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Boulanger T, Pigeon P, Crawford S. Diagnostic challenges and burden of idiopathic hypersomnia: a systematic literature review. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae059. [PMID: 39211350 PMCID: PMC11359170 DOI: 10.1093/sleepadvances/zpae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/23/2024] [Indexed: 09/04/2024]
Abstract
Idiopathic hypersomnia (IH) is a rare neurological sleep disorder, characterized by excessive daytime sleepiness despite normal sleep duration, that can significantly impact patient's lives. The burden of IH goes beyond excessive daytime sleepiness, pervading all aspects of everyday life. Characteristic and burdensome symptoms of IH include sleep inertia/drunkenness, long sleep duration, and daytime cognitive dysfunction. This systematic review assessed current knowledge regarding IH diagnostic challenges and burden of illness. Literature searches for original epidemiological, clinical, humanistic, or economic research relevant to IH published between 2012 and 2022 in MEDLINE, Embase, Cochrane, gray literature (diagnostic criteria and treatment guidelines), conferences (2019-2022), and clinical trial databases yielded 97 articles. Findings indicate that IH remains a poorly defined diagnosis of exclusion that is difficult to distinguish from narcolepsy type 2 because of symptom overlap and inadequacies of objective testing. Consequently, individuals with IH endure diagnostic delays of up to 9 years. The economic burden of IH has not been characterized to any appreciable extent. Pharmacological treatment options can improve symptoms and functional status, but rarely restores normal levels of functioning. These findings highlight the need to reclassify central disorders of hypersomnolence. Further collaboration is now required between research groups to identify and validate objective markers to help redefine diagnostic criteria for IH. This would move IH into a position that could benefit from future targeted therapeutic interventions. The study was funded by Takeda Development Center Americas, Inc.
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2
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Abstract
Idiopathic hypersomnia (IH) includes a clinical phenotype resembling narcolepsy (with repeated, short restorative naps), and a phenotype with an excess of sleep, sleep drunkenness, drowsiness, and infrequent long, nonrestorative naps. Sleep tests reflect this heterogeneity. MSLTs are greater than 8 min in 2/3 of the cases and poorly repeatable. Sleep excess is better captured by extended monitoring identifying 11 to 16h of sleep/24 h. Patients with IH are young and more often female. Possible mechanisms of IH include deficiencies in arousal systems, inappropriate stimulation of sleep-inducing systems, and long biological night. Treatments now include robust studies of modafinil, clarithromycin, and sodium oxybate.
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Affiliation(s)
- Isabelle Arnulf
- Service des pathologies du sommeil, Hopital Pitie-Salpetriere, 83 boulevard de l'Hopital, Paris 75013, France; Sorbonne University, Paris, France.
| | - Smaranda Leu-Semenescu
- Service des pathologies du sommeil, Hopital Pitie-Salpetriere, 83 boulevard de l'Hopital, Paris 75013, France
| | - Pauline Dodet
- Service des pathologies du sommeil, Hopital Pitie-Salpetriere, 83 boulevard de l'Hopital, Paris 75013, France
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3
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Futenma K, Takaesu Y, Nakamura M, Hayashida K, Takeuchi N, Inoue Y. Metabolic-Syndrome-Related Comorbidities in Narcolepsy Spectrum Disorders: A Preliminary Cross-Sectional Study in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106285. [PMID: 35627822 PMCID: PMC9141676 DOI: 10.3390/ijerph19106285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022]
Abstract
Narcolepsy types 1 (NT1) and 2 (NT2) and idiopathic hypersomnia (IH) are thought to be a disease continuum known as narcolepsy spectrum disorders (NSDs). This study aimed to assess the prevalence of and factors associated with metabolic-syndrome-related disorders (MRDs) among patients with NSD. Japanese patients with NSD (NT1, n = 94; NT2, n = 83; and IH, n = 57) aged ≥35 years were enrolled in this cross-sectional study. MRD was defined as having at least one of the following conditions: hypertension, diabetes, or dyslipidemia. Demographic variables and MRD incidence were compared among patients in the respective NSD categories. Multivariate logistic regression analysis was used to investigate the factors associated with MRDs. Patients with NT1 had a higher body mass index (BMI) and incidence of MRD than that had by those with NT2 or IH. Age, BMI, and the presence of OSA were significantly associated with the incidence of MRD in NSDs. Age and BMI in NT1, BMI and human leukocyte antigen (HLA)-DQB1*06:02 positivity in NT2, and only age in IH were factors associated with the incidence of MRD. Obesity should be carefully monitored in narcolepsy; however, NT2 with HLA-DQB1*06:02 positive should be followed up for the development of MRD even without obesity.
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Affiliation(s)
- Kunihiro Futenma
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan;
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Correspondence: (K.F.); (Y.I.); Tel.: +81-98-895-1157 (K.F.); +81-3-6804-8995 (Y.I.)
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan;
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
| | - Masaki Nakamura
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Department of Somnology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Aoyama-Omotesando Sleep Stress Clinic, Aoyama Rise Square 3F, 5-1-22 Minamiaoyama, Minato-ku, Tokyo 107-0062, Japan
| | - Kenichi Hayashida
- Sleep Support Clinic, Miranbeena 1F, 1-18-8 Higashioi, Shinagawa-Ku, Tokyo 140-0011, Japan;
| | - Noboru Takeuchi
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Department of Somnology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Department of Neuropsychiatry, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, 5-10-10, Yoyogi, Shinjuku-ku, Tokyo 151-0053, Japan; (M.N.); (N.T.)
- Department of Somnology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Correspondence: (K.F.); (Y.I.); Tel.: +81-98-895-1157 (K.F.); +81-3-6804-8995 (Y.I.)
