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Nirogi R, Jayarajan P, Benade V, Abraham R, Goyal VK. Hits and misses with animal models of narcolepsy and the implications for drug discovery. Expert Opin Drug Discov 2024; 19:755-768. [PMID: 38747534 DOI: 10.1080/17460441.2024.2354293] [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: 01/13/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Narcolepsy is a chronic and rare neurological disorder characterized by disordered sleep. Based on animal models and further research in humans, the dysfunctional orexin system was identified as a contributing factor to the pathophysiology of narcolepsy. Animal models played a larger role in the discovery of some of the pharmacological agents with established benefit/risk profiles. AREAS COVERED In this review, the authors examine the phenotypes observed in animal models of narcolepsy and the characteristics of clinically used pharmacological agents in these animal models. Additionally, the authors compare the effects of clinically used pharmacological agents on the phenotypes in animal models with those observed in narcolepsy patients. EXPERT OPINION Research in canine and mouse models have linked narcolepsy to the O×R2mutation and orexin deficiency, leading to new diagnostic criteria and a drug development focus. Advancements in pharmacological therapies have significantly improved narcolepsy management, with insights from both clinical experience and from animal models having led to new treatments such as low sodium oxybate and solriamfetol. However, challenges persist in addressing symptoms beyond excessive daytime sleepiness and cataplexy, highlighting the need for further research, including the development of diurnal animal models to enhance understanding and treatment options for narcolepsy.
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Affiliation(s)
- Ramakrishna Nirogi
- Drug Discovery & Development, Suven Life Sciences Limited, Hyderabad, India
| | - Pradeep Jayarajan
- Drug Discovery & Development, Suven Life Sciences Limited, Hyderabad, India
| | - Vijay Benade
- Drug Discovery & Development, Suven Life Sciences Limited, Hyderabad, India
| | - Renny Abraham
- Drug Discovery & Development, Suven Life Sciences Limited, Hyderabad, India
| | - Vinod Kumar Goyal
- Drug Discovery & Development, Suven Life Sciences Limited, Hyderabad, India
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Yaria J, Olusakin T. Challenges in the Management of Narcolepsy in a Resource Limited Setting: A Case Report. Cureus 2024; 16:e58143. [PMID: 38738054 PMCID: PMC11088952 DOI: 10.7759/cureus.58143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
The management of Narcolepsy, from the initial presentation to the long-term management and follow-up, remains a challenging endeavor, especially in developing climes. Worldwide, it has been recognized as a medical condition that is frequently associated with initial misdiagnoses, and delays in definitive management, further highlighted, in resource-limited settings like Nigeria where issues are further compounded by social, cultural, and political factors. In this report, we aim to shed some light on the peculiar challenges encountered by clinicians in Nigeria, and in other similar settings, in the process of diagnosis and management of narcolepsy. We present a case of a 17-year-old male teenager with Narcolepsy Type 1 (NT1) who had been previously managed as a case of Juvenile Absence Epilepsy in various centers prior to presentation at our facility. The symptoms began two years prior to presentation at our outpatient clinic, and they were excessive daytime sleepiness, cataplexy, and sleep paralysis. The symptoms were corroborated by laboratory parameters - reduced mean sleep latency (conducted in an improvised sleep laboratory), and a low cerebrospinal fluid (CSF) hypocretin level. The patient was initially placed on Modafinil for excessive daytime sleepiness and a trial of Fluoxetine for the Cataplexy. However, due to the scarcity of Modafinil, behavioral modifications - scheduled sleep naps and sleep hygiene - were eventually employed. Narcolepsy is a debilitating illness, and consequently, the far-reaching effects of these challenges must be understood. It is important that concerted efforts be made towards improving the overall quality of care received by patients from the early identification to the treatment of narcolepsy in the Nigerian healthcare system.
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Affiliation(s)
- Joseph Yaria
- Medicine, University College Hospital Ibadan, Ibadan, NGA
| | - Tobi Olusakin
- General Practice, Vine Branch Medical Center, Ibadan, NGA
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Valizadeh P, Momtazmanesh S, Plazzi G, Rezaei N. Connecting the dots: An updated review of the role of autoimmunity in narcolepsy and emerging immunotherapeutic approaches. Sleep Med 2024; 113:378-396. [PMID: 38128432 DOI: 10.1016/j.sleep.2023.12.005] [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: 08/24/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Narcolepsy type 1 (NT1) is a chronic disorder characterized by pathological daytime sleepiness and cataplexy due to the disappearance of orexin immunoreactive neurons in the hypothalamus. Genetic and environmental factors point towards a potential role for inflammation and autoimmunity in the pathogenesis of the disease. This study aims to comprehensively review the latest evidence on the autoinflammatory mechanisms and immunomodulatory treatments aimed at suspected autoimmune pathways in NT1. METHODS Recent relevant literature in the field of narcolepsy, its autoimmune hypothesis, and purposed immunomodulatory treatments were reviewed. RESULTS Narcolepsy is strongly linked to specific HLA alleles and T-cell receptor polymorphisms. Furthermore, animal studies and autopsies have found infiltration of T cells in the hypothalamus, supporting T cell-mediated immunity. However, the role of autoantibodies has yet to be definitively established. Increased risk of NT1 after H1N1 infection and vaccination supports the autoimmune hypothesis, and the potential role of coronavirus disease 2019 and vaccination in triggering autoimmune neurodegeneration is a recent finding. Alterations in cytokine levels, gut microbiota, and microglial activation indicate a potential role for inflammation in the disease's development. Reports of using immunotherapies in NT1 patients are limited and inconsistent. Early treatment with IVIg, corticosteroids, plasmapheresis, and monoclonal antibodies has seldomly shown some potential benefits in some studies. CONCLUSION The current body of literature supports that narcolepsy is an autoimmune disorder most likely caused by T-cell involvement. However, the potential for immunomodulatory treatments to reverse the autoinflammatory process remains understudied. Further clinical controlled trials may provide valuable insights into this area.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic, and Neural Sciences, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Wu M, Li X, Li SX, Tan L, Fang J, Zhou J, Tang X. Early- and late-onset narcolepsy: possibly two distinct clinical phenotypes. Sleep Breath 2023; 27:2443-2452. [PMID: 37046113 DOI: 10.1007/s11325-023-02820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To investigate the clinical characteristics and the risk factors associated with excessive daytime sleepiness (EDS) in patients with early- and late-onset narcolepsy. METHODS Patients with narcolepsy were consecutively recruited. All patients were separated into early- and late-onset groups according to the onset age of disease ≤ 15 and > 15 years, respectively. Demographic, clinical, and sleep parameters were compared between the two groups. Linear regressions were performed to examine the risk factors of subjective and objective EDS in patients with early- and late-onset narcolepsy. RESULTS A total of 101 patients with narcolepsy (median age at recruitment = 18.0 years) were classified into an early-onset group (67 patients with median age at onset = 12.0 years) and a late-onset group (34 patients with median age at onset = 28.5 years). Compared with early-onset group, late-onset group scored significantly higher on Epworth Sleepiness Scale (ESS), Ullanlinna Narcolepsy Scale (UNS), sleep paralysis, rapid eye movement (REM) sleep behavior disorder (RBD) questionnaire-Hong Kong (all P < 0.050). UNS-cataplexy and sleep paralysis had significantly positive associations with subjective EDS, and N1%, arousal index, and periodic limb movements index were positively associated with objective EDS in the early-onset group (all P < 0.050). However, these associations were not observed in late-onset narcolepsy. CONCLUSION Late onset narcolepsy had more severe self-reported narcolepsy symptoms. REM sleep related symptoms and disrupted nighttime sleep were associated with EDS in early-onset narcolepsy. These findings suggest that early- and late-onset narcolepsy may represent two distinct phenotypes.
