Medical comorbidity in narcolepsy: findings from the Burden of Narcolepsy Disease (BOND) study

Black, Jed; Reaven, Nancy L.; Funk, Susan Ens; McGaughey, Karen; Ohayon, Maurice M.; Guilleminault, Christian; Ruoff, Chad

doi:10.1016/j.sleep.2016.04.004

Cited by 86 publications

(56 citation statements)

References 30 publications

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“…The field has struggled to deal with this non‐cataplectic sleepy group of young patients without other obvious causes for their sleepiness. As reported by Black et al., both groups respond to medications, including sodium oxybate (Black et al., ), but recent studies indicate that type 1 narcoleptics or narcoleptic‐cataplectic patients have more comorbidities (Jennum, Ibsen, Knudsen, & Kjellberg, ; Black et al., ), and at a young age have much greater difficulty than type 2 subjects in PET studies testing performance that is associated with different types of brain metabolism (Huang, Liu, Lin, Hsiao, & Guilleminault, ; Huang, et al, ).…”

Section: Discussionmentioning

confidence: 97%

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Huang

Guilleminault

Lin

et al. 2018

Journal of Sleep Research

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Excessively sleepy teenagers and young adults without sleep-disordered breathing are diagnosed with either narcolepsy type 1 or narcolepsy type 2, or hypersomnia, based on the presence/absence of cataplexy and the results of a multiple sleep latency test. However, there is controversy surrounding this nomenclature. We will try to find the differences between different diagnoses of hypersomnia from the results of the long-term follow-up evaluation of a sleep study. We diagnosed teenagers who had developed excessive daytime sleepiness based on the criteria of the International Classification of Sleep Disorders, 3rd edition. Each individual received the same clinical neurophysiologic testing every year for 5 years after the initial diagnosis of narcolepsy type 1 (n = 111) or type 2 (n = 46). The follow-up evaluation demonstrated that narcolepsy type 1 (narcolepsy-cataplexy) is a well-defined clinical entity, with very reproducible clinical neurophysiologic findings over time, whereas patients with narcolepsy type 2 presented clear clinical and test variability. By the fifth year of the follow-up evaluation, 17.6% of subjects did not meet the diagnostic criteria of narcolepsy type 2, and 23.9% didn't show any two sleep-onset rapid eye movement periods in multiple sleep latency during the 5-year follow-up. Therefore narcolepsy type 1 (narcolepsy-cataplexy) is a well-defined syndrome, with the presentation clearly related to the known consequences of destruction of hypocretin/orexin neurons. Narcolepsy type 2 covers patients with clinical and test variability over time, thus bringing into question the usage of the term "narcolepsy" to label these patients.

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Section: Discussionmentioning

confidence: 97%

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Huang

Guilleminault

Lin

et al. 2018

Journal of Sleep Research

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“…A recent large-scale epidemiological study demonstrated high burden of comorbid mental illnesses in narcoleptic patients (e.g., mood disorder and anxiety disorder). [ 19 ] Besides, the DLPFC region is one of the most popular targets of rTMS in various neuropsychiatric diseases, and magnetic stimulation over this area seems to be safe and tolerable. [ 12 ] The mechanism underlying rTMS treatment over left DLPFC is possibly by modulating the anterior cingulated cortex connectivity in the meso-cortico-limbic circuit.…”

Section: Discussionmentioning

confidence: 99%

Effective treatment of narcolepsy-like symptoms with high-frequency repetitive transcranial magnetic stimulation

Lai

Han

et al. 2017

Medicine

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Rationale:Narcolepsy is a rare sleep disorder with disrupted sleep-architecture. Clinical management of narcolepsy lies dominantly on symptom-driven pharmacotherapy. The treatment role of repetitive transcranial magnetic stimulation (rTMS) for narcolepsy remains unexplored.Patient concerns:In this paper, we present a case of a 14-year-old young girl with excessive daytime sleepiness (EDS), cataplexy and hypnagogic hallucinations.Diagnoses:After excluding other possible medical conditions, this patient was primarily diagnosed with narcolepsy.Interventions:The patient received 25 sessions of high-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC).Outcomes:The symptoms of EDS and cataplexy significantly improved after rTMS treatment. Meanwhile, her score in the Epworth sleep scale (ESS) also remarkably decreased.Lessons:This case indicates that rTMS may be selected as a safe and effective alternative strategy for treating narcolepsy-like symptoms. Well-designed researches are warranted in future investigations on this topic.

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“…Several studies have shown the frequent occurrence of one or more comorbidities among narcolepsy patients, including medical and neuropsychiatric conditions [29][30][31][32]. In addition to contributing to the diagnostic delay [27], some disorders have symptoms that overlap with narcolepsy, increasing the complexity of diagnosis, and their management may rely on treatments that mask narcolepsy symptoms, such as antidepressants for depression, stimulant use for attention-deficit hyperactivity disorder, or continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA).…”

Section: Comorbid Conditionsmentioning

confidence: 99%

“…It often remains undiagnosed until many years after initial symptom onset [27], a delay that likely results from a confluence of factors such as the lack of symptom recognition among clinicians [28], the lack of a readily available narcolepsy-specific screening instrument, and the presence of physical and neuropsychiatric comorbidities [29][30][31][32], some of which may have symptoms that overlap with narcolepsy and result in misdiagnosis [33].…”

Section: Introductionmentioning

confidence: 99%

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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Medical comorbidity in narcolepsy: findings from the Burden of Narcolepsy Disease (BOND) study

Cited by 86 publications

References 30 publications

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Effective treatment of narcolepsy-like symptoms with high-frequency repetitive transcranial magnetic stimulation

Clinical and practical considerations in the pharmacologic management of narcolepsy

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