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4
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Zhang Y, Ren R, Yang L, Zhang H, Shi Y, Vitiello MV, Tang X, Sanford LD. Comparative polysomnography parameters between narcolepsy type 1/type 2 and idiopathic hypersomnia: A systematic review and meta-analysis. Sleep Med Rev 2022; 63:101610. [DOI: 10.1016/j.smrv.2022.101610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
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5
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Fronczek R, Arnulf I, Baumann CR, Maski K, Pizza F, Trotti LM. To split or to lump? Classifying the central disorders of hypersomnolence. Sleep 2021; 43:5810298. [PMID: 32193539 PMCID: PMC7420691 DOI: 10.1093/sleep/zsaa044] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/10/2020] [Indexed: 01/20/2023] Open
Abstract
The classification of the central disorders of hypersomnolence has undergone multiple iterations in an attempt to capture biologically meaningful disease entities in the absence of known pathophysiology. Accumulating data suggests that further refinements may be necessary. At the 7th International Symposium on Narcolepsy, a group of clinician-scientists evaluated data in support of keeping or changing classifications, and as a result suggest several changes. First, idiopathic hypersomnia with long sleep durations appears to be an identifiable and meaningful disease subtype. Second, idiopathic hypersomnia without long sleep time and narcolepsy without cataplexy share substantial phenotypic overlap and cannot reliably be distinguished with current testing, and so combining them into a single disease entity seems warranted at present. Moving forward, it is critical to phenotype patients across a wide variety of clinical and biological features, to aid in future refinements of disease classification.
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Affiliation(s)
- Rolf Fronczek
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Sleep-Wakecentre SEIN, Heemstede, The Netherlands
| | - Isabelle Arnulf
- Sorbonne University, National Reference Center for Rare Hypersomnia, Pitie-Salpetriere Hospital, Paris, France
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kiran Maski
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
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6
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Inoue Y, Tabata T, Tsukimori N. Efficacy and safety of modafinil in patients with idiopathic hypersomnia without long sleep time: a multicenter, randomized, double-blind, placebo-controlled, parallel-group comparison study. Sleep Med 2021; 80:315-321. [PMID: 33631500 DOI: 10.1016/j.sleep.2021.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few treatments are available for patients with idiopathic hypersomnia (IH). Modafinil, an established treatment for narcolepsy, was tested for efficacy and safety in Japanese patients with IH without long sleep time. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group comparison study was conducted at 20 institutions in Japan. Patients who met the diagnostic criteria of IH in the International Classification of Sleep Disorders (second edition) were included. The study comprised a ≥17-day observation period and a 3-week treatment period during which modafinil (200 mg) or placebo was administered orally once daily (in the morning). The primary efficacy endpoint was change in mean sleep latency on the Maintenance of Wakefulness Test (MWT). Adverse events (AEs) were also recorded to evaluate safety. RESULTS In total, 123 patients were screened and 71 were randomized to receive modafinil (N = 34) or placebo (N = 37). Patients treated with modafinil experienced a significantly prolonged mean sleep latency on the MWT at the end of the study compared with placebo (5.02 min, 95% confidence interval: 3.26-6.77 min; p < 0.001). AEs occurred in 58.8% (20/34) and 27.0% (10/37) of patients in the modafinil and placebo groups, respectively. Frequent AEs in the modafinil group were headache (n = 6), dry mouth (n = 3), and nausea (n = 3); no clinically significant AEs occurred. CONCLUSION Modafinil was shown to be an effective and safe treatment for excessive daytime sleepiness in patients with IH without long sleep time. CLINICAL TRIAL REGISTRATION JapicCTI; 142539.
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Affiliation(s)
- Yuichi Inoue
- Japan Somnology Center, Institute of Neuropsychiatry, 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Department of Somnology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Toshiyuki Tabata
- Research and Development Headquarters, Alfresa Pharma Corporation, 2-2-9 Koku-machi, Chuo-ku, Osaka, 540-8575, Japan
| | - Naoji Tsukimori
- Medical Affairs Headquarters, Alfresa Pharma Corporation, 2-2-9 Koku-machi, Chuo-ku, Osaka, 540-8575, Japan
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7
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Arnulf I, Leu-Semenescu S, Dodet P. Precision Medicine for Idiopathic Hypersomnia. Sleep Med Clin 2019; 14:333-350. [DOI: 10.1016/j.jsmc.2019.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Narcolepsy is the most common neurological cause of chronic sleepiness. The discovery about 20 years ago that narcolepsy is caused by selective loss of the neurons producing orexins (also known as hypocretins) sparked great advances in the field. Here, we review the current understanding of how orexin neurons regulate sleep-wake behaviour and the consequences of the loss of orexin neurons. We also summarize the developing evidence that narcolepsy is an autoimmune disorder that may be caused by a T cell-mediated attack on the orexin neurons and explain how these new perspectives can inform better therapeutic approaches.
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Affiliation(s)
- Carrie E Mahoney
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Andrew Cogswell
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Igor J Koralnik
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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9
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Fujita Y, Furukawa H, Asano T, Sato S, Yashiro Furuya M, Kobayashi H, Watanabe H, Suzuki E, Koga T, Shimizu T, Ueki Y, Eguchi K, Tsuchiya N, Kawakami A, Migita K. HLA-DQB1 DPB1 alleles in Japanese patients with adult-onset Still's disease. Mod Rheumatol 2018; 29:843-847. [PMID: 30136608 DOI: 10.1080/14397595.2018.1514999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: HLA class II alleles are major determinants of genetic predisposition to rheumatic diseases. Predisposing effects of HLA had been suggested in AOSD, however, ethnic differences may account for variations in AOSD association with HLA. We determined the contribution of HLA-DQB1, DPB1 alleles to susceptibility to Adult-onset Still's disease (AOSD) in the Japanese population. Methods: HLA-DQB1 and DPB1 alleles were analyzed in 87 Japanese patients with AOSD and 413 Japanese healthy subjects. Results: We found significant association between HLA-DQB1*06:02 (Pc = 0.010, odds ratio: 2.54) and AOSD, whereas there was no association between the DQB1*06:02 allele and disease phenotypes of AOSD. Moreover, we did not find a predisposing effect of the HLA-DPB1 allele to AOSD. Haplotype analysis showed that presence of DRB1*15:01-DQB1*06:02 was associated with Japanese patients with AOSD. However, conditional logistic regression tests were unable to demonstrate independent association between DRB1*1501 or DQB1*0602 and AOSD. Conclusions: Our results show significant association between AOSD and the HLA DQB1*06:02 allele, and between the DRB1*1501-DQB1*06:02 haplotype and AOSD susceptibility. These findings suggest that genetic susceptibility to AOSD depends on the genotype combinations of HLA DRB1 and DQB1 alleles.
