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Simoncini Malucelli G, Mercante A, Pizza F, Brunetti V, Biscarini F, Vandi S, Mazzoni A, Franceschini C, Della Marca G, Vollono C, Chieffo DPR, Plazzi G. Exploring the emotional and behavioural profile in paediatric narcolepsy type 1: A case-control study. J Sleep Res 2024; 33:e14064. [PMID: 37872846 DOI: 10.1111/jsr.14064] [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: 06/23/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/25/2023]
Abstract
Narcolepsy type 1 (NT1) is a central disorder of hypersomnolence often arising in childhood and adolescence. NT1 has a significant, but poorly defined, psychological impact. We aimed to investigate the psycho-social functioning of children and adolescents with NT1. We performed a cross-sectional, child and parent-reported questionnaire survey in 37 children and adolescents (6-17 years) with NT1, compared with age- and sex-matched controls. Questionnaires (SSHS, ESS-CHAD, CDI, MASC, CBCL, CRS-R, and SNAP-IV) evaluated various aspects of behavioural and emotional profiles, sleep habits, and daytime sleepiness. Subsequently, NT1 intra-group analysis was performed to investigate the effect of sex (males vs females) and pharmacological treatment (treated vs non-treated) on psychological features. The NT1 questionnaires total scores were then correlated with the clinical characteristics (age, body mass index [BMI], ESS-CHAD score, cerebrospinal hypocretin-1 [Hcrt-1] levels, and diagnostic delay). Patients with NT1 showed a higher tendency to depressive symptoms, anxiety, somatisation, inattention, hyperactivity, oppositional/defiant problems, and other maladaptive behaviours compared with controls. Among NT1 patients, females showed a higher propensity to anxiety, and non-treated patients displayed higher depressive symptoms. Psychological symptoms increased with age, BMI, and daytime sleepiness in patients with NT1, while a younger age was associated with more frequent somatisation symptoms. Lower cerebrospinal Hcrt-1 levels correlated with poorer social competencies, daily activities, and inattention. Diagnostic delay was associated with a higher impact of depressive symptoms and behavioural problems. NT1 in children and adolescents is associated with poorer functioning in multiple psychological domains calling for a multidisciplinary approach and monitoring to reduce disease burden and to prevent psychiatric consequences.
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Affiliation(s)
| | - Anna Mercante
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Valerio Brunetti
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Neurologia - Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alice Mazzoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Giacomo Della Marca
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Neurologia - Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Catello Vollono
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Neurofisiopatologia - Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department Women Children and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Tang SH, Min J, Zhang X, Uwah E, Griffis HM, Cielo CM, Fiks AG, Mindell JA, Tapia IE, Williamson AA. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med 2024; 20:1141-1151. [PMID: 38450539 PMCID: PMC11217630 DOI: 10.5664/jcsm.11104] [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: 11/02/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
STUDY OBJECTIVES The purpose of this study was to characterize the incidence of pediatric narcolepsy diagnosis, subsequent care, and potential sociodemographic disparities in a large US claims database. METHODS Merative MarketScan insurance claims (n = 12,394,902) were used to identify youth (6-17 years of age) newly diagnosed with narcolepsy (International Classification of Diseases, 10th revision codes). Narcolepsy diagnosis and care 1 year postdiagnosis included polysomnography with Multiple Sleep Latency Test, pharmacological care, and clinical visits. Potential disparities were examined by insurance coverage and child race and ethnicity (Medicaid-insured only). RESULTS The incidence of narcolepsy diagnosis was 10:100,000, primarily type 2 (69.9%). Most diagnoses occurred in adolescents with no sex differences, but higher rates in Black vs White youth with Medicaid. Two thirds had a prior sleep disorder diagnosis and 21-36% had other co-occurring diagnoses. Only half (46.6%) had polysomnography with Multiple Sleep Latency Test (± 1 year postdiagnosis). Specialty care (18.9% pulmonary, 26.9% neurology) and behavioral health visits were rare (34.4%), although half were prescribed stimulant medications (51.0%). Medicaid-insured were 86% less likely than commercially insured youth to have any clinical care and 33% less likely to have polysomnography with Multiple Sleep Latency Test. CONCLUSIONS Narcolepsy diagnoses occurred in 0.01% of youth, primarily during adolescence, and at higher rates for Black vs White children with Medicaid. Only half overall had evidence of a diagnostically required polysomnography with Multiple Sleep Latency Test, underscoring potential misdiagnosis. Many patients had co-occurring conditions, but specialty and behavioral health care were limited. Results suggest misdiagnosis, underdiagnosis, and limited narcolepsy treatment, as well as possible disparities. Results highlight the need to identify determinants of evidence-based pediatric narcolepsy diagnosis and management. CITATION Tang SH, Min J, Zhang X, et al. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med. 2024;20(7):1141-1151.
