS + hallucinations (4.7%) and EDS + sleep paralysis (7.5%). Symptomatic participants were predominantly women and younger compared with patients without any narcolepsy symptom (n = 451). Narcolepsy symptomatology was also associated with a poor quality of life and symptoms of depression, anxiety, and fatigue. Conclusions: Narcolepsy-related symptoms are associated with poor quality of life and worse psychological parameters. A lthough narcolepsy may be considered a rare neurological condition, the repercussions of this disorder are substantial. Narcolepsy induces a 1.5-fold increase in the mortality rate compared with healthy individuals.1 As a consequence, narcoleptic patients have approximately 2-fold increased rates of hospital or other medical services admissions.2 Narcolepsy is often associated with a tetrad of symptoms, including, excessive daytime sleepiness (EDS), hypnagogic or hypnopompic hallucinations, sleep paralysis, and cataplexy. EDS is the most frequent symptom observed in narcoleptic patients. 3 In the natural history of EDS, several cardiometabolic and psychiatric conditions are associated with the incidence and persistence of EDS. 4 Patients with narcolepsy experience the symptoms over a long period until receiving the defi nitive diagnosis, ranging between 10 and 15 years. 5,6 A possible factor associated with this delay could be the failure to recognize the characteristic clinical features.7 Indeed, Jennum et al. demonstrated that narcoleptic patients present a wide range of comorbidities at least 3 years before the narcolepsy diagnosis, including a higher frequency of neurological diseases and other sleep disorders. 8 The recognition of the symptoms associated with narcolepsy seems to be an important approach for a better long-term progn...

Examining the Impact of Excessive Daytime Sleepiness on Utility Scores in Patients with Obstructive Sleep Apnoea and/or Narcolepsy in Five European Countries

“…Future research could look to address this through other statistical methods, such as propensity score matching, in order to further understand the association between ESS scores and EQ-5D utility scores. Finally, we did not examine an alternative linear spline regression model using segments that correspond to the established intervals of non-pathological levels of EDS (ESS score 0-10) and pathological EDS (ESS score [11][12][13][14][15][16][17][18][19][20][21][22][23][24], despite the proximity of our nal model results to this breakpoint. While it is possible that such a model would indicate adequate t, the segments used to develop the nal equation were based on where the best breakpoint(s) existed for the given data and were con rmed with the validation analyses.…”

“…[18] Narcolepsy is associated with signi cant impact on HRQoL, [19] with EDS emerging as a strong predictor of poor HRQoL in patients with narcolepsy. [20][21][22][23] Furthermore, treatment with stimulants or wakefulness-promoting agents at dosages high enough to alleviate EDS in patients with narcolepsy often leads to adverse effects. [3] There is also increasing evidence that higher levels of EDS in patients with OSA account for an increased burden of disease.…”

Pharmacologic Therapy for Narcolepsy

“…The most frequently reported symptom of narcolepsy is EDS. 6,7 Stimulants such as amphetamines and methylphenidate were among the first available agents to address EDS before newer agents discussed later in this review. 8 These medications increase noradrenergic, dopaminergic and serotonergic (only for amphetamines) activity by inhibiting their reuptake and increasing their synaptic concentrations to promote alertness.…”

Manual de trastornos del sueño

“…En México, un estudio realizado por Caraveo-Anduaga y Jiménez-Genchi (2003), reporta prevalencia del 0,09%, con mayor incidencia en mujeres, otro estudio refleja prevalencia de 0,031%, siendo mayor en hombres. Otro estudio brasileño, en Sao Paulo, refleja prevalencia de 0,043% (Kim et al, 2015). Los datos de morbimortalidad son controvertidos, y no conclusivos, en los demás países de Latinoamérica.…”