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Affiliation(s)
- Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Hiroshi Furukawa
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba , Tsukuba , Japan
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Makiko Yashiro Furuya
- Department of Rheumatology, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Hiroko Kobayashi
- Department of Rheumatology, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation , Koriyama , Fukushima , Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital , Sasebo , Japan
| | - Katsumi Eguchi
- Department of Rheumatology, Sasebo Chuo Hospital , Sasebo , Japan
| | - Naoyuki Tsuchiya
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba , Tsukuba , Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine , Fukushima , Japan
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10
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Miyagawa T, Khor SS, Toyoda H, Kanbayashi T, Imanishi A, Sagawa Y, Kotorii N, Kotorii T, Ariyoshi Y, Hashizume Y, Ogi K, Hiejima H, Kamei Y, Hida A, Miyamoto M, Ikegami A, Wada Y, Takami M, Higashiyama Y, Miyake R, Kondo H, Fujimura Y, Tamura Y, Taniyama Y, Omata N, Tanaka Y, Moriya S, Furuya H, Kato M, Kawamura Y, Otowa T, Miyashita A, Kojima H, Saji H, Shimada M, Yamasaki M, Kobayashi T, Misawa R, Shigematsu Y, Kuwano R, Sasaki T, Ishigooka J, Wada Y, Tsuruta K, Chiba S, Tanaka F, Yamada N, Okawa M, Kuroda K, Kume K, Hirata K, Uchimura N, Shimizu T, Inoue Y, Honda Y, Mishima K, Honda M, Tokunaga K. A variant at 9q34.11 is associated with HLA-DQB1*06:02 negative essential hypersomnia. J Hum Genet 2018; 63:1259-1267. [PMID: 30266950 DOI: 10.1038/s10038-018-0518-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/29/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022]
Abstract
Essential hypersomnia (EHS) is a lifelong disorder characterized by excessive daytime sleepiness without cataplexy. EHS is associated with human leukocyte antigen (HLA)-DQB1*06:02, similar to narcolepsy with cataplexy (narcolepsy). Previous studies suggest that DQB1*06:02-positive and -negative EHS are different in terms of their clinical features and follow different pathological pathways. DQB1*06:02-positive EHS and narcolepsy share the same susceptibility genes. In the present study, we report a genome-wide association study with replication for DQB1*06:02-negative EHS (408 patients and 2247 healthy controls, all Japanese). One single-nucleotide polymorphism, rs10988217, which is located 15-kb upstream of carnitine O-acetyltransferase (CRAT), was significantly associated with DQB1*06:02-negative EHS (P = 7.5 × 10-9, odds ratio = 2.63). The risk allele of the disease-associated SNP was correlated with higher expression levels of CRAT in various tissues and cell types, including brain tissue. In addition, the risk allele was associated with levels of succinylcarnitine (P = 1.4 × 10-18) in human blood. The leading SNP in this region was the same in associations with both DQB1*06:02-negative EHS and succinylcarnitine levels. The results suggest that DQB1*06:02-negative EHS may be associated with an underlying dysfunction in energy metabolic pathways.
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Affiliation(s)
- Taku Miyagawa
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan. .,Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Seik-Soon Khor
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Toyoda
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kanbayashi
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan.,International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan
| | - Aya Imanishi
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan
| | - Yohei Sagawa
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan
| | - Nozomu Kotorii
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan.,Kotorii Isahaya Hospital, Nagasaki, Japan
| | | | | | - Yuji Hashizume
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Kimihiro Ogi
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroshi Hiejima
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Yuichi Kamei
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Akiko Hida
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | | | - Yamato Wada
- Department of Psychiatry, Hannan Hospital, Osaka, Japan
| | - Masanori Takami
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | - Yuichi Higashiyama
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Ryoko Miyake
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Hideaki Kondo
- Center for Sleep Medicine, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Yota Fujimura
- Department of Psychiatry and Neurology, Asahikawa Medical University, Hokkaido, Japan.,Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yoshiyuki Tamura
- Department of Psychiatry and Neurology, Asahikawa Medical University, Hokkaido, Japan
| | - Yukari Taniyama
- Department of Neurology, Junwakai Memorial Hospital, Miyazaki, Japan
| | - Naoto Omata
- Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuji Tanaka
- Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shunpei Moriya
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hirokazu Furuya
- Department of Neurology, Neuro-Muscular Center, National Omuta Hospital, Fukuoka, Japan.,Department of Neurology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan.,Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Yoshiya Kawamura
- Department of Psychiatry, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takeshi Otowa
- Graduate School of Clinical Psychology, Teikyo Heisei University Major of Professional Clinical Psychology, Tokyo, Japan
| | - Akinori Miyashita
- Department of Molecular Genetics, Center for Bioresources, Brain Research Institute, Niigata University, Niigata, Japan
| | | | | | - Mihoko Shimada
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Maria Yamasaki
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takumi Kobayashi
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Rumi Misawa
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Yosuke Shigematsu
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ryozo Kuwano
- Department of Molecular Genetics, Center for Bioresources, Brain Research Institute, Niigata University, Niigata, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | | | - Yuji Wada
- Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazuhito Tsuruta
- Department of Neurology, Junwakai Memorial Hospital, Miyazaki, Japan
| | - Shigeru Chiba
- Department of Psychiatry and Neurology, Asahikawa Medical University, Hokkaido, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Naoto Yamada
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | - Masako Okawa
- Department of Sleep Medicine, Shiga University of Medical Science, Shiga, Japan.,Japan Foundation for Neuroscience and Mental Health, Tokyo, Japan.,Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Kenji Kuroda
- Department of Psychiatry, Hannan Hospital, Osaka, Japan
| | - Kazuhiko Kume
- Sleep Center, Kuwamizu Hospital, Kumamoto, Japan.,Department of Stem Cell Biology, Institute of Molecular Genetics and Embryology, Kumamoto University, Kumamoto, Japan.,Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Aichi, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Tetsuo Shimizu
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan.,International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Yoyogi Sleep Disorder Center, Tokyo, Japan
| | - Yutaka Honda
- Seiwa Hospital, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan.,International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Makoto Honda
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Seiwa Hospital, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Hypersomnia with ADHD: a possible subtype of narcolepsy type 2. Sleep Biol Rhythms 2017. [DOI: 10.1007/s41105-017-0139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Abstract
Idiopathic hypersomnia (IH) is a chronic neurologic disorder of daytime sleepiness, accompanied by long sleep times, unrefreshing sleep, difficulty in awakening, cognitive dysfunction, and autonomic symptoms. The cause is unknown; a genetic predisposition is suggested. Autonomic, inflammatory, or immune dysfunction has been proposed. Diagnosis involves a clinical history and objective testing. There are no approved treatments for IH, but modafinil is typically considered first-line. A substantial fraction of patients with IH are refractory or intolerant to standard treatments, and different treatment strategies using novel therapeutics are necessary. Even with current treatment options, quality of life and safety may remain impaired.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA.
