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Zeng S, Feng F, Li W, Xu Y, Zhao R, Liang S, Cheng Y, Fang R, Jia H, Wang Y, Lv D, Zhang B. Exploring sleep characteristics in Chinese patients with narcolepsy: insights from the nocturnal sleep onset rapid eye movement period (nSOREMP). J Clin Sleep Med 2024; 20:1349-1355. [PMID: 38648114 PMCID: PMC11294126 DOI: 10.5664/jcsm.11168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
STUDY OBJECTIVES This study aimed to investigate the unique characteristics and clinical significance of the nocturnal sleep onset rapid eye movement period (nSOREMP) in the Chinese population with narcolepsy, enhancing our understanding and management of the disorder globally. METHODS This retrospective analysis investigated narcolepsy in Chinese patients from six hospitals, using the International Classification of Sleep Disorders. A parallel retrospective analysis of the Chinese Clinical Sleep Database focused on polysomnography records was conducted to evaluate nSOREMP prevalence in other sleep disorders. RESULTS The study found a 2.51% nSOREMP prevalence in other sleep disorders in the Chinese Clinical Sleep Database. Significant differences in age, N2 and rapid eye movement percentages, rapid eye movement latency, and various indexes were noted among patients with narcolepsy with or without nSOREMP and other sleep disorders with nSOREMP in the Chinese Clinical Sleep Database. nSOREMP prevalence in narcolepsy type 1 was 33.33% and in narcolepsy type 2 was 28.30%. Noteworthy disparities in narcolepsy type 1 included N2 percentages, rapid eye movement latency, and SOREMPs on Multiple Sleep Latency Test. In narcolepsy type 2, differences were significant for age, sleep latency, N2 and rapid eye movement latencies, arousal index, mean sleep latency on the Multiple Sleep Latency Test, and Multiple Sleep Latency Test SOREMPs. CONCLUSIONS This study highlights the distinct characteristics of nSOREMP in the Chinese population. Patients exhibiting symptoms suggestive of the onset of narcolepsy are advised to undergo a Multiple Sleep Latency Test, irrespective of the occurrence of SOREMP during nocturnal polysomnography. CITATION Zeng S, Feng F, Li W, et al. Exploring sleep characteristics in Chinese patients with narcolepsy: insights from the nocturnal sleep onset rapid eye movement period (nSOREMP). J Clin Sleep Med. 2024;20(8):1349-1355.
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Affiliation(s)
- Shufei Zeng
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, Guangdong, China
| | - Fei Feng
- Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Weimin Li
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, Guangdong, China
| | - Yan Xu
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, Guangdong, China
| | - Rui Zhao
- Inner Mongolia Mental Health Center (The Third Hospital of Inner Mongolia Autonomous Region, Brain Hospital of Inner Mongolia Autonomous Region), Hohhot, Inner Mongolia autonomous Region, China
| | - Shengpeng Liang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, Guangdong, China
| | - Yihong Cheng
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, Guangdong, China
| | - Ruichen Fang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, Guangdong, China
| | - Hailing Jia
- Mental Health Center of Hebei Province, Baoding, Hebei, China
| | - Yang Wang
- The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Dongsheng Lv
- Inner Mongolia Mental Health Center (The Third Hospital of Inner Mongolia Autonomous Region, Brain Hospital of Inner Mongolia Autonomous Region), Hohhot, Inner Mongolia autonomous Region, China
| | - Bin Zhang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, Guangdong, China
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Wang J, Yan Z, Dong X, Li J, Zhao L, Zhang X, Lv C, Zhao Z, Strohl KP, Han F. Diurnal changes in blood pressure and heart rate in children with narcolepsy with cataplexy. J Sleep Res 2023; 32:e13736. [PMID: 36163423 DOI: 10.1111/jsr.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
The hypocretin neurons in the lateral hypothalamus are connected not only to brain alertness systems but also to brainstem nuclei that regulate blood pressure and heart rate. The premise is that regulation of blood pressure and heart rate is altered and affected by methylphenidate, a stimulant drug in children with narcolepsy with cataplexy. The changes in 24-hr ambulatory systolic and diastolic blood pressure and heart rate were compared among pre-treated narcolepsy with cataplexy patients (40 males, 10 females), with mean age 10.4 ± 3.5 years (M ± SD, range 5-17 years) with values from 100 archival age-sex-body mass index matched controls. Patients had a lower diurnal systolic blood pressure (-6.5 mmHg; p = 0.000) but higher heart rate (+11.0 bpm; p = 0.000), particularly evident in the waketime, while diastolic blood pressure was comparable. With methylphenidate (18 mg sustained release at 08:00 hours), patients with narcolepsy with cataplexy had higher systolic blood pressure (+4.6 mmHg, p = 0.015), diastolic blood pressure (+3.3 mmHg, p = 0.005) and heart rate (+7.1 bpm, p = 0.028) during wake time, but nighttime cardiovascular values were unchanged from pre-treated values; amplitude variation in cardiovascular values was unchanged over 24 hr. In conclusion, children with narcolepsy with cataplexy had downregulation blood pressure profile but a higher heart rate, and lesser non-dipping profiles. Daytime methylphenidate treatment increases only waketime blood pressure and further elevated heart rate values.