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Affiliation(s)
- Si Hao Tang
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jungwon Min
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Xuemei Zhang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Christopher M Cielo
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jodi A Mindell
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Ignacio E Tapia
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Ballmer Institute, University of Oregon, Portland, Oregon
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Kamada Y, Imanishi A, Chiu SW, Yamaguchi T. Burden of narcolepsy in Japan: A health claims database study evaluating direct medical costs and comorbidities. Sleep Med 2024; 114:119-127. [PMID: 38181583 DOI: 10.1016/j.sleep.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE This study aimed to determine the burden of narcolepsy in terms of direct medical costs and comorbidities and compare it with the respective burden of schizophrenia, epilepsy, and ulcerative colitis as controls. METHODS Patients diagnosed with narcolepsy (at least once based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, code G47.4) between April 2017 and March 2022 were identified on the health insurance claims database compiled by JMDC Inc. Patients with schizophrenia (F20), epilepsy (G40), and ulcerative colitis (K51) were matched as controls. Direct medical costs (including inpatient, outpatient, and medication costs) and comorbidities were analyzed. RESULTS We identified 4,594 patients with narcolepsy (≥18 years), 18,376 with schizophrenia, 18,376 with epilepsy, and 4,594 with ulcerative colitis. The total annual direct medical cost per person with narcolepsy was 349,188 JPY. The cost for narcolepsy was less than that for schizophrenia, epilepsy, and ulcerative colitis. Several comorbidities, such as sleep apnea, attention deficit hyperactivity disorder (ADHD), and obesity were more prevalent in the narcolepsy group. CONCLUSIONS The total direct cost for narcolepsy was approximately three times higher than the national medical expense for people aged 15-44 years (122,000 JPY in 2020), but lower than the total cost for all control diseases. The patients with narcolepsy were also likely to have comorbidities that affected their burden. These findings can contribute to future discussions on medical expense assistance programs for patients with narcolepsy.
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Affiliation(s)
- Yuta Kamada
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan; Eisai Co., Ltd., Tokyo, Japan.
| | - Aya Imanishi
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan.
| | - Shih-Wei Chiu
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan.
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan.
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Ben-Joseph RH, Saad R, Black J, Dabrowski EC, Taylor B, Gallucci S, Somers VK. Cardiovascular Burden of Narcolepsy Disease (CV-BOND): a real-world evidence study. Sleep 2023; 46:zsad161. [PMID: 37305967 PMCID: PMC10566243 DOI: 10.1093/sleep/zsad161] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
STUDY OBJECTIVES Narcolepsy is associated with cardiovascular risk factors; however, the risk of new-onset cardiovascular events in this population is unknown. This real-world study evaluated the excess risk of new-onset cardiovascular events in U.S. adults with narcolepsy. METHODS A retrospective cohort study using IBM MarketScan administrative claims data (2014-2019) was conducted. A narcolepsy cohort, comprising adults (≥18 years) with at least two outpatient claims containing a narcolepsy diagnosis, of which at least one was non-diagnostic, was matched to a non-narcolepsy control cohort (1:3) based on cohort entry date, age, sex, geographic region, and insurance type. The relative risk of new-onset cardiovascular events was estimated using a multivariable Cox proportional hazards model to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS The narcolepsy and matched non-narcolepsy control cohorts included 12 816 and 38 441 individuals, respectively. At baseline, cohort demographics were generally similar; however, patients with narcolepsy had more comorbidities. In adjusted analyses, the risk of new-onset cardiovascular events was higher in the narcolepsy cohort compared with the control cohort: any stroke (HR [95% CI], 1.71 [1.24, 2.34]); heart failure (1.35 [1.03, 1.76]); ischemic stroke (1.67 [1.19, 2.34]); major adverse cardiac event (1.45 [1.20, 1.74]); grouped instances of stroke, atrial fibrillation, or edema (1.48 [1.25, 1.74]); and cardiovascular disease (1.30 [1.08, 1.56]). CONCLUSION Individuals with narcolepsy are at increased risk of new-onset cardiovascular events compared with individuals without narcolepsy. Physicians should consider cardiovascular risk in patients with narcolepsy when weighing treatment options.