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Affiliation(s)
- Min Wu
- Sleep Medicine Center, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan Province, China
- Shihezi University School of Medicine, Shihezi University, Shihezi, China
| | - Xiao Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lu Tan
- Sleep Medicine Center, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan Province, China
| | - Jinbo Fang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Junying Zhou
- Sleep Medicine Center, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan Province, China.
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan Province, China.
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Frase L, Nissen C, Spiegelhalder K, Feige B. The importance and limitations of polysomnography in insomnia disorder-a critical appraisal. J Sleep Res 2023; 32:e14036. [PMID: 37680011 DOI: 10.1111/jsr.14036] [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: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the science regarding PSG indications and findings in ID, and the indications to conduct PSG in ID as stated by relevant guidelines. It then highlights the most relevant questions regarding the topic, including the relevance of ID subtyping, to allow an individualised pharmacological or psychotherapeutic treatment approach.
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Affiliation(s)
- Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Siegenthaler P, Valko PO, Renzel R, Werth E, Poryazova R, Baumann CR, Büchele F. How reliable is a simplified MSLT nap termination protocol? Sleep Med 2023; 109:285-292. [PMID: 37499464 DOI: 10.1016/j.sleep.2023.07.016] [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: 05/02/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE According to current practical guidelines, naps of the Mean Sleep Latency Test (MSLT) must be terminated 15 min after sleep onset, which requires ad hoc scoring. For clinical convenience, some sleep clinics use a simplified protocol with fixed nap lengths of 20min. Its diagnostic accuracy remains unknown. METHODS A subset of MSLT naps of 56 narcolepsy type 1 (NT1), 98 Parkinson's disease (PD), 117 sleep disordered breathing (SDB), 22 insufficient sleep syndrome (ISS) patients, and 24 patients with idiopathic hypersomnia (IH), originally performed according to the simplified protocol, were retrospectively adjusted to standard protocol (nap termination 15min after sleep onset or after 20min when no sleep occurs). This was feasible in 60% of MSLT naps; in this subset, we compared sensitivity and specificity of both MSLT protocols for identification of patients with and without NT1. RESULTS Sensitivity of classical MSLT criteria for NT1, i.e. mean sleep latency ≤8.0min and ≥2 sleep onset rapid eye movement periods (SOREMPs), did not differ between protocols (95%). Specificity, however, was slightly lower (88.1% vs. 89.7%) in the simplified nap termination protocol, with 3 SDB patients and 1 ISS patient having false-positive MSLT findings in the simplified but not in the standard protocol. CONCLUSIONS The use of a simplified MSLT protocol with fixed nap duration had no impact on MSLT sensitivity for NT1, but the longer sleep periods in the simplified protocol increased the likelihood of REM sleep occurrence particularly in non-NT1 conditions, resulting in a slightly lower MSLT specificity compared to the standard protocol.
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Affiliation(s)
- Philippe Siegenthaler
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Philipp Oliver Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Roland Renzel
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Christian Rainer Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Fabian Büchele
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
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Janssens K, Amesz P, Nuvelstijn Y, Donjacour C, Hendriks D, Peeters E, Quaedackers L, Vandenbussche N, Pillen S, Lammers GJ. School Problems and School Support for Children with Narcolepsy: Parent, Teacher, and Child Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5175. [PMID: 36982084 PMCID: PMC10049178 DOI: 10.3390/ijerph20065175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess problems faced by children with type 1 narcolepsy (NT1) at school and obtain insight into potential interventions for these problems. METHODS We recruited children and adolescents with NT1 from three Dutch sleep-wake centers. Children, parents, and teachers completed questionnaires about school functioning, interventions in the classroom, global functioning (DISABKIDS), and depressive symptoms (CDI). RESULTS Eighteen children (7-12 years) and thirty-seven adolescents (13-19 years) with NT1 were recruited. Teachers' most frequently reported school problems were concentration problems and fatigue (reported by about 60% in both children and adolescents). The most common arrangements at school were, for children, discussing school excursions (68%) and taking a nap at school (50%) and, for adolescents, a place to nap at school (75%) and discussing school excursions (71%). Regular naps at home on the weekend (children 71% and adolescents 73%) were more common than regular naps at school (children 24% and adolescents 59%). Only a minority of individuals used other interventions. School support by specialized school workers was associated with significantly more classroom interventions (3.5 versus 1.0 in children and 5.2 versus 4.1 in adolescents) and napping at school, but not with better global functioning, lower depressive symptom levels, or napping during the weekends. CONCLUSIONS Children with NT1 have various problems at school, even after medical treatment. Interventions to help children with NT1 within the classroom do not seem to be fully implemented. School support was associated with the higher implementation of these interventions. Longitudinal studies are warranted to examine how interventions can be better implemented within the school.