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What Does One Sleep-Onset REM Period—During Either Nocturnal Polysomnography or Multiple Sleep Latency Test—Mean in Differential Diagnosis of Central Hypersomnias? J Clin Neurophysiol 2016; 32:364-8. [PMID: 26241245 DOI: 10.1097/wnp.0000000000000192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The differentiation of narcolepsy without cataplexy from idiopathic hypersomnia is based on the number of sleep-onset rapid eye movement periods (SOREMPs) observed by multiple sleep latency test (MSLT) and nocturnal polysomnography. The main aim of this study was to investigate the utility of SOREMP in differential diagnosis of central hypersomnias. METHODS The authors retrospectively evaluated consecutive 101 patients with a normal polysomnography other than the presence of SOREMP and/or REM without atonia and a latency of ≤8 minutes in MSLT. RESULTS The authors classified patients as follows: 52 patients had at least 2 SOREMPs (narcolepsy group), 23 had no SOREMPs (idiopathic hypersomnia group), and 26 patients had only 1 SOREMP (intermediate group). In polysomnographic recordings, both mean sleep latency and REM latency were significantly shorter in the narcolepsy (P = 0.012, P < 0.001, respectively) and intermediate groups (P = 0.005 and P = 0.035, respectively) compared with the idiopathic hypersomnia group. In MSLT recordings, sleep latency was 2.7 ± 2.2 minutes in the narcolepsy group, 3.6 ± 1.4 minutes in the intermediate group, and 5.2 ± 2.7 minutes in the idiopathic hypersomnia group (P < 0.001). The mean REM latency and sleep stages SOREMPs arised from were similar between the narcolepsy and intermediate groups. CONCLUSIONS To date, SOREMPs in MSLT and polysomnography remain the sole electrodiagnostic feature that discriminates narcolepsy without cataplexy from idiopathic hypersomnia. Different parameters or combined criteria are being increasingly investigated to increase the sensitivity and specificity of MSLT. The findings showed an altered instability of REM sleep not only in patients with 2 or more SOREMPs in MSLT but also in patients with one SOREMP.
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Sowa NA. Idiopathic Hypersomnia and Hypersomnolence Disorder: A Systematic Review of the Literature. PSYCHOSOMATICS 2016; 57:152-64. [DOI: 10.1016/j.psym.2015.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 01/26/2023]
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Shimada-Sugimoto M, Otowa T, Miyagawa T, Khor SS, Omae Y, Toyo-Oka L, Sugaya N, Kawamura Y, Umekage T, Miyashita A, Kuwano R, Kaiya H, Kasai K, Tanii H, Okazaki Y, Tokunaga K, Sasaki T. Polymorphisms in the TMEM132D region are associated with panic disorder in HLA-DRB1*13:02-negative individuals of a Japanese population. Hum Genome Var 2016; 3:16001. [PMID: 27081567 PMCID: PMC4766370 DOI: 10.1038/hgv.2016.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/09/2022] Open
Abstract
We herein report an association between TMEM132D and panic disorder (PD) in a Japanese population, evaluating the effects of HLA-DRB1*13:02, which we previously reported as a susceptibility genetic factor for PD. SNPs in TMEM132D showed significant associations with PD in subjects without HLA-DRB1*13:02 (rs4759997; P=5.02×10−6, odds ratio=1.50) but not in those with the HLA allele. TMEM132D might have a role in the development of PD in subjects without HLA-DRB1*13:02.
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Affiliation(s)
- Mihoko Shimada-Sugimoto
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Takeshi Otowa
- Graduate School of Clinical Psychology, Teikyo Heisei University Major of Professional Clinical Psychology , Tokyo, Japan
| | - Taku Miyagawa
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Seik-Soon Khor
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Yosuke Omae
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Licht Toyo-Oka
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Nagisa Sugaya
- Department of Epidemiology and Public Health, Graduate School of Medicine, Yokohama City University , Kanagawa, Japan
| | - Yoshiya Kawamura
- Department of Psychiatry, Shonan Kamakura General Hospital , Kanagawa, Japan
| | - Tadashi Umekage
- Division for Environment, Health and Safety, The University of Tokyo , Tokyo, Japan
| | - Akinori Miyashita
- Department of Molecular Genetics, Center for Bioresources, Brain Research Institute, Niigata University , Niigata, Japan
| | - Ryozo Kuwano
- Department of Molecular Genetics, Center for Bioresources, Brain Research Institute, Niigata University , Niigata, Japan
| | - Hisanobu Kaiya
- Panic Disorder Research Center, Warakukai Med. Corp. , Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Hisashi Tanii
- Department of Psychiatry, Institute of Medical Life Science, Graduate School of Medicine, Mie University , Mie, Japan
| | - Yuji Okazaki
- Tokyo Metropolitan Matsuzawa Hospital , Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo , Tokyo, Japan
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Khan Z, Trotti LM. Central Disorders of Hypersomnolence: Focus on the Narcolepsies and Idiopathic Hypersomnia. Chest 2015; 148:262-273. [PMID: 26149554 DOI: 10.1378/chest.14-1304] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The central disorders of hypersomnolence are characterized by severe daytime sleepiness, which is present despite normal quality and timing of nocturnal sleep. Recent reclassification distinguishes three main subtypes: narcolepsy type 1, narcolepsy type 2, and idiopathic hypersomnia (IH), which are the focus of this review. Narcolepsy type 1 results from loss of hypothalamic hypocretin neurons, while the pathophysiology underlying narcolepsy type 2 and IH remains to be fully elucidated. Treatment of all three disorders focuses on the management of sleepiness, with additional treatment of cataplexy in those patients with narcolepsy type 1. Sleepiness can be treated with modafinil/armodafinil or sympathomimetic CNS stimulants, which have been shown to be beneficial in randomized controlled trials of narcolepsy and, quite recently, IH. In those patients with narcolepsy type 1, sodium oxybate is effective for the treatment of both sleepiness and cataplexy. Despite these treatments, there remains a subset of hypersomnolent patients with persistent sleepiness, in whom alternate therapies are needed. Emerging treatments for sleepiness include histamine H3 antagonists (eg, pitolisant) and possibly negative allosteric modulators of the gamma-aminobutyric acid-A receptor (eg, clarithromycin and flumazenil).