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Affiliation(s)
| | - Ragy Saad
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | - Jed Black
- Jazz Pharmaceuticals, Palo Alto, CA, USA
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA, USA
| | | | | | | | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Shelton AR. Sleep Disorders in Childhood. Continuum (Minneap Minn) 2023; 29:1205-1233. [PMID: 37590830 DOI: 10.1212/con.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
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Abad VC. Pharmacological options for narcolepsy: are they the way forward? Expert Rev Neurother 2023; 23:819-834. [PMID: 37585269 DOI: 10.1080/14737175.2023.2249234] [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: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Narcolepsy is an under-recognized, rare neurologic disorder of hypersomnolence that is associated with increased mortality and medical and psychiatric co-morbidities. Narcolepsy exerts a substantial economic burden on patients and society. There is currently no cure, and life-long symptomatic therapy is needed. Available drugs do not modify the disease course. AREAS COVERED This manuscript provides an overview of narcolepsy symptoms, diagnosis, pathophysiology, current pharmacotherapies, and emerging treatments. Gaps and unresolved issues in diagnosis and management of narcolepsy are discussed to answer whether pharmacological options are the way forward. EXPERT OPINION Diagnostic criteria for narcolepsy (ICSD-3) need revision and greater clarity. Improved recognition of cataplexy and other symptoms through educational outreach, new biomarkers, improved test scoring through artificial intelligence algorithms, and use of machine learning may facilitate earlier diagnosis and treatment. Pharmacological options need improved symptomatic therapy in addition to targeted therapies that address the loss of hypocretin signaling. Optimal narcolepsy care also needs a better understanding of the pathophysiology, recognition of the different phenotypes in narcolepsy, identification of at-risk individuals and early recognition of symptoms, better diagnostic tools, and a database for research and disease monitoring of treatment, side-effects, and comorbidities.
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Affiliation(s)
- Vivien C Abad
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences Stanford University, Redwood, CA, USA
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Zhou ES, Revette A, Heckler GK, Worhach J, Maski K, Owens JA. Building a deeper understanding of social relationship health in adolescents with narcolepsy disorder. J Clin Sleep Med 2023; 19:491-498. [PMID: 36468655 PMCID: PMC9978442 DOI: 10.5664/jcsm.10372] [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: 07/11/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Common symptoms for patients with narcolepsy can have a significant impact on social health. As one peak for symptom onset is adolescence, these symptoms impact social relationships during a critical developmental period. Much of the existing literature in this domain has relied on broad questionnaires, with less insight into the nuances of patients' potential social struggles. METHODS Adolescents (aged 12-17 years) with narcolepsy and their parents individually completed a semistructured interview (n = 14 dyads). Interview transcripts were analyzed using a multistage thematic analysis. RESULTS An overarching theme was the difficulty adolescents experienced trying to balance narcolepsy symptom management with engaging in social activities in a meaningful way. Narcolepsy affected social relationships in 3 primary domains: mood, physical activities, and driving. Adolescents reported that they were frustrated with feeling as though narcolepsy sometimes defined their social lives. Adolescents and parents expressed a desire for medical providers to better understand their evolving priorities, to validate their social limitations, and to provide more information around the social implications of narcolepsy and its treatment. CONCLUSIONS Narcolepsy has a significant impact on social relationships in adolescents, one that is not adequately managed in current clinical care models. A routine, structured assessment of social health is a vital first step for providers treating adolescents with narcolepsy. Medical centers and patient organizations can play an important role in facilitating social opportunities for this underserved population. CITATION Zhou ES, Revette A, Heckler GK, Worhach J, Maski K, Owens JA. Building a deeper understanding of social relationship health in adolescents with narcolepsy disorder. J Clin Sleep Med. 2023;19(3):491-498.