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Affiliation(s)
- Jingyu Wang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China.,Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Zhihui Yan
- Institute of Materia Medica, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinnan, China
| | - Xiaosong Dong
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Jing Li
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Long Zhao
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Xueli Zhang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Changjun Lv
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Ziyan Zhao
- Institute of Materia Medica, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinnan, China
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, and Cleveland Louis Stokes VA Medical Center, Cleveland, Ohio, USA
| | - Fang Han
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
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Buonocore SM, van der Most RG. Narcolepsy and H1N1 influenza immunology a decade later: What have we learned? Front Immunol 2022; 13:902840. [PMID: 36311717 PMCID: PMC9601309 DOI: 10.3389/fimmu.2022.902840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
In the wake of the A/California/7/2009 H1N1 influenza pandemic vaccination campaigns in 2009-2010, an increased incidence of the chronic sleep-wake disorder narcolepsy was detected in children and adolescents in several European countries. Over the last decade, in-depth epidemiological and immunological studies have been conducted to investigate this association, which have advanced our understanding of the events underpinning the observed risk. Narcolepsy with cataplexy (defined as type-1 narcolepsy, NT1) is characterized by an irreversible and chronic deficiency of hypocretin peptides in the hypothalamus. The multifactorial etiology is thought to include genetic predisposition, head trauma, environmental triggers, and/or infections (including influenza virus infections), and an increased risk was observed following administration of the A/California/7/2009 H1N1 vaccine Pandemrix (GSK). An autoimmune origin of NT1 is broadly assumed. This is based on its strong association with a predisposing allele (the human leucocyte antigen DQB1*0602) carried by the large majority of NT1 patients, and on links with other immune-related genetic markers affecting the risk of NT1. Presently, hypotheses on the underlying potential immunological mechanisms center on molecular mimicry between hypocretin and peptides within the A/California/7/2009 H1N1 virus antigen. This molecular mimicry may instigate a cross-reactive autoimmune response targeting hypocretin-producing neurons. Local CD4+ T-cell responses recognizing peptides from hypocretin are thought to play a central role in the response. In this model, cross-reactive DQB1*0602-restricted T cells from the periphery would be activated to cross the blood-brain barrier by rare, and possibly pathogen-instigated, inflammatory processes in the brain. Current hypotheses suggest that activation and expansion of cross-reactive T-cells by H1N1/09 influenza infection could have been amplified following the administration of the adjuvanted vaccine, giving rise to a “two-hit” hypothesis. The collective in silico, in vitro, and preclinical in vivo data from recent and ongoing research have progressively refined the hypothetical model of sequential immunological events, and filled multiple knowledge gaps. Though no definitive conclusions can be drawn, the mechanistical model plausibly explains the increased risk of NT1 observed following the 2009-2010 H1N1 pandemic and subsequent vaccination campaign, as outlined in this review.