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Affiliation(s)
- Zeeshan Khan
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA
| | - Lynn Marie Trotti
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA.
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An association analysis of HLA-DQB1 with narcolepsy without cataplexy and idiopathic hypersomnia with/without long sleep time in a Japanese population. Hum Genome Var 2015; 2:15031. [PMID: 27081540 PMCID: PMC4785567 DOI: 10.1038/hgv.2015.31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/08/2015] [Indexed: 12/28/2022] Open
Abstract
Narcolepsy without cataplexy (NA w/o CA) (narcolepsy type 2) is a lifelong disorder characterized by excessive daytime sleepiness and rapid eye movement (REM) sleep abnormalities, but no cataplexy. In the present study, we examined the human leukocyte antigen HLA-DQB1 in 160 Japanese patients with NA w/o CA and 1,418 control subjects. Frequencies of DQB1*06:02 were significantly higher in patients with NA w/o CA compared with controls (allele frequency: 16.6 vs. 7.8%, P=1.1×10−7, odds ratio (OR)=2.36; carrier frequency: 31.3 vs. 14.7%, P=7.6×10−8, OR=2.64). Distributions of HLA-DQB1 alleles other than DQB1*06:02 were compared between NA w/o CA and narcolepsy with cataplexy (NA-CA) to assess whether the genetic backgrounds of the two diseases have similarities. The distribution of the HLA-DQB1 alleles in DQB1*06:02-negative NA w/o CA was significantly different from that in NA-CA (P=5.8×10−7). On the other hand, the patterns of the HLA-DQB1 alleles were similar between DQB1*06:02-positive NA w/o CA and NA-CA. HLA-DQB1 analysis was also performed in 186 Japanese patients with idiopathic hypersomnia (IHS) with/without long sleep time, but no significant associations were observed.
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Sasai-Sakuma T, Kinoshita A, Inoue Y. Polysomnographic Assessment of Sleep Comorbidities in Drug-Naïve Narcolepsy-Spectrum Disorders--A Japanese Cross-Sectional Study. PLoS One 2015; 10:e0136988. [PMID: 26322978 PMCID: PMC4556112 DOI: 10.1371/journal.pone.0136988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/11/2015] [Indexed: 01/01/2023] Open
Abstract
This is a large cross-sectional study which aimed to investigate comorbidity rate, degree of sleep-related breathing disorder, polysomnigraphically diagnosible rapid eye movement sleep behavior disorder/rapid eye movement sleep without atonia and periodic limb movements during sleep in Japanese drug-naïve patients with narcolepsy-spectrum disorders. A total of 158 consecutive drug naïve patients with narcolepsy with cataplexy, 295 patients with narcolepsy without cataplexy and 395 patients with idiopathic hypersomnia without long sleep time were enrolled. From retrospectively analyzed data of nocturnal polysomnography and multiple sleep latency test, higher rates of periodic limb movements during sleep (> = 15 h-1) (10.2%) and polysomnographically diagnosable rapid eye movement sleep behavior disorder (1.9%) were found in patients with narcolepsy with cataplexy. They had more severe periodic limb movements during sleep especially during rapid eye movement sleep and higher percentages of rapid eye movement sleep without atonia than the other two patient groups. In the present large sample study, Japanese drug naïve patients with narcolepsy with cataplexy showed the highest comorbidity rates of periodic limb movements during sleep, polysomnographically diagnosable rapid eye movement sleep behavior disorder and rapid eye movement sleep without atonia among those with the other narcolepsy-spectrum disorders; the rates were lower than those for Western patients.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
| | - Akihiko Kinoshita
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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Yaman M, Karakaya F, Aydin T, Mayda H, Güzel Hİ, Kayaalp D. Evaluation of the Effect of Modafinil on Cognitive Functions in Patients with Idiopathic Hypersomnia with P300. Med Sci Monit 2015; 21:1850-5. [PMID: 26116438 PMCID: PMC4487186 DOI: 10.12659/msm.893448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Modafinil is a well-tolerated psychostimulant drug with low addictive potential that is used to treat patients with narcolepsy and other excessive sleepiness. Whereas favorable effects of modafinil on cognitive functions have been shown in a large number of studies, there are very few reports presenting the effects of modafinil electrophysiologically. The aim of this study was to investigate the effects of modafinil on auditory P300 latency and amplitude electrophysiologically. Material/Methods Eighteen patients (age range: 16–48 years) with a diagnosis of idiopathic hypersomnia (IH) were included in the present study. As a standard treatment, 200 mg/day modafinil was administered to each patient. The P300 auditory test was performed for each patient before and at the end of 1 week of modafinil treatment. Results After 1 week of modafinil treatment, mean P300 latencies (at all electrode sites) were significantly lower than the latencies before the treatment (P values for Fz, Cz and Pz recording sites were 0.039, 0.002, and 0.004, respectively). An increase in the P300 amplitudes was detected only at the Fz recording site, but not at Cz or Pz recording sites (P values for Fz, Cz, and Pz recording sites were 0.014, 0.100, and 0.05, respectively). Conclusions One week of modafinil treatment improved the cognitive performance, alertness, and executive functions in IH patients. Our electrophysiologically obtained findings provide further confirmation for previous reports in which modafinil has been shown to exert favorable effects on cognitive performance, alertness, and executive functions.