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Affiliation(s)
- Eric S. Zhou
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anna Revette
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gillian K. Heckler
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Jennifer Worhach
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Judith A. Owens
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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Imanishi A, Kamada Y, Shibata K, Sakata Y, Munakata H, Ishii M. Prevalence, incidence, and medications of narcolepsy in Japan: a descriptive observational study using a health insurance claims database. Sleep Biol Rhythms 2022; 20:585-594. [PMID: 38468628 PMCID: PMC10899966 DOI: 10.1007/s41105-022-00406-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to describe prevalence, incidence, and medications among patients who were diagnosed with narcolepsy in Japan using a claims database. Patients diagnosed with narcolepsy were identified from January 2010 to December 2019 using an employment-based health insurance claims database compiled by JMDC Inc. The prevalence and incidence of narcolepsy were estimated annually in the overall population and by age and sex among employees and their dependents aged < 75 years. Medications, examined for each quarter in the overall population, were modafinil, methylphenidate, pemoline, tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors. We identified 1539 patients with narcolepsy. The overall annual prevalence increased from 5.7 to 18.5/100,000 persons in 2010 and 2019, respectively. Large increases were found from 2010 to 2019 in patients aged 20-29 years and 10-19 years, with the highest prevalence in 2019 (9.7-37.5/100,000 persons and 5.0-27.1/100,000 persons). The overall incidence slightly increased from 3.6 to 4.3/100,000 person-year from 2010 to 2019, and the highest incidence was found in patients aged 20-29 years and 10-19 years (5.8-11.3/100,000 person-year, and 3.8-7.4/100,000 person-year from 2010 to 2019, respectively). Methylphenidate and modafinil were commonly prescribed in 2010 (27.3-38.9% and 17.5-45.5%, respectively). Methylphenidate prescriptions declined during the 10 years, whereas modafinil prescriptions increased (15.6-17.1% and 43.8-45.8% in 2019, respectively). The estimated prevalence and incidence of narcolepsy appeared to increase from 2010 to 2019, especially in teenagers and 20-year olds. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-022-00406-4.
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Affiliation(s)
- Aya Imanishi
- Department of Neuropsychiatry, Akita University School of Medicine, Akita, Japan
| | - Yuta Kamada
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
| | - Kai Shibata
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
| | - Yukinori Sakata
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
| | - Hiroaki Munakata
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
| | - Mika Ishii
- Clinical Planning and Development Department, Medical HQs, Eisai Co., Ltd, Tokyo, Japan
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Increased very low frequency pulsations and decreased cardiorespiratory pulsations suggest altered brain clearance in narcolepsy. COMMUNICATIONS MEDICINE 2022; 2:122. [PMID: 36193214 PMCID: PMC9525269 DOI: 10.1038/s43856-022-00187-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Narcolepsy is a chronic neurological disease characterized by daytime sleep attacks, cataplexy, and fragmented sleep. The disease is hypothesized to arise from destruction or dysfunction of hypothalamic hypocretin-producing cells that innervate wake-promoting systems including the ascending arousal network (AAN), which regulates arousal via release of neurotransmitters like noradrenalin. Brain pulsations are thought to drive intracranial cerebrospinal fluid flow linked to brain metabolite transfer that sustains homeostasis. This flow increases in sleep and is suppressed by noradrenalin in the awake state. Here we tested the hypothesis that narcolepsy is associated with altered brain pulsations, and if these pulsations can differentiate narcolepsy type 1 from healthy controls. Methods In this case-control study, 23 patients with narcolepsy type 1 (NT1) were imaged with ultrafast fMRI (MREG) along with 23 age- and sex-matched healthy controls (HC). The physiological brain pulsations were quantified as the frequency-wise signal variance. Clinical relevance of the pulsations was investigated with correlation and receiving operating characteristic analysis. Results We find that variance and fractional variance in the very low frequency (MREGvlf) band are greater in NT1 compared to HC, while cardiac (MREGcard) and respiratory band variances are lower. Interestingly, these pulsations differences are prominent in the AAN region. We further find that fractional variance in MREGvlf shows promise as an effective bi-classification metric (AUC = 81.4%/78.5%), and that disease severity measured with narcolepsy severity score correlates with MREGcard variance (R = −0.48, p = 0.0249). Conclusions We suggest that our novel results reflect impaired CSF dynamics that may be linked to altered glymphatic circulation in narcolepsy type 1. The flow of fluid surrounding and inside the human brain is thought to be caused by the movement of brain vessels, breathing and heart rate. These so called brain pulsations are linked to clearing waste from the brain. This process is increased during sleep and suppressed while we are awake. Narcolepsy is a neurological disease where the brain areas regulating being awake and asleep are affected. The diagnosis requires time-consuming hospital tests and is often delayed which has a prolonged negative impact on the patients. Here, we use brain imaging to investigate whether brain pulsations are altered in patients with narcolepsy, and if they can be utilized to differentiate patients with narcolepsy from healthy individuals. We find that narcolepsy affects all brain pulsations, and these findings show promise as an additional diagnostic tool that could help detect the disease earlier. Järvelä et al. investigate if narcolepsy is associated with altered brain pulsations using ultrafast fMRI. They find differences in the brain pulsations between narcolepsy type 1 patients and healthy controls that may link to altered brain clearance in narcolepsy, have diagnostic potential and correlate with the severity of narcolepsy.