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Affiliation(s)
- Karin Janssens
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 8025 BV Zwolle, The Netherlands
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands
| | - Pauline Amesz
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 8025 BV Zwolle, The Netherlands
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands
| | - Yvonne Nuvelstijn
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 8025 BV Zwolle, The Netherlands
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands
- LWOE, 2142 ED Cruquius, The Netherlands
| | - Claire Donjacour
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 8025 BV Zwolle, The Netherlands
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands
| | - Danielle Hendriks
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 8025 BV Zwolle, The Netherlands
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands
- Sleeping Center, Medical Centre Haaglanden, 2512 VA The Hague, The Netherlands
| | - Els Peeters
- Sleeping Center, Medical Centre Haaglanden, 2512 VA The Hague, The Netherlands
- Department of Child Neurology, Juliana Children’s Hospital-Haga Teaching Hospital, 2545 AA The Hague, The Netherlands
| | - Laury Quaedackers
- Center for Sleep Medicine, Kempenhaeghe, 5591 VE Heeze, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, 2612 AZ Eindhoven, The Netherlands
| | - Nele Vandenbussche
- Center for Sleep Medicine, Kempenhaeghe, 5591 VE Heeze, The Netherlands
- Noorderhart, Mariaziekenhuis, 3900 Pelt, Belgium
| | - Sigrid Pillen
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 8025 BV Zwolle, The Netherlands
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands
- Kinderslaapexpert BV (Pediatric Sleep Expert Ltd.), 6585 KK Mook, The Netherlands
| | - Gert Jan Lammers
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 8025 BV Zwolle, The Netherlands
- Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), 2103 SW Heemstede, The Netherlands
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Winter Y, Mayer G, Kotterba S, Benes H, Burghaus L, Koch A, Girfoglio D, Setanoians M, Kallweit U. Solriamfetol real world experience study (SURWEY): Initiation, titration, safety, effectiveness, and experience during follow-up for patients with narcolepsy from Germany. Sleep Med 2023; 103:138-143. [PMID: 36796288 DOI: 10.1016/j.sleep.2023.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/22/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a core narcolepsy symptom, for which solriamfetol (Sunosi®) was recently approved in the European Union. SURWEY characterises real-world strategies used by physicians when initiating solriamfetol, and patient outcomes after follow-up. METHODS SURWEY is an ongoing retrospective chart review conducted by physicians in Germany/France/Italy. Here, data are reported from 70 German patients with EDS and narcolepsy. Eligibility included age ≥18 years, reached a stable solriamfetol dose, and completed ≥6 weeks of treatment. Patients were classified (based on existing EDS treatment) into changeover, add-on, or new-to-therapy subgroups. RESULTS Patients' mean ± SD age was 36.9 ± 13.9 years. Changeover from prior EDS medication was the most common initiation strategy. Initial solriamfetol dose was typically 75 mg/day (69%). In 30 patients (43%), solriamfetol was titrated; 27/30 (90%) completed titration as prescribed, most within 7 days. Mean ± SD Epworth Sleepiness Scale (ESS) score was 17.6 ± 3.1 at initiation (n = 61) and 13.6 ± 3.8 at follow-up (n = 51). Slight/strong improvements in EDS were perceived for >90% of patients (patient and physician report). Sixty-two percent reported an effect duration of 6 to <10 h; 72% reported no change in perceived nighttime sleep quality. Common adverse events included headache (9%), decreased appetite (6%), and insomnia (6%); no cardiovascular events were reported. CONCLUSIONS Most patients in this study were switched from a prior EDS medication to solriamfetol. Solriamfetol was typically initiated at 75 mg/day; titration was common. ESS scores improved after initiation, and most patients perceived improvement in EDS. Common adverse events were consistent with those reported in clinical trials. CLINICALTRIALS GOV REGISTRATION N/A.
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Affiliation(s)
- Yaroslav Winter
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany; Department of Neurology, Philipps-University, Biegenstraße 10, 35037, Marburg, Germany.
| | - Geert Mayer
- Hephata Klinik, Schimmelpfengstraße 6, 34613, Schwalmstadt, Germany; Philipps University, Biegenstraße 10, 35037, Marburg, Germany
| | - Sylvia Kotterba
- Klinikum Leer gGmbH, Augustenstraße 35, 26789, Leer (Ostfriesland), Lower Saxony, Germany
| | - Heike Benes
- Somni bene GmbH Institut für Medizinische Forschung and Schlafmedizin Schwerin GmbH, Goethestraße 1, 19053, Schwerin, Germany
| | - Lothar Burghaus
- Department of Neurology, Heilig Geist-Hospital, Graseggerstr. 105, 50737, Cologne-Longerich, Germany
| | - Andreas Koch
- Jazz Pharmaceuticals, Einsteinstrasse 174, 81677, München, Munich, Germany
| | - Daniela Girfoglio
- Jazz Pharmaceuticals, Wing B, Building 5700, Spires House, John Smith Drive, Oxford Business Park South, Oxford, OX4 2RW, United Kingdom
| | - Melinda Setanoians
- Jazz Pharmaceuticals, Wing B, Building 5700, Spires House, John Smith Drive, Oxford Business Park South, Oxford, OX4 2RW, United Kingdom
| | - Ulf Kallweit
- Institute of Immunology and Center for Biomedical Education and Research, University Witten/Herdecke, Stockumer Str. 10, 58453, Witten, Germany
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Davidson-Urbain W, Servot S, Godbout R, Montplaisir JY, Touchette E. [Sleepiness among adolescents: etiology and multiple consequences]. L'ENCEPHALE 2023; 49:87-93. [PMID: 35970642 DOI: 10.1016/j.encep.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/21/2023]
Abstract