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Ding Q, Li J, Xiao F, Zhang C, Dong X, Han F. Anti-streptococcal antibodies in Chinese patients with type -1 narcolepsy. Sleep Med 2020; 72:37-40. [PMID: 32540635 DOI: 10.1016/j.sleep.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Narcolepsy type 1 (NT1) is considered to be an autoimmune disease, and streptococcal infection may be an environmental trigger. However, previous studies from Asian narcolepsy patients did not reveal elevated anti-streptolysin O [ASO]. The aim is to investigate whether large sample Chinese patients with NT1 have an increase in antistreptococcal antibody titers. METHODS A total of 214 narcolepsy patients and 360 healthy controls were recruited. All patients were DQB1∗0602 positive with clear-cut cataplexy or had low CSF hypocretin-1. Participants were tested for ASO and anti DNAse B [ADB]. These patients were divided into five groups according to disease duration, including 29 patients less than 3 months; 25 from 3 months to 1 year; 40 from 1 to 3 years; 61 from 3 to 10 years and 59 patients over 10 years. Comparison was also made between children and adults with age matched controls, respectively. RESULTS There were no significant differences between patients and healthy controls in regard to both ASO ≥200 IU (19.2% vs. 16.9%, p = 0.50) and ADB≥480IU (9.8% vs. 10.3%, p = 0.86). For children narcolepsy patients, ASO positive rates (19.8% vs. 18%, p = 0.68) and ADB positive rates (10.4% vs. 12%, p = 0.72) had no differences compared to age matched controls. No difference was observed in adult narcolepsy patients either, with ASO positive rates (18.5% vs. 13.8%, p = 0.39) and ADB positive rates (9.3% vs. 5.3%, p = 0.42) compared to age matched controls, respectively. ASO and ADB positive rates had no significant differences among different disease duration groups (p = 0.55 and 0.9, respectively). CONCLUSION Streptococcus infection reflected by increase of ASO and ADB levels was not found in Chinese patients with type 1 narcolepsy, additional triggers for narcolepsy need to be addressed in this population.
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Affiliation(s)
- Qidi Ding
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Jing Li
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Fulong Xiao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Chi Zhang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaosong Dong
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Fang Han
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China.
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Ouyang H, Han F, Zheng Q, Zhang J. Chinese version of narcolepsy severity scale: a validation study. BMC Neurol 2019; 19:334. [PMID: 31864300 PMCID: PMC6925432 DOI: 10.1186/s12883-019-1570-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/11/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The narcolepsy severity scale (NSS) was developed to measure the severity and consequences of symptoms in patients with narcolepsy. The scale has been validated in France, though no other studies have further validated this instrument. The current study aimed to present psychometric properties and describe the score distribution of the Chinese-NSS. METHODS One hundred twenty-two patients with narcolepsy (41 females and 81 males; mean age 26.14 ± 15.40 years) participated in the study. All patients completed the Chinese-NSS. Cronbach's α, item-total score correlations, exploratory factor analysis (EFA), and correlations between NSS total scores and clinical or sleep parameters were then calculated. RESULTS EFA yielded a three-factor model. Internal consistency was acceptable (Cronbach'sα = 0.799). The NSS total score had significant correlations with the Epworth sleepiness score (0.447), pediatric daytime sleepiness scale (0.318), the insomnia severity index (0.592), Beck depression inventory (0.593), EurQol five dimensions-utility (0.457), EurQol five dimensions -VAS (- 0.323), the sleep disturbance scale for children (0.440), the children depression inventory (0.553), and the pediatric quality of life inventory (0.555) total scores, demonstrating acceptable convergence as predicted. CONCLUSIONS The current study is the first validation study of the narcolepsy severity scale in an Asian population. The findings validated the Chinese-narcolepsy severity scale in a Chinese population with acceptable psychometric properties. There are minor differences between our results and those of the original study due to cultural differences.
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Affiliation(s)
- Hui Ouyang
- Department of Neuromedicine, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Fang Han
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Qiwen Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jun Zhang
- Department of Neuromedicine, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China.
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