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Lecendreux M, Plazzi G, Dauvilliers Y, Rosen CL, Ruoff C, Black J, Parvataneni R, Guinta D, Wang YG, Mignot E. Long-term safety and maintenance of efficacy of sodium oxybate in the treatment of narcolepsy with cataplexy in pediatric patients. J Clin Sleep Med 2022; 18:2217-2227. [PMID: 35689598 PMCID: PMC9435339 DOI: 10.5664/jcsm.10090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Evaluate long-term efficacy and safety of sodium oxybate (SXB) in children and adolescents (aged 7-16 years) with narcolepsy with cataplexy. METHODS A double-blind randomized withdrawal study was conducted. Prior to randomization, SXB-naive participants were titrated to an efficacious and tolerable dose of SXB; participants taking SXB entered on their established dose. Following a 2-week stable-dose period and 2-week, double-blind, randomized withdrawal period, participants entered an open-label period (OLP; ≤ 47 weeks). Efficacy measures during the OLP included number of weekly cataplexy attacks, cataplexy-free days, and Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). Safety outcomes included treatment-emergent adverse events; assessments of depression, anxiety, and suicidality; and polysomnography. RESULTS Of 106 enrolled participants, 95 entered and 85 completed the OLP. In SXB-naive participants and participants previously taking SXB, efficacy of SXB established prior to the double-blind, randomized withdrawal period was maintained throughout the OLP for number of weekly cataplexy attacks (median [quartile 1, quartile 3] change from the stable-dose period to end of the OLP: 0.0 [-2.5, 4.9] and 0.0 [-3.4, 2.6], respectively) and ESS-CHAD scores (0.0 [-3.0, 2.5] and 1.0 [-3.0, 3.0], respectively). The median (quartile 1, quartile 3) number of cataplexy-free days per week was 2.3 (0.0, 6.0) in OLP week 1 and 3.8 (0.5, 5.5) in week 48. Treatment-emergent adverse events (≥ 5%) were enuresis, nausea, vomiting, headache, decreased weight, decreased appetite, nasopharyngitis, upper respiratory tract infection, and dizziness. CONCLUSIONS SXB demonstrated long-term maintenance of efficacy in pediatric narcolepsy with cataplexy, with a safety profile consistent with that observed in adults. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A Multicenter Study of the Efficacy and Safety of Xyrem with an Open-Label Pharmacokinetic Evaluation and Safety Extension in Pediatric Subjects with Narcolepsy with Cataplexy; URL: https://clinicaltrials.gov/ct2/show/NCT02221869; Identifier: NCT02221869. CITATION Lecendreux M, Plazzi G, Dauvilliers Y, et al. Long-term safety and maintenance of efficacy of sodium oxybate in the treatment of narcolepsy with cataplexy in pediatric patients. J Clin Sleep Med. 2022;18(9):2217-2227.
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Affiliation(s)
- Michel Lecendreux
- AP-HP, Pediatric Sleep Center, Hospital Robert-Debré, Paris, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (CNR Narcolepsie-Hypersomnie), Paris, France
- INSERM CIC1426, Paris, France
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France
- University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chad Ruoff
- Stanford Sleep Medicine Center, Redwood City, California
- Division of Pulmonary Medicine, Center for Sleep Medicine, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Jed Black
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California
- Jazz Pharmaceuticals, Palo Alto, California
| | | | | | | | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California
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Gudka S, Haynes E, Scotney J, Mukherjee S, Frenkel S, Sivam S, Swieca J, Chamula K, Cunnington D, Saini B. Narcolepsy: Comorbidities, complexities and future directions. Sleep Med Rev 2022; 65:101669. [PMID: 36037569 DOI: 10.1016/j.smrv.2022.101669] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/15/2022]
Abstract
Patients with narcolepsy live with a lifelong sleep-wake disorder, impairing their quality of life, productivity, educational and employment outcomes. Clinicians are becoming aware that a significant aspect of the burden of this disease relates to frequent comorbid conditions, including aspects of the patient's emotional, metabolic, sleep and immune health. This review explores the literature describing the comorbidities seen in patients with narcolepsy, to enhance understanding of these often complex presentations. It hopes to encourage a multidisciplinary approach, to collaborate with patients and a broad clinical team, and to maximise clinical and quality of life outcomes, for those living with narcolepsy.