Over the past century a dramatic decline in sleep duration among adolescents, such as more than one hour of sleep loss per night, has been reported. A debt in sleep duration could lead to sleep deprivation, a major risk factor associated with daytime sleepiness. Sleepiness refers to the inability to maintain an adequate level of alertness during the day which may result in more or less being able to control falling asleep at inappropriate times. This literature review updates on sleepiness regarding its characteristics, etiology and consequences on adolescents. Studies revealed that from 25 % to 78 % of adolescents had reported sleepiness. Its manifestations may include heavy lids, yawns, difficulties to concentrate and emotional irritability. In addition, while it is recommended that adolescents under 18 years-old should sleep from eight to ten hours a night, only 63 % of them actually do so. The etiology of sleep deprivation and sleepiness in this population can be explained by various biological and societal factors. First, the sleep-wake cycle of adolescents shows a biological shift from the beginning of pubertal maturation, described as a perfect storm. It refers to a social jetlag by going to sleep and waking up later and accumulating a sleep debt during weekdays which they try to reimburse during weekends. This phenomenon can be explained by physiological changes such as a slower accumulation of sleep pressure. In addition to this perfect storm, environmental and societal factors contribute to the social jetlag and reduce sleep duration in adolescents. Screen exposure before bedtime can delay sleep and wake onset, which is a risk factor for sleeping debt. Substance use such as caffeine, cigarettes or electronic vaporizer, ADHD or freely available medication, alcohol, cannabis use or drug consumption could further disrupt sleep-wake cycle by stimulating, depressing or otherwise disrupting the central nervous system. Early, before 8:30 am, class start times have been associated with chronic sleep deprivation, higher level of sleepiness and delayed melatonin peak secretion. Adolescents working or doing extracurricular occupations for more than 20hours a week are more at risk for reduced sleep duration and sleepiness. Parental supervision about sleep during the weekdays were associated with more appropriate bedtime. Adolescents from low socio-demographic characteristics and from minority ethnic groups have reported displaying a shorter sleep duration. Finally, sleep disorders of a physiological origin such as narcolepsy, sleep apnea or restless legs syndrome, may explain the sleep deprivation and sleepiness. Sleep deprivation and sleepiness in adolescents have consequences on their health. Cognitive functioning, such as problem solving, attention or memory, as well as school performance, can be compromised by sleep deprivation and sleepiness. At the psychological level, adolescents reporting sleepiness are more prone to display mental health problems: associations were found between sleepiness and subjective perception of depression, anxiety, somatic complaints as well as with antisocial behaviors. Finally, 68 % of 16 year-old adolescents reported they drove a car, and the reported sleepiness could lead to road accidents due to reduced attentional functioning, reaction time and decision-making abilities. In the United-States, from 7 % to 16.5 % of deadly accidents were related to driving while drowsy. Highlighting etiology and problems associated with sleep deprivation and sleepiness in adolescents could guide researchers and clinicians towards the development of possible interventions. Public health measures and knowledge transfer programs regarding modifiable psychosocial and societal factors associated with sleep-wake bioregulation could increase awareness in parents as well as in political and societal decision makers.
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Affiliation(s)
- W Davidson-Urbain
- Département de psychiatrie et addictologie, université de Montréal, Montréal, Canada
| | - S Servot
- Département de psychoéducation, université du Québec à Trois-Rivières, Québec, Canada; Centre de recherche universitaire sur les jeunes et les familles, Québec, Canada
| | - R Godbout
- Département de psychiatrie et addictologie, université de Montréal, Montréal, Canada; Laboratoire et Clinique du sommeil, hôpital en santé mentale Rivière-des-Prairies, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Canada
| | - J-Y Montplaisir
- Département de psychiatrie et addictologie, université de Montréal, Montréal, Canada; Centre d'études avancées en médecine du sommeil, hôpital du Sacré-Cœur, Québec, Canada
| | - E Touchette
- Département de psychoéducation, université du Québec à Trois-Rivières, Québec, Canada; Centre de recherche universitaire sur les jeunes et les familles, Québec, Canada; Centre d'études avancées en médecine du sommeil, hôpital du Sacré-Cœur, Québec, Canada; Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Québec, Canada; Groupe de recherche en inadaptation psychosociale, Québec, Canada.
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10
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Klaus S, Carolan A, O'Rourke D, Kennedy B. What respiratory physicians should know about narcolepsy and other hypersomnias. Breathe (Sheff) 2022; 18:220157. [PMID: 36865656 PMCID: PMC9973529 DOI: 10.1183/20734735.0157-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Narcolepsy and related central disorders of hypersomnolence may present to the sleep clinic with excessive daytime sleepiness. A strong clinical suspicion and awareness of the diagnostic clues, such as cataplexy, are essential to avoid unnecessary diagnostic delay. This review provides an overview of the epidemiology, pathophysiology, clinical features, diagnostic criteria and management of narcolepsy and related disorders, including idiopathic hypersomnia, Kleine-Levin syndrome (recurrent episodic hypersomnia) and secondary central disorders of hypersomnolence.
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Affiliation(s)
- Stephen Klaus
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland
| | - Aoife Carolan
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland
| | - Deirdre O'Rourke
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland
| | - Barry Kennedy
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland,Corresponding author: Barry Kennedy ()
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11
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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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Xu J, Liu Q, Huang T, Zhong R, Zhang Y. Stellate ganglion block rectifies excessive daytime sleepiness: a case report. J Int Med Res 2022; 50:3000605221118681. [PMID: 35983675 PMCID: PMC9393672 DOI: 10.1177/03000605221118681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is classified as a neurofunctional disorder that
manifests as uncontrolled sleeping propensity in the daytime. Currently, consistent and
effective therapeutic approaches for EDS are lacking. Stellate ganglion block (SGB) has a
clear effect in various complicated pain syndromes, vascular insufficiency, hyperhidrosis,
and posttraumatic stress syndrome. We report an EDS case that involved a patient who
recovered after several sessions of SGB.
