Increased Mortality in Narcolepsy

Ohayon, Maurice M.; Black, Jed; Lai, Chinglin; Eller, Mark G.; Guinta, Diane; Bhattacharyya, Arun

doi:10.5665/sleep.3470

Cited by 62 publications

(35 citation statements)

References 31 publications

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“…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.…”

mentioning

confidence: 99%

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

Kim

Coelho

Hirotsu

et al. 2015

Journal of Clinical Sleep Medicine

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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...

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mentioning

confidence: 99%

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

Kim

Coelho

Hirotsu

et al. 2015

Journal of Clinical Sleep Medicine

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“…It reduces functional ability, work productivity, quality of life, and psychosocial functioning [36][37][38], and also increases the risk of work-and drivingrelated accidents [39,40]. A study by Ohayon et al [41] has also shown that narcolepsy is associated with an approximately 1.5-fold higher rate of mortality relative to those without narcolepsy.…”

Section: Introductionmentioning

confidence: 95%

Clinical and practical considerations in the pharmacologic management of narcolepsy

Thorpy¹,

Dauvilliers²

2015

Sleep Medicine

109

110

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Despite published treatment recommendations and the availability of approved and off-label pharmacologic therapies for narcolepsy, the clinical management of this incurable, chronic neurologic disorder remains challenging. While treatment is generally symptomatically driven, decisions regarding which drug(s) to use need to take into account a variety of factors that may affect adherence, efficacy, and tolerability. Type 1 narcolepsy (predominantly excessive daytime sleepiness with cataplexy) or type 2 narcolepsy (excessive daytime sleepiness without cataplexy) may drive treatment decisions, with consideration given either to a single drug that targets multiple symptoms or to multiple drugs that each treat a specific symptom. Other drug-related characteristics that affect drug choice are dosing regimens, tolerability, and potential drug-drug interactions. Additionally, the patient should be an active participant in treatment decisions, and the main symptomatic complaints, treatment goals, psychosocial setting, and use of lifestyle substances (ie, alcohol, nicotine, caffeine, and cannabis) need to be discussed with respect to treatment decisions. Although there is a lack of narcolepsy-specific instruments for monitoring therapeutic effects, clinically relevant subjective and objective measures of daytime sleepiness (eg, Epworth Sleepiness Scale and Maintenance of Wakefulness Test) can be used to provide guidance on whether treatment goals are being met. These considerations are discussed with the objective of providing clinically relevant recommendations for making treatment decisions that can enhance the effective management of patients with narcolepsy.

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“…Since the majority of the epidemiological studies included patients with both NT1 and NT2 (55,56), there are no valid data related to the prevalence of NT2. Its challenging detection, due to lack of awareness of the condition, nonspecific criteria, and lack of pathognomonic features such as cataplexy, may result in under or overdiagnosis of the disorder (43).…”

Section: Nt2mentioning

confidence: 99%

Clinical update on central hypersomnias

Pérez-Carbonell

Leschziner

2018

J. Thorac. Dis.

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The central hypersomnias encompass a range of conditions causing persisting or intermittent excessive daytime sleepiness (EDS). These conditions therefore present not infrequently in general clinical sleep practice, and remain in the differential for patients presenting with sleepiness. Our understanding of the pathophysiology, diagnosis and management of these conditions has progressed significantly over recent years, and in this article we review this group of disorders, focussing in particular on recent changes in classification and diagnosis, pathophysiological advances, and novel treatment options.

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Increased Mortality in Narcolepsy

Abstract: Narcolepsy was associated with approximately 1.5-fold excess mortality relative to those without narcolepsy. While the cause of this increased mortality is unknown, these findings warrant further investigation.

Cited by 62 publications

References 31 publications

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

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

Clinical and practical considerations in the pharmacologic management of narcolepsy

Clinical update on central hypersomnias

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