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Affiliation(s)
- Mehmet Yaman
- Department of Neurology, University of Afyon Kocatepe, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Fatıma Karakaya
- Department of Neurology, University of Afyon Kocatepe, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Tuğçe Aydin
- Department of Neurology, University of Afyon Kocatepe, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Hasan Mayda
- Department of Psychiatry, University of Afyon Kocatepe, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Hail İbrahim Güzel
- Department of Psychiatry, University of Afyon Kocatepe, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Dilek Kayaalp
- Department of Neurology, University of Afyon Kocatepe, Faculty of Medicine, Afyonkarahisar, Turkey
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Sasai-Sakuma T, Inoue Y. Differences in electroencephalographic findings among categories of narcolepsy-spectrum disorders. Sleep Med 2015; 16:999-1005. [PMID: 26026626 DOI: 10.1016/j.sleep.2015.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/08/2014] [Accepted: 01/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To clarify the differences in quantitative electroencephalographic (EEG) measures and their relation to clinical symptoms among narcolepsy-spectrum disorders. METHODS The enrolled patients were: 28 with narcolepsy with cataplexy (NA-CA); 16 with NA without cataplexy (NA w/o CA) and HLA-DRB1*1501/DQB1*0602 positive (NA w/o CA HLA+); 22 with NA w/o CA and HLA negative (NA w/o CA HLA-); and 22 with idiopathic hypersomnia without long sleep time (IHS w/o LST). Nocturnal polysomnography (n-PSG) and quantitative EEG evaluation, as well as the Multiple Sleep Latency test (MSLT), were conducted for all patients. RESULTS Patients with NA-CA or NA w/o CA HLA+ showed lower alpha power, higher delta and theta power during wakefulness, and higher alpha and beta power during rapid eye movement (REM) sleep, compared to those with NA w/o CA HLA- or IHS w/o LST. The former two groups also showed lower sleep efficiency and a higher rate of positivity of REM-related symptoms than the other two groups. CONCLUSIONS In narcolepsy, the presence of cataplexy and HLA positivity are associated with EEG slowing during wakefulness and increased fast EEG activity during REM sleep, REM-related symptoms and disrupted nocturnal sleep in narcolepsy.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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Idiopathic Hypersomnia. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Conditional ablation of orexin/hypocretin neurons: a new mouse model for the study of narcolepsy and orexin system function. J Neurosci 2014; 34:6495-509. [PMID: 24806676 DOI: 10.1523/jneurosci.0073-14.2014] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The sleep disorder narcolepsy results from loss of hypothalamic orexin/hypocretin neurons. Although narcolepsy onset is usually postpubertal, current mouse models involve loss of either orexin peptides or orexin neurons from birth. To create a model of orexin/hypocretin deficiency with closer fidelity to human narcolepsy, diphtheria toxin A (DTA) was expressed in orexin neurons under control of the Tet-off system. Upon doxycycline removal from the diet of postpubertal orexin-tTA;TetO DTA mice, orexin neurodegeneration was rapid, with 80% cell loss within 7 d, and resulted in disrupted sleep architecture. Cataplexy, the pathognomic symptom of narcolepsy, occurred by 14 d when ∼5% of the orexin neurons remained. Cataplexy frequency increased for at least 11 weeks after doxycycline. Temporary doxycycline removal followed by reintroduction after several days enabled partial lesion of orexin neurons. DTA-induced orexin neurodegeneration caused a body weight increase without a change in food consumption, mimicking metabolic aspects of human narcolepsy. Because the orexin/hypocretin system has been implicated in the control of metabolism and addiction as well as sleep/wake regulation, orexin-tTA; TetO DTA mice are a novel model in which to study these functions, for pharmacological studies of cataplexy, and to study network reorganization as orexin input is lost.
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Nakamura M, Nishida S, Hayashida K, Ueki Y, Dauvilliers Y, Inoue Y. Differences in brain morphological findings between narcolepsy with and without cataplexy. PLoS One 2013; 8:e81059. [PMID: 24312261 PMCID: PMC3842956 DOI: 10.1371/journal.pone.0081059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Maps of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) obtained by diffusion tensor imaging (DTI) can detect microscopic axonal changes by estimating the diffusivity of water molecules using magnetic resonance imaging (MRI). We applied an MRI voxel-based statistical approach to FA and ADC maps to evaluate microstructural abnormalities in the brain in narcolepsy and to investigate differences between patients having narcolepsy with and without cataplexy. Methods Twelve patients with drug-naive narcolepsy with cataplexy (NA/CA), 12 with drug-naive narcolepsy without cataplexy (NA w/o CA) and 12 age-matched healthy normal controls (NC) were enrolled. FA and ADC maps for these 3 groups were statistically compared by using voxel-based one-way ANOVA. In addition, we investigated the correlation between FA and ADC values and clinical variables in the patient groups. Results Compared to the NC group, the NA/CA group showed higher ADC values in the left inferior frontal gyrus and left amygdala, and a lower ADC value in the left postcentral gyrus. The ADC value in the right inferior frontal gyrus and FA value in the right precuneus were higher for NA/CA group than for the NA w/o CA group. However, no significant differences were observed in FA and ADC values between the NA w/o CA and NC groups in any of the areas investigated. In addition, no correlation was found between the clinical variables and ADC and FA values of any brain areas in these patient groups. Conclusions Several microstructural changes were noted in the inferior frontal gyrus and amygdala in the NA/CA but not in the NA w/o CA group. These findings suggest that these 2 narcolepsy conditions have different pathological mechanisms: narcolepsy without cataplexy form appears to be a potentially broader condition without any significant brain imaging differences from normal controls.
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Affiliation(s)
- Masaki Nakamura
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Tokyo Medical University, Department of Somnology, Tokyo, Japan
- * E-mail:
| | - Shingo Nishida
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Tokyo Medical University, Department of Somnology, Tokyo, Japan
| | - Kenichi Hayashida
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoichiro Ueki
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep-Disorders Center, Department of Neurology, Hôpital Gui de Chauliac, Inserm U1061, UM1, Montpellier, France
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Tokyo Medical University, Department of Somnology, Tokyo, Japan
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Narcolepsy: clinical differences and association with other sleep disorders in different age groups. J Neurol 2012; 260:767-75. [PMID: 23070467 DOI: 10.1007/s00415-012-6702-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 10/03/2012] [Accepted: 10/03/2012] [Indexed: 01/01/2023]
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Abstract
The classification of sleep disorders is necessary to discriminate between disorders and to facilitate an understanding of symptoms, etiology, and pathophysiology that allows for appropriate treatment. The earliest classification systems, largely organized according to major symptoms (insomnia, excessive sleepiness, and abnormal events that occur during sleep), were unable to be based on pathophysiology because the cause of most sleep disorders was unknown. These 3 symptom-based categories are easily understood by physicians and are therefore useful for developing a differential diagnosis. The International Classification of Sleep Disorders, version 2, published in 2005 and currently undergoing revision, combines a symptomatic presentation (e.g., insomnia) with 1 organized in part on pathophysiology (e.g., circadian rhythms) and in part on body systems (e.g., breathing disorders). This organization of sleep disorders is necessary because of the varied nature and because the pathophysiology for many of the disorders is still unknown. The International Classification of Sleep Disorders, version 2 provides relevant diagnostic and epidemiological information on sleep disorders to more easily differentiate between the disorders.