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Affiliation(s)
- Jian Xu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou City, China
| | - Qingyan Liu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou City, China
| | - Tao Huang
- Department of Anesthesiology, Fengshun County Hospital of Traditional Chinese Medicine, Meizhou City, China
| | - Ruiqiong Zhong
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou City, China
| | - Yuenong Zhang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou City, China
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13
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van der Hoeven AE, Fronczek R, Schinkelshoek MS, Roelandse FWC, Bakker JA, Overeem S, Bijlenga D, Lammers GJ. Intermediate hypocretin-1 cerebrospinal fluid levels and typical cataplexy: their significance in the diagnosis of narcolepsy type 1. Sleep 2022; 45:zsac052. [PMID: 35554594 PMCID: PMC9113791 DOI: 10.1093/sleep/zsac052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/01/2022] [Indexed: 12/15/2022] Open
Abstract
STUDY OBJECTIVES The diagnosis of narcolepsy type 1 (NT1) is based upon the presence of cataplexy and/or a cerebrospinal fluid (CSF) hypocretin-1/orexin-A level ≤ 110 pg/mL. We determined the clinical and diagnostic characteristics of patients with intermediate hypocretin-1 levels (111-200 pg/mL) and the diagnostic value of cataplexy characteristics in individuals with central disorders of hypersomnolence. METHODS Retrospective cross-sectional study of 355 people with known CSF hypocretin-1 levels who visited specialized Sleep-Wake Centers in the Netherlands. For n = 271, we had full data on cataplexy type ("typical" or "atypical" cataplexy). RESULTS Compared to those with normal hypocretin-1 levels (>200 pg/mL), a higher percentage of individuals with intermediate hypocretin-1 levels had typical cataplexy (75% or 12/16 vs 9% or 8/88, p < .05), and/or met the diagnostic polysomnographic (PSG) and Multiple Sleep Latency Test (MSLT) criteria for narcolepsy (50 vs 6%, p < .001). Of those with typical cataplexy, 88% had low, 7% intermediate, and 5% normal hypocretin-1 levels (p < .001). Atypical cataplexy was also associated with hypocretin deficiency but to a lesser extent. A hypocretin-1 cutoff of 150 pg/mL best predicted the presence of typical cataplexy and/or positive PSG and MSLT findings. CONCLUSION Individuals with intermediate hypocretin-1 levels or typical cataplexy more often have outcomes fitting the PSG and MSLT criteria for narcolepsy than those with normal levels or atypical cataplexy. In addition, typical cataplexy has a much stronger association with hypocretin-1 deficiency than atypical cataplexy. We suggest increasing the NT1 diagnostic hypocretin-1 cutoff and adding the presence of clearly defined typical cataplexy to the diagnostic criteria of NT1. Clinical trial information: This study is not registered in a clinical trial register, as it has a retrospective database design.
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Affiliation(s)
- Adrienne Elisabeth van der Hoeven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Mink Sebastian Schinkelshoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | | | - Jaap Adriaan Bakker
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Denise Bijlenga
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
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14
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Kim HC, Lee DA, Lee HJ, Shin KJ, Park KM. Alterations in the structural covariance network of the hypothalamus in patients with narcolepsy. Neuroradiology 2022; 64:1351-1357. [PMID: 35013760 DOI: 10.1007/s00234-021-02878-6] [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: 09/08/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The hypothalamus plays a pivotal role in the pathogenesis of narcolepsy. This study aimed to evaluate the differences in the structural covariance network of thehypothalamus based on volume differences between patients with narcolepsy and healthy controls. METHODS We retrospectively enrolled 15 patients with narcolepsy and 19 healthy controls.All subjects underwent three-dimensional T1-weighted imaging using a 3-T magnetic resonance imaging scanner. Hypothalamic subunits were segmented, and the volumes of individual hypothalamic subunits were obtained using the FreeSurfer program. Subsequently, we conducted a structural covariance network analysis of the subunit volumes with graph theory using the BRAPH program in patients with narcolepsy and in healthy controls. RESULTS There were no significant differences in the volumes of the entire right and left hypothalamus nor in the hypothalamic subunit between patients with narcolepsy and healthy controls. However, we found significant differences in the structural covariance network in the hypothalamus between these groups. The characteristic path length was significantly lower in patients with narcolepsy than in healthy controls (1.698 vs. 2.831, p = 0.001). However, other network measures did not differ between patients with narcolepsy and healthy controls. CONCLUSION We found that the structural covariance network of the hypothalamus, as assessed from the subunit volumes of hypothalamic regions using a graph theoretical analysis, is different in patients with narcolepsy compared to healthy controls. These findings may contribute to the understanding of the pathogenesis of narcolepsy.
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Affiliation(s)
- Hyung Chan Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea.
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15
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Never Miss Sleep Disorder in Children with Drop Attacks. Indian J Pediatr 2022; 89:95. [PMID: 34468940 DOI: 10.1007/s12098-021-03856-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
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16
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Sleep Disturbances Linked to Genetic Disorders. Sleep Med Clin 2022; 17:77-86. [DOI: 10.1016/j.jsmc.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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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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18
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Behar JA, Shamay Y, Álvarez D, Del Campo F, Penzel T. From sleep medicine to medicine during sleep. Physiol Meas 2021; 42. [PMID: 34964719 DOI: 10.1088/1361-6579/ac3e38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Joachim A Behar
- Faculty of Biomedical Engineering, Technion Institute of Technology, Haifa, Israel
| | - Yosi Shamay
- Faculty of Biomedical Engineering, Technion Institute of Technology, Haifa, Israel
| | - Daniel Álvarez
- Río Hortega University Hospital Valladolid, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - Félix Del Campo
- Río Hortega University Hospital Valladolid, Valladolid, Spain.,Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
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19
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Wang Y, Salas RME. Approach to Common Sleep Disorders. Semin Neurol 2021; 41:781-794. [PMID: 34826879 DOI: 10.1055/s-0041-1726364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sleep disorders are highly relevant in clinical practice given their prevalence as well as their impact on health outcomes and quality of life. The most common concerns are excessive daytime sleepiness, insomnia, disordered breathing, and abnormal movements or behaviors during sleep. A detailed but targeted history is vital, particularly from the sleep partner/witness. In-laboratory sleep testing (polysomnography and multiple sleep latency test) remains vital in the diagnosis of certain sleep disorders (such as sleep-disordered breathing and central hypersomnia) and in specific populations (such as in children and individuals with comorbid medical disorders). Advances in technology have allowed for a variety of methods in assessing a patient's sleep, from compact devices to evaluate for sleep apnea, wrist actigraphy, and mobile device-based applications. As the pathophysiology of various sleep disorders becomes better elucidated, disease-specific medications have been developed for these conditions. Nonetheless, a multidisciplinary approach to management is necessary, including improving sleep hygiene and cognitive behavioral therapy.
