Narcolepsy with cataplexy: Does age at diagnosis change the clinical picture?

Abstract

Objective To compare symptoms and sleep characteristics in patients diagnosed with narcolepsy‐cataplexy (NC) before and after the age of 18 years. Methods De novo patients with NC diagnosis completed a standardized questionnaire and interview, followed by a sleep study. The clinical and sleep measures were compared between patients diagnosed before (46 children, median age: 12 year old) and after (46 adults, median age: 28.5 year old) 18 years of age. Results The frequency of obesity (54% vs 17%), night eating (29% vs 7%), parasomnia (89% vs 43%), sleep talking (80% vs 34%), and sleep drunkenness (69% vs 24%) were higher in children than in adults, the frequency of sleep paralysis was lower (20% vs 55%) but the frequency of cataplexy and the severity of sleepiness were not different. Children scored higher than adults at the attention‐deficit/hyperactivity disorder (ADHD) scale. Depressive feelings affected not differently children (24%) and adults (32%). However, adults had lower quality of life than children. There was no difference between groups for insomnia and fatigue scores. Quality of life was essentially impacted by depressive feelings in both children and adults. Obstructive apnea‐hypopnea index (OAHI) was lower in children with higher mean and minimal oxygen saturation than in adults. No between‐group differences were found at the multiple sleep latency test. The body mass index (z‐score) was correlated with OAHI (r = .32). Conclusion At time of NC diagnosis, children have more frequent obesity, night eating, parasomnia, sleep talking, drunkenness, and ADHD symptoms than adults, even if sleepiness and cataplexy do not differ. These differences should be considered to ensure a prompt diagnosis.

Intellectual Abilities of Children with Narcolepsy

“…This could indicate that the No-HP group represents a more severe expression of the disease. Obesity is found in more than 50% of children with narcolepsy [ 8 , 48 ]. In our study, we did not find a statistically significant difference for obesity/overweight between groups after corrections for multiple comparisons, which was probably due to our limited number of patients.…”

“…In our study, we did not find a statistically significant difference for obesity/overweight between groups after corrections for multiple comparisons, which was probably due to our limited number of patients. The mechanisms responsible for obesity in children with narcolepsy are not well known and could involve a severe hypothalamic involvement, decreased metabolism, and subtle changes in eating behavior [ 8 , 48 ].…”

“…More than half of the patients have a disease onset prior to 18 years old [ 7 ]. At diagnostic time, the clinical picture is quite different in children compared to adults [ 8 ]. Children present more frequently obesity, night eating, parasomnia, sleep talking, sleep drunkenness and Attention Deficit Hyperactivity Disorders’ symptoms than adults [ 8 ].…”

“…At diagnostic time, the clinical picture is quite different in children compared to adults [ 8 ]. Children present more frequently obesity, night eating, parasomnia, sleep talking, sleep drunkenness and Attention Deficit Hyperactivity Disorders’ symptoms than adults [ 8 ]. Although depressive feelings affect similarly children and adults, they have a higher impact on adults’ quality of life [ 8 ].…”

Recognizing the Symptom Spectrum of Narcolepsy to Improve Timely Diagnosis: A Narrative Review

“…Its occurrence gradually increases with age. 72 , 73 Similar to hallucinations, verbalizing the inability to move and distinguish the transitional conditions between REM sleep and wakefulness can be quite difficult and stressful for young narcolepsy patients and might lead to underestimation. Anxiety when going to bed could be a potential signal for the presence of sleep paralysis and warrants further exploration.…”