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Affiliation(s)
- Michael J Thorpy
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, NY, USA.
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Nevsimalova S, Jara C, Prihodova I, Kemlink D, Sonka K, Skibova J. Clinical features of childhood narcolepsy. Can cataplexy be foretold? Eur J Paediatr Neurol 2011; 15:320-5. [PMID: 21345702 DOI: 10.1016/j.ejpn.2011.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/28/2010] [Accepted: 01/30/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Narcolepsy is a life-long disease characterized by abnormal regulation of the sleep-wake cycle and increased penetration of rapid eye movement (REM) sleep. In children, narcolepsy without cataplexy is more frequently seen than in adults. The aim of our study was to evaluate clinical and polysomnographic parameters to verify if cataplexy appearing later in life can be foretold. METHODS 30 patients (12 boys), who contracted narcolepsy before the age of 18, were enrolled. All underwent clinical examination, nocturnal polysomnography (PSG), multiple sleep latency test (MSLT), HLA-DQB1∗0602 testing and, most of them Epworth Sleepiness Scale (ESS) rating. The Mann-Whitney rank and Fisher's tests were used for statistical analysis. RESULTS Narcolepsy without cataplexy (NwC) was diagnosed in 40% of the patients. The mean age at the first symptoms was 14.0 ± 3.0, at diagnosis 15.6 ± 3.1 years. Narcolepsy was accompanied by hypnagogic hallucinations in 15 and sleep paralysis in 12 patients. Frequent symptoms were sleep inertia during awakening, REM behavior symptoms, behavioral and serious school problems. BMI was higher in patients with narcolepsy-cataplexy (N-C). A high ESS score was indicative of excessive daytime sleepiness (17.1 ± 2.5). Mean MSLT sleep latency was 4.0 ± 3.1 min with 3.2 ± 1.4 sleep onset REM periods (SOREMs) with no difference between the two study groups. HLA typing revealed no differences either. The N-C group showed a higher degree of wakefulness and superficial non-REM (NREM) stage 1 with a lower NREM stage 3 during PSG. CONCLUSION Narcolepsy in childhood leaves very little scope for the prediction of cataplexy later in life.
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Affiliation(s)
- Sona Nevsimalova
- Department of Neurology, 1st Faculty of Medicine and Teaching Hospital, Charles University, Prague, Czech Republic.
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Takei Y, Komada Y, Namba K, Sasai T, Nakamura M, Sugiura T, Hayashida K, Inoue Y. Differences in findings of nocturnal polysomnography and multiple sleep latency test between narcolepsy and idiopathic hypersomnia. Clin Neurophysiol 2011; 123:137-41. [PMID: 21723190 DOI: 10.1016/j.clinph.2011.05.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 04/17/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare differences in nocturnal and daytime polysomnographic findings between narcolepsy (NA) with and without cataplexy (CA) and idiopathic hypersomnia without long sleep time (IHS w/o LST). METHODS Nocturnal polysomnography (n-PSG) and multiple sleep latency test (MSLT) findings were compared among subjects with NA with CA (n=52), NA without CA (n=62), and IHS w/o LST (n=50). RESULTS The NA with CA group had significantly more disrupted and shallower nocturnal sleep than the other groups. On MSLT, the IHS w/o LST group had significantly longer sleep latency (SL) compared with the two NA groups. The latter two groups did not show statistical differences in diurnal variation of SL. CONCLUSIONS The IHS w/o LST group had milder objective daytime sleepiness compared with the NA groups. In patients with NA, nocturnal sleep disturbances appeared only in cases with CA, despite a similar trend in diurnal changes in sleep propensity between the two NA groups. SIGNIFICANCE Objective nocturnal sleep disturbances are specific to NA patients with CA, whereas diurnal variations of sleep propensity are observed irrespective of the presence of CA among NA patients. These findings could be helpful for choosing optimal treatment plans for patients with these disorders.
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Affiliation(s)
- Yoichiro Takei
- Japan Somnology Center, Neuropsychiatric Research Institute, 1-24-10 Yoyogi, Shibuya-ku, Tokyo, Japan
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Nakamura M, Kanbayashi T, Sugiura T, Inoue Y. Relationship between clinical characteristics of narcolepsy and CSF orexin-A levels. J Sleep Res 2011; 20:45-9. [PMID: 20642748 DOI: 10.1111/j.1365-2869.2010.00870.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although an abnormally low cerebrospinal fluid (CSF)-orexin level is well known to be a specific finding in narcoleptic patients, the relationships between the severity of the core symptoms of narcolepsy [i.e. daytime sleepiness and increased rapid eye movement (REM) propensity], as well as levels of obesity, and CSF-orexin levels have not been well elucidated. The aim of this study was to examine the relationship between these characteristic symptoms of narcolepsy and CSF-orexin level. Fifty-three patients with narcolepsy with cataplexy (NA/CA) and 17 without cataplexy (NA w/o CA) were enrolled. Sleep latency and sleep onset REM latency were measured using the multiple sleep latency test (MSLT). Multiple linear regression analysis was used to determine factors associated with both mean sleep latency and mean sleep onset REM latency on MSLT, with %body mass index (BMI), gender, onset age, length of excessive daytime sleepiness (EDS) morbidity, diagnostic subgroup and CSF-orexin levels being used as independent variables. The NA/CA group included a significantly higher number of patients with undetectable CSF-orexin levels and shorter sleep onset and rapid eye movement (SOREM) latency, as well as a higher %BMI, versus NA w/o CA. Multiple linear regression analysis revealed that sleep latency was associated significantly with CSF-orexin levels and gender. With regard to sleep onset REM latency and %BMI, only CSF-orexin levels appeared to be a significantly associated factor. In narcoleptic patients, the severity of both excessive daytime sleepiness and increased REM propensity, as well as the level of obesity, could be associated with CSF-orexin deficiency, rather than with subcategories of the disorder.