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Affiliation(s)
- Yujie Wang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Marie E Salas
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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20
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Porwal A, Yadav YC, Pathak K, Yadav R. An Update on Assessment, Therapeutic Management, and Patents on Insomnia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6068952. [PMID: 34708126 PMCID: PMC8545506 DOI: 10.1155/2021/6068952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022]
Abstract
Insomnia is an ordinary situation related to noticeable disability in function and quality of life, mental and actual sickness, and mishappenings. It represents more than 5.5 million appointments to family doctors every year. Nonetheless, the ratio of insomniacs who are treated keeps on being low, demonstrating the requirement for proceeding with advancement and dispersal of effective treatments. Accordingly, it becomes significant to provide a compelling treatment for clinical practice. It indicates a need for the determination of various critical viewpoints for the evaluation of insomnia along with various accessible alternatives for treatment. These alternatives incorporate both nonpharmacological therapy, specifically cognitive behavioural therapy for insomnia, and a number of pharmacological treatments like orexin antagonists, "z-drugs," benzodiazepines, selective histamine H1 antagonists, nonselective antihistamines, melatonin receptor agonists, antipsychotics, antidepressants, and anticonvulsants. Besides in individuals whose insomnia is due to restless leg syndrome, depression/mood disorder, or/and circadian disturbance, there is insignificant proof favouring the effectiveness of different prescriptions for the treatment of insomnia though they are widely used. Other pharmacological agents producing sedation should be prescribed with care for insomnia therapy because of greater risk of next-day sleepiness along with known adverse effects and toxicities. This review is also aimed at providing an update on various patents on dosage forms containing drugs for insomnia therapy.
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Affiliation(s)
- Amit Porwal
- Faculty of Pharmacy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
| | - Yogesh Chand Yadav
- Faculty of Pharmacy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
| | - Kamla Pathak
- Faculty of Pharmacy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
| | - Ramakant Yadav
- Faculty of Medical Sciences, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130 Uttar Pradesh, India
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21
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Levy J, Álvarez D, Del Campo F, Behar JA. Machine learning for nocturnal diagnosis of chronic obstructive pulmonary disease using digital oximetry biomarkers. Physiol Meas 2021; 42. [PMID: 33827067 DOI: 10.1088/1361-6579/abf5ad] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 11/12/2022]
Abstract
Objective.Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic condition. COPD is a major cause of morbidity, mortality and healthcare costs globally. Spirometry is the gold standard test for a definitive diagnosis and severity grading of COPD. However, a large proportion of individuals with COPD are undiagnosed and untreated. Given the high prevalence of COPD and its clinical importance, it is critical to develop new algorithms to identify undiagnosed COPD. This is particularly true in specific disease groups in which the presence of concomitant COPD increases overall morbidity/mortality such as those with sleep-disordered breathing. To our knowledge, no research has looked at the feasibility of automated COPD diagnosis using a data-driven analysis of the nocturnal continuous oximetry time series. We hypothesize that patients with COPD will exert certain patterns and/or dynamics of their overnight oximetry time series that are unique to this condition and that may be captured using a data-driven approach.Approach.We introduce a novel approach to nocturnal COPD diagnosis using 44 oximetry digital biomarkers and five demographic features and assess its performance in a population sample at risk of sleep-disordered breathing. A total ofn=350 unique patients' polysomnography (PSG) recordings were used. A random forest (RF) classifier was trained using these features and evaluated using nested cross-validation.Main results.The RF classifier obtainedF1 = 0.86 ± 0.02 and AUROC = 0.93 ± 0.02 on the test sets. A total of 8 COPD individuals out of 70 were misclassified. No severe cases (GOLD 3-4) were misdiagnosed. Including additional non-oximetry derived PSG biomarkers resulted in minimal performance increase.Significance.We demonstrated for the first time, the feasibility of COPD diagnosis from nocturnal oximetry time series for a population sample at risk of sleep-disordered breathing. We also highlighted what set of digital oximetry biomarkers best reflect how COPD manifests overnight. The results motivate that overnight single channel oximetry can be a valuable modality for COPD diagnosis, in a population sample at risk of sleep-disordered breathing. Further data is needed to validate this approach on other population samples.
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Affiliation(s)
- Jeremy Levy
- Faculty of Biomedical Engineering, Technion Institute of Technology, Haifa, Israel.,Faculty of Electrical Engineering, Technion Institute of Technology, Haifa, Israel
| | - Daniel Álvarez
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Pneumology Department, Río Hortega University Hospital, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - Felix Del Campo
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain.,Pneumology Department, Río Hortega University Hospital, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - Joachim A Behar
- Faculty of Electrical Engineering, Technion Institute of Technology, Haifa, Israel
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22
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Sunwoo JS. Narcolepsy, autoimmunity, and influenza A H1N1 vaccination. ENCEPHALITIS 2021; 1:31-35. [PMID: 37469760 PMCID: PMC10295885 DOI: 10.47936/encephalitis.2021.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 07/21/2023] Open
Abstract
Narcolepsy is a rare neurological disorder characterized by excessive daytime sleepiness (EDS) with or without cataplexy. A main pathophysiology of narcolepsy is hypocretin deficiency in the central nervous system resulting from a selective loss of hypocretin neurons in the lateral hypothalamus. To date, the pathogenesis of hypocretin neuron loss in narcolepsy is the most commonly accepted autoimmune hypothesis which is supported by genetic risk factors for narcolepsy such as HLA‑DQB1*06:02 allele and T-cell receptor alpha polymorphisms. Other evidence supporting the immune-mediated mechanisms include the presence of anti-Tribbles homolog 2 (TRIB2) and anti-streptococcal antibodies in patients with narcolepsy, seasonal patterns of narcolepsy onset, and increased incidence of narcolepsy after the H1N1 pandemic influenza A infections and vaccinations. Among several types of vaccines, the AS03-adjuvanted vaccine Pandemrix (GlaxoSmithKline) was the only vaccine found to increase the risk of narcolepsy. However, the comprehensive results of several epidemiological studies indicate the adjuvant AS03 alone cannot cause the disease. The genetic predisposition, environmental triggers, molecular mimicry of specific H1N1 antigens, and bystander immune activation caused by the adjuvant AS03 may have combined to contribute to autoimmunity against hypocretin neurons and development of narcolepsy.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
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23
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Malter M, Neuneier J, Triller A, Kallweit U. [Narcolepsy in adults: Definition, etiology and treatment]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 89:103-113. [PMID: 33339064 DOI: 10.1055/a-1244-2612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Narcolepsy is a hypersomnolence disorder of central origin that presents with a disturbance of the wake-sleep regulation. Lead symptoms consist of excessive daytime sleepiness and cataplexy. Nowadays, two types of narcolepsy are distinguished. Type 1 narcolepsy, formerly known as narcolepsy with cataplexy, is based on hypocretin deficiency. The cause of type 2 narcolepsy, formerly known as narcolepsy without cataplexy, remains mainly unknown. A multimodal approach is necessary for diagnosis. The mean latency between the onset of disease and diagnosis in Europe ranges 14 years. Narcolepsy has a major impact on workability and quality of life. The management of narcolepsy is usually life-long and includes non-pharmacological approaches and a symptomatic pharmacological treatment.