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Affiliation(s)
- Sajni Gudka
- Urban Impact Project and Adjunct Senior Research Fellow, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Emma Haynes
- Urban Impact Project and Research Fellow, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | | | - Sutapa Mukherjee
- Respiratory and Sleep Medicine, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University and Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Sheila Sivam
- Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - John Swieca
- Sleep Doctors Australia, Melbourne Sleep Disorders Centre, VIC, Australia
| | | | | | - Bandana Saini
- Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
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12
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Current Understanding of Narcolepsy 1 and its Comorbidities: What Clinicians Need to Know. Adv Ther 2022; 39:221-243. [PMID: 34894325 PMCID: PMC8799537 DOI: 10.1007/s12325-021-01992-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
Narcolepsy is a chronic neurologic disorder associated with the dysregulation of the sleep–wake cycle that often leads to a decreased quality of life and results in a considerable health burden. There is often a delay to diagnosis of narcolepsy, mainly due to the lack of recognition of this disorder. One of the main factors hindering the diagnosis of narcolepsy is the association of comorbidities, which include other sleep disorders, psychiatric disorders, cardiovascular disorders, and metabolic disorders. The signs and symptoms of these comorbidities often overlap with those of narcolepsy, and some of the medications used for their treatment may obscure the symptoms of narcolepsy, leading to a delay in diagnosis. This review is targeted to clinicians unaccustomed to working with sleep disorders and aims to increase recognition and improve the management of narcolepsy.
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13
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The link between neurology and behavior in veterinary medicine: A review. J Vet Behav 2021. [DOI: 10.1016/j.jveb.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Ingram DG, Jesteadt L, Crisp C, Simon SL. Treatment and care delivery in pediatric narcolepsy: a survey of parents, youth, and sleep physicians. J Clin Sleep Med 2021; 17:875-884. [PMID: 33283753 DOI: 10.5664/jcsm.9054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES To describe the most commonly used treatments in pediatric narcolepsy and their perceived effectiveness, as well as to elicit key stakeholder perspectives on the most optimal manner in which care ought to be delivered to youth with narcolepsy. METHODS A cross-sectional survey of youth with narcolepsy, parents, and sleep physicians. RESULTS Complete survey results were available for 35 youth with narcolepsy, 116 parents, and 30 sleep physicians. Overall there was general agreement among family and physicians regarding most effective treatments, including both pharmacologic (stimulants, sodium oxybate, and modafinil/armodafinil) and nonpharmacologic (sleep schedule, exercise, diet) approaches. There was a stronger interested in cannabidiol oil (CBD) from families compared to physicians. Both families and physicians also endorsed a need for multispecialty care, ideally delivered in a same day setting and including specialists in mental health, social work, and nutrition. Quality measures were felt to be important but are not currently tracked by most sleep physicians. Qualitative responses highlight the value families place on providers who listen well and remain open-minded. CONCLUSIONS Our results suggest strong support by key stakeholders for an interdisciplinary approach to care for youth with narcolepsy.
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Affiliation(s)
| | | | | | - Stacey L Simon
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
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15
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Ingram DG, Jesteadt L, Crisp C, Simon SL. Perceived challenges in pediatric narcolepsy: a survey of parents, youth, and sleep physicians. J Clin Sleep Med 2021; 17:13-22. [PMID: 32895119 DOI: 10.5664/jcsm.8774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To clarify the most common and problematic symptoms, psychosocial challenges, and comorbidities among youth with narcolepsy based on input from key stakeholders. METHODS A nationwide cross-sectional survey of youth with narcolepsy, parents, and sleep physicians. RESULTS Overall, 116 parents, 35 youth, and 30 providers completed the entire survey. Symptoms that were rated as most common and problematic by both parents and youth were (in descending order) as follows: daytime sleepiness, disturbed nighttime sleep, mood challenges, cataplexy, sleep-related hallucinations, and sleep paralysis. Most of the 18 queried psychosocial concerns were identified as substantial challenges by both adults and youth, including difficulty focusing and memory, school, worry and anxiety, diet and nutrition, lack of motivation, mood problems, and relationship problems. In contrast, while physicians did recognize some of these challenges, they rated medication side effects and driver's license issues as relatively greater challenges. CONCLUSIONS These data highlight the high prevalence of psychosocial challenges, discordance between physician and family ratings of challenges, and a high rate of medical comorbidities in youth with narcolepsy and support the application of a biopsychosocial framework in the assessment and treatment of pediatric narcolepsy.