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Affiliation(s)
- Masaki Nakamura
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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Excessive daytime sleepiness among Japanese public transportation drivers engaged in shiftwork. J Occup Environ Med 2010; 52:813-8. [PMID: 20657307 DOI: 10.1097/jom.0b013e3181ea5a67] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the actual condition of sleep disorders underlying subjective excessive daytime sleepiness (EDS) among train and bus drivers engaged in shiftwork. METHODS This study targeted 3109 public transportation drivers. Clinical diagnoses were made based on 147 drivers who claimed to have subjective EDS, and 285 drivers who were judged to have obstructive sleep apnea syndrome (OSAS), based on the screening process. RESULTS Among these subjects, the prevalence of OSAS was 3.7% and that of shiftwork disorder (SWD) was 1.5%. SWD was common among drivers who had EDS (32.7% of drivers with EDS), and their EDS severity was higher than that of OSAS drivers. The drivers with SWD were mostly young and neither obese nor hypertensive. CONCLUSIONS Encouraging awareness of SWD and OSAS could be necessary to prevent sleepiness-related accidents.
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Goel N, Banks S, Mignot E, Dinges DF. DQB1*0602 predicts interindividual differences in physiologic sleep, sleepiness, and fatigue. Neurology 2010; 75:1509-19. [PMID: 20975052 PMCID: PMC2974463 DOI: 10.1212/wnl.0b013e3181f9615d] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The human leukocyte antigen (HLA) DQB1*0602 allele is closely associated with narcolepsy, a neurologic disorder characterized by excessive daytime sleepiness, fragmented sleep, and shortened REM sleep latency. We evaluated whether DQB1*0602 was a novel marker of interindividual differences by determining its relationship to sleep homeostatic, sleepiness, and cognitive responses to baseline and chronic partial sleep deprivation (PSD) conditions. METHODS Ninety-two DQB1*0602-negative and 37 DQB1*0602-positive healthy adults participated in a protocol of 2 baseline 10 hours time in bed (TIB) nights followed by 5 consecutive 4 hours TIB nights. DQB1*0602 allelic frequencies did not differ significantly between Caucasians and African Americans. RESULTS During baseline, although DQB1*0602-positive subjects were subjectively sleepier and more fatigued, they showed greater sleep fragmentation, and decreased sleep homeostatic pressure and differentially sharper declines during the night (measured by non-REM EEG slow-wave energy [SWE]). During PSD, DQB1*0602-positive subjects were sleepier and showed more fragmented sleep, despite SWE elevation comparable to negative subjects. Moreover, they showed differentially greater REM sleep latency reductions and smaller stage 2 reductions, along with differentially greater increases in fatigue. Both groups demonstrated comparable cumulative decreases in cognitive performance. CONCLUSIONS DQB1*0602 positivity in a healthy population may represent a continuum of some sleep-wake features of narcolepsy. DQB1*0602 was associated with interindividual differences in sleep homeostasis, physiologic sleep, sleepiness, and fatigue-but not in cognitive measures-during baseline and chronic PSD. Thus, DQB1*0602 may represent a genetic biomarker for predicting such individual differences in basal and sleep loss conditions.
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Affiliation(s)
- Namni Goel
- Division of Sleep and Chronobiology, Unit for Experimental Psychiatry, Department of Psychiatry, University of Pennsylvania School of Medicine, 1013 Blockley Hall, Philadelphia, PA 19104-6021, USA.
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Alóe F, Alves RC, Araújo JF, Azevedo A, Bacelar A, Bezerra M, Bittencourt LRA, Bustamante G, Cardoso TAMDO, Eckeli AL, Fernandes RMF, Goulart L, Pradella-Hallinan M, Hasan R, Sander HH, Pinto LR, Lopes MC, Minhoto GR, Moraes W, Moreira GA, Pachito D, Pedrazolli M, Poyares D, Prado L, Rizzo G, Rodrigues RN, Roitman I, Silva AB, Tavares SMA. [Brazilian guidelines for the diagnosis of narcolepsy]. ACTA ACUST UNITED AC 2010; 32:294-304. [PMID: 20585744 DOI: 10.1590/s1516-44462010005000014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022]
Abstract
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period -free narcolepsy.
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Affiliation(s)
- Flávio Alóe
- Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.
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Watson NF, Ton TGN, Koepsell TD, Gersuk VH, Longstreth WT. Does narcolepsy symptom severity vary according to HLA-DQB1*0602 allele status? Sleep 2010; 33:29-35. [PMID: 20120618 DOI: 10.1093/sleep/33.1.29] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To investigate associations between HLA-DQB1*0602 allele status and measures of narcolepsy symptom severity. DESIGN Cross-sectional study of population-based narcolepsy patients. SETTING King County, Washington. PARTICIPANTS All prevalent cases (n = 279) of physician-diagnosed narcolepsy ascertained from 2001-2005. INTERVENTIONS N/A. MEASUREMENTS Narcolepsy diagnosis was based on cataplexy status, diagnostic sleep study results, and chart review. The number of HLA-DQB1 alleles was determined from buccal genomic DNA. Symptom severity instruments included the Epworth Sleepiness Scale (ESS), the Ullanlinna Narcolepsy Scale (UNS), age of symptom onset, subjective sleep latency and duration, and various clinical sleep parameters. We used linear regression adjusted for African American race and an extended chi-square test of trend to assess relationships across ordered groups defined by allele number (0, 1, or 2). RESULTS Narcolepsy patients were 63% female and 82% Caucasian, with a mean age of 47.6 years (SD = 17.1). One hundred forty-one (51%) patients had no DQB1*0602 alleles; 117 (42%) had one; and 21 (7%) had two. In the complete narcolepsy sample after adjustment for African American race, we observed a linear relationship between HLA-DQB1*0602 frequency and sleepiness as defined by the ESS (P < 0.01), narcolepsy severity as defined by UNS (P < 0.001), age of symptom onset (P < 0.05), and sleep latency (P < 0.001). In univariate analyses, HLA-DQB1*0602 frequency was also associated with napping (P < 0.05) and increased car and work accidents or near accidents (both P < 0.01). Habitual sleep duration was not associated with HLA status. These race-adjusted associations remained for the ESS (P < 0.05), UNS (P < 0.01), and sleep latency (P < 0.001) when restricting to narcolepsy with cataplexy. CONCLUSIONS Narcolepsy symptom severity varies in a linear manner according to HLA-DQB1*0602 allele status. These findings support the notion that HLA-DQ is a disease-modifying gene.
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