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Affiliation(s)
| | | | - Annika Triller
- Zentrum für Narkolepsie/Hypersomnien, Klin. Schlaf- und Neuroimmunologie, Institut für Immunologie, Universität Witten/Herdecke
| | - Ulf Kallweit
- Zentrum für Narkolepsie/Hypersomnien, Klin. Schlaf- und Neuroimmunologie, Institut für Immunologie, Universität Witten/Herdecke
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24
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Diukova GM, Makarov SA, Golubev VL, Tyutina RR, Degterev DA, Danilov AB. Psychogenic Seizure Imitating Narcolepsy. Case Rep Neurol 2020; 12:472-481. [PMID: 33442377 PMCID: PMC7772851 DOI: 10.1159/000510517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022] Open
Abstract
Psychogenic or functional neurological disorders (FND) often occur in the practice of a neurologist. Diagnosis of FND usually causes significant difficulties. Among FND, psychogenic non-epileptic seizures (PNES) comprise around 40% cases. Sometimes it is necessary to differentiate PNES from narcolepsy. We describe a 55-year-old man with frequent brief and sudden sleep-like attacks in combination with nocturnal sleep disturbance. During attacks he was unresponsive, snoring but maintained posture. He resisted passive eye opening but with rolling eyes. The patient was confused on waking. In the interictal period, there were FND signs including give-way weakness of the left hand, typical functional “leg-dragging” gait, mistake in the finger-to-nose test. Video-electroencephalogram monitoring did not detect specific epileptic activity or sleep pattern during the attacks. Polysomnography showed multiple waking episodes during the night, but no typical pattern of narcolepsy was found in the multiple sleep latency test. The patient had frequent urgent hospitalizations due to different diseases and numerous invasive procedures. Six month later, the patient obtained state related disability financial benefit, after which hospitalizations in various hospitals continued, and PNES became shorter and less pronounced.
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Affiliation(s)
- Galina M Diukova
- Neurological Department, Moscow Clinical Research Center, Moscow, Russian Federation
| | - Sergey A Makarov
- Department of Nervous Disease, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Valery L Golubev
- Department of Nervous Disease, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ruslana R Tyutina
- Neurological Department, Moscow Clinical Research Center, Moscow, Russian Federation.,Department of Nervous Disease, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Daniil A Degterev
- Neurological Department, Moscow Clinical Research Center, Moscow, Russian Federation
| | - Alexey B Danilov
- Department of Nervous Disease, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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25
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Chang ET, Lin CL, Chen SF, Shen YC. Risk of Burn Injury in Patients With Narcolepsy: A Nationwide Population-Based Cohort Study. J Burn Care Res 2020; 41:663-667. [PMID: 31927592 DOI: 10.1093/jbcr/iraa004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Narcolepsy is a rare brain disorder characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Stimulants have been used to relieve the symptoms of EDS. Narcolepsy symptoms may pose a risk to burn injury. The study aimed to investigate the risk of burn injury in narcolepsy patients and to examine the relationship between the use of stimulants and the risk of burn injury. In all, 507 narcolepsy patients and 504 controls matched by gender, age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan's National Health Insurance Research Database. During the follow-up period, participants who developed burn injury were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the burn incidence rate between narcolepsy patients and unaffected controls. Narcolepsy patients had a significantly increased risk of burn injury compared to unaffected controls (5.37 versus 2.69 per 1,000 person-years, HR: 2.04, 95% CI: 1.13-3.67) after adjusting for gender, age, CCI score, urbanization degree, and duration of stimulants use. Also, the use of stimulants in narcolepsy patients was associated with a lower incidence rate of developing burn injury, but the risk estimate was not statistically significant after adjusting for the above-mentioned variables. This study shows narcolepsy patients have an increased risk of burn injury and the use of stimulants may reduce the burn incidence rate, providing a reference for developing prevention interventions.
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Affiliation(s)
- En-Ting Chang
- Department of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, and College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Fen Chen
- Center of Medical Genetics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Chih Shen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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26
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A Case of Daytime Sleepiness after Motor Vehicle Collision. Ann Am Thorac Soc 2020; 16:265-267. [PMID: 30707059 DOI: 10.1513/annalsats.201806-383cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Scheer D, Schwartz SW, Parr M, Zgibor J, Sanchez-Anguiano A, Rajaram L. Prevalence and incidence of narcolepsy in a US health care claims database, 2008-2010. Sleep 2020; 42:5475508. [PMID: 31004158 DOI: 10.1093/sleep/zsz091] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/12/2019] [Indexed: 01/03/2023] Open
Abstract
STUDY OBJECTIVES To determine the prevalence and incidence of narcolepsy using a large US health care claims database. METHODS The Truven Health MarketScan Commercial Dissertation Database (THMCDD) was used to estimate prevalence and incidence of narcolepsy, with and without cataplexy, by age groups, gender, and region among patients under age 66 years with continuous enrollment for years 2008-2010. THMCDD contains health claims information for more than 18 million people. Prevalence was expressed as cases/100 000 persons. Average annual incidence (using varying criteria for latency between the diagnostic tests, polysomnograph coupled with multiple sleep latency test [MSLT], and the diagnosis) was expressed as new cases/100 000 persons/year. RESULTS There were 8 444 517 continuously enrolled patients and 6703 diagnosed with narcolepsy (prevalence overall: 79.4/100 000; without cataplexy: 65.4/100 000; with cataplexy: 14.0/100 000). On the basis of the three definitions of incidence, overall average annual incidence was 7.67, 7.13, and 4.87/100 000 persons/year. Incidence for narcolepsy without cataplexy was generally several times higher than narcolepsy with cataplexy. Prevalence and incidence were approximately 50% greater for females compared to males across most age groups. Prevalence was highest among the 21-30 years age group, with incidence highest among enrollees in their early 20s and late teens. Regionally, the North Central United States had the highest prevalence and incidence, whereas the West was the lowest. CONCLUSION We found greater prevalence and incidence of narcolepsy (including without cataplexy) than most previous studies. The increased proportions in females, enrollees in their early 20s, and US regional differences require further study. Increased awareness and early identification is critical in the management of this burdensome condition.