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Affiliation(s)
| | | | | | - Stacey L Simon
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
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16
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Jennum PJ, Plazzi G, Silvani A, Surkin LA, Dauvilliers Y. Cardiovascular disorders in narcolepsy: Review of associations and determinants. Sleep Med Rev 2021; 58:101440. [PMID: 33582582 DOI: 10.1016/j.smrv.2021.101440] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Narcolepsy type 1 (NT1) is a lifelong disorder of sleep-wake dysregulation defined by clinical symptoms, neurophysiological findings, and low hypocretin levels. Besides a role in sleep, hypocretins are also involved in regulation of heart rate and blood pressure. This literature review examines data on the autonomic effects of hypocretin deficiency and evidence about how narcolepsy is associated with multiple cardiovascular risk factors and comorbidities, including cardiovascular disease. An important impact in NT1 is lack of nocturnal blood pressure dipping, which has been associated with mortality in the general population. Hypertension is also prevalent in NT1. Furthermore, disrupted nighttime sleep and excessive daytime sleepiness, which are characteristic of narcolepsy, may increase cardiovascular risk. Patients with narcolepsy also often present with other comorbidities (eg, obesity, diabetes, depression, other sleep disorders) that may contribute to increased cardiovascular risk. Management of multimorbidity in patients with narcolepsy should include regular assessment of cardiovascular health (including ambulatory blood pressure monitoring), mitigation of cardiovascular risk factors (eg, cessation of smoking and other lifestyle changes, sleep hygiene, and pharmacotherapy), and prescription of a regimen of narcolepsy medications that balances symptomatic benefits with cardiovascular safety.
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Affiliation(s)
- Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark.
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy; IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lee A Surkin
- Empire Sleep Medicine, New York, NY, United States
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France; University of Montpellier, INSERM U1061, Montpellier, France
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17
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Li C, Xie L, Shang S, Dong X, Wang X, Zhao L, Zhang C, Han F. Narcolepsy Quality-of-Life Instrument with 21 Questions: A Translation and Validation Study in Chinese Pediatric Narcoleptics. Nat Sci Sleep 2021; 13:1701-1710. [PMID: 34675719 PMCID: PMC8502071 DOI: 10.2147/nss.s322796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to translate and validate the narcolepsy quality-of-life instrument with 21 questions (NARQoL-21) in Chinese pediatrics with narcolepsy. METHODS NARQoL-21 was translated following the 10 steps of scale translation. The translated version was tested by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), known-group validity, criterion validity, Cronbach's α and test-rest reliability. RESULTS The Chinese version of NARQoL-21 consisted of two factors: (psychosocial factors and future outlook factor), including 20 items. EFA yielded 3 domains for psychosocial factors and 1 domain for future outlook factor. The Chinese version had a negative correlation with the overall Modified Epworth Sleepiness Scale (r = -0.518, p<0.001) and meaningful difference in score between drug naïve and treated group (p<0.05). The Cronbach's α coefficient was higher than 0.7 and intraclass correlation coefficient (ICC) ranged from 0.75 to 0.905, indicating that it had good reliability. CONCLUSION The Chinese version of the NARQoL-21 is available and can be used to evaluate the health-related quality of life (HRQoL) of pediatric narcoleptics, despite that there is a shift in factors compared to the English version due to cultural differences. Future studies are recommended to further validate the scale in Chinese pediatrics with narcolepsy.