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Affiliation(s)
- Darren Scheer
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL.,Department of Epidemiology and Pharmacovigilance, Biotech Research Group Corp., Tampa, FL.,Pharmaceutical Development Group Inc., Tampa, FL.,Pharmacovigilance and Epidemiology, Spotline Inc., San Jose, CA
| | - Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Maria Parr
- EviCore Healthcare, Department of Sleep Medicine, Franklin, TN
| | - Janice Zgibor
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Aurora Sanchez-Anguiano
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Lakshminarayan Rajaram
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
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Murillo-Rodríguez E, Budde H, Veras AB, Rocha NB, Telles-Correia D, Monteiro D, Cid L, Yamamoto T, Machado S, Torterolo P. The Endocannabinoid System May Modulate Sleep Disorders in Aging. Curr Neuropharmacol 2020; 18:97-108. [PMID: 31368874 PMCID: PMC7324886 DOI: 10.2174/1570159x17666190801155922] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
Aging is an inevitable process that involves changes across life in multiple neurochemical, neuroanatomical, hormonal systems, and many others. In addition, these biological modifications lead to an increase in age-related sickness such as cardiovascular diseases, osteoporosis, neurodegenerative disorders, and sleep disturbances, among others that affect activities of daily life. Demographic projections have demonstrated that aging will increase its worldwide rate in the coming years. The research on chronic diseases of the elderly is important to gain insights into this growing global burden. Novel therapeutic approaches aimed for treatment of age-related pathologies have included the endocannabinoid system as an effective tool since this biological system shows beneficial effects in preclinical models. However, and despite these advances, little has been addressed in the arena of the endocannabinoid system as an option for treating sleep disorders in aging since experimental evidence suggests that some elements of the endocannabinoid system modulate the sleep-wake cycle. This article addresses this less-studied field, focusing on the likely perspective of the implication of the endocannabinoid system in the regulation of sleep problems reported in the aged. We conclude that beneficial effects regarding the putative efficacy of the endocannabinoid system as therapeutic tools in aging is either inconclusive or still missing.
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Affiliation(s)
- Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, México
- Intercontinental Neuroscience Research Group
| | - Henning Budde
- Intercontinental Neuroscience Research Group
- Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - André Barciela Veras
- Intercontinental Neuroscience Research Group
- Dom Bosco Catholic University, Campo Grande, Mato Grosso do Sul, Brazil
| | - Nuno Barbosa Rocha
- Intercontinental Neuroscience Research Group
- School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Diogo Telles-Correia
- Intercontinental Neuroscience Research Group
- University of Lisbon, Faculty of Medicine, Lisbon, Portugal
| | - Diogo Monteiro
- Intercontinental Neuroscience Research Group
- Sport Science School of Rio Maior-Polytechnic Institute of Santarém, Rio Maior, Portugal
- Research Center in Sport, Health and Human Development-CIDESD, Vila Real, Portugal
| | - Luis Cid
- Intercontinental Neuroscience Research Group
- Sport Science School of Rio Maior-Polytechnic Institute of Santarém, Rio Maior, Portugal
- Research Center in Sport, Health and Human Development-CIDESD, Vila Real, Portugal
| | - Tetsuya Yamamoto
- Intercontinental Neuroscience Research Group
- Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
| | - Sérgio Machado
- Intercontinental Neuroscience Research Group
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University, Niterói, Brazil
| | - Pablo Torterolo
- Intercontinental Neuroscience Research Group
- Laboratorio de Neurobiología del Sueño, Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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29
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Aguilar AC, Frange C, Pimentel Filho LH, Reis MJ, Tufik S, Coelho FMS. Lisdexamfetamine to improve excessive daytime sleepiness and weight management in narcolepsy: a case series. ACTA ACUST UNITED AC 2019; 42:314-316. [PMID: 31859793 PMCID: PMC7236164 DOI: 10.1590/1516-4446-2019-0544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/05/2019] [Indexed: 11/22/2022]
Abstract
Objective: To report the successful use of lisdexamfetamine in the management of narcolepsy. Methods: Five narcoleptic patients received lisdexamfetamine, at different dosages and for different periods, for management of excessive daytime sleepiness and weight control. Results: All patients experienced improvement of excessive daytime sleepiness and lost weight without side effects. Conclusion: Lisdexamfetamine appears promising for the treatment of two of the most common symptoms of narcolepsy: excessive daytime sleepiness and weight gain.
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Affiliation(s)
- Ana C Aguilar
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Cristina Frange
- Departamento de Neurologia e Neurocirurgia, UNIFESP, São Paulo, SP, Brazil
| | - Lucio H Pimentel Filho
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria J Reis
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernando M S Coelho
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Neurologia e Neurocirurgia, UNIFESP, São Paulo, SP, Brazil
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30
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Rémi J, Pollmächer T, Spiegelhalder K, Trenkwalder C, Young P. Sleep-Related Disorders in Neurology and Psychiatry. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:681-688. [PMID: 31709972 PMCID: PMC6865193 DOI: 10.3238/arztebl.2019.0681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/07/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep-related disorders are a group of illnesses with marked effects on patients' quality of life and functional ability. Their diagnosis and treatment is a matter of common interest to multiple medical disciplines. METHODS This review is based on relevant publications retrieved