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Affiliation(s)
- Chenyang Li
- Peking University School of Nursing, Beijing, People's Republic of China
| | - Liang Xie
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Shaomei Shang
- Peking University School of Nursing, Beijing, People's Republic of China
| | - Xiaosong Dong
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiaoling Wang
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, People's Republic of China
| | - Long Zhao
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Chi Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Fang Han
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
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18
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Quaedackers L, Pillen S, Overeem S. Recognizing the Symptom Spectrum of Narcolepsy to Improve Timely Diagnosis: A Narrative Review. Nat Sci Sleep 2021; 13:1083-1096. [PMID: 34262379 PMCID: PMC8273742 DOI: 10.2147/nss.s278046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Narcolepsy is a chronic sleep disorder with a strong negative impact on quality of life, especially when untreated. Diagnostic delay is a persistent problem, with obvious detrimental effects on patients. A diagnosis of narcolepsy may be delayed because of its broad symptom presentation which is much more encompassing than the classical "tetrad" of sleepiness, cataplexy, hallucinations, and sleep paralysis. Furthermore, symptoms can vary over time. Presentation of symptoms can also be markedly different between children and adults. Finally, common sleep-related comorbidities increase the risk of narcolepsy being masked by overlapping symptoms or treatment. In this review, we provide a detailed description of the broad and dynamic symptom spectrum of narcolepsy, with specific attention to the different manifestations in both adults and children. The overarching goal is to help not only sleep specialists, but general practitioners, pediatricians, and other caregivers with early recognition and prompt diagnosis of this severe but treatable disorder.
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Affiliation(s)
| | - Sigrid Pillen
- Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands
| | - Sebastiaan Overeem
- Biomedical Diagnostics Laboratory, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Ingravallo F, Vignatelli L, Pagotto U, Vandi S, Moresco M, Mangiaruga A, Oriolo C, Zenesini C, Pizza F, Plazzi G. Protocols of a diagnostic study and a randomized controlled non-inferiority trial comparing televisits vs standard in-person outpatient visits for narcolepsy diagnosis and care: TElemedicine for NARcolepsy (TENAR). BMC Neurol 2020; 20:176. [PMID: 32393279 PMCID: PMC7212602 DOI: 10.1186/s12883-020-01762-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Narcolepsy is a rare chronic sleep disorder that typically begins in youth. Excessive daytime sleepiness is the main disabling symptom, but the disease is often associated with severe endocrine-metabolic and psychosocial issues, worsened by a long diagnostic delay, requiring a multidisciplinary approach. The scarcity of reference Sleep Centres forces the patient and family to travel for seeking medical consultations, increasing the economic and psychosocial burden of the disease. Growing evidence suggests that Telemedicine may facilitate patient access to sleep consultations and its non-inferiority in terms of patient satisfaction, adherence to treatment, and symptom improvement for sleep disorders. However, Telemedicine clinical and economic benefits for patients with narcolepsy are still unknown. METHODS TENAR is a two-part project, including: 1. a cross-sectional study (involving 250 children and adults with suspected narcolepsy) evaluating the accuracy of Teletriage (i.e., a synchronous live interactive sleep assessment through a Televisit) for narcolepsy diagnosis compared to the reference standard; and 2. a two-arm, parallel, open randomized controlled trial (RCT) to demonstrate the non-inferiority of the multidisciplinary care of narcolepsy through Televisits versus standard care. In this RCT, 202 adolescents (> 14 y.o.) and adults with narcolepsy will be randomly allocated (1:1 ratio) either to Televisits via videoconference or to standard in-person outpatient follow-up visits (control arm). The primary outcome is sleepiness control (according to the Epworth Sleepiness Scale). Secondary outcomes are other symptoms control, compliance with treatment, metabolic control, quality of life, feasibility, patient and family satisfaction with care, safety, and disease-related costs. At baseline and at 12 months, patients will undergo neurologic, metabolic, and psychosocial assessments and we will measure primary and secondary outcomes. Primary outcomes will be also measured at 6 months (remotely or in person, according to the arm). DISCUSSION TENAR project will assess, for the first time, the feasibility, accuracy, efficacy and safety of Telemedicine procedures applied to the diagnosis and the multidisciplinary care of children and adults with narcolepsy. The study may be a model for the remote management of other rare disorders, offering care access for patients living in areas lacking medical centres with specific expertise. TRIAL REGISTRATION Number of the Tele-multidisciplinary care study NCT04316286. Registered 20 March 2020.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy.
| | - Uberto Pagotto
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Monica Moresco
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Anastasia Mangiaruga
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Claudia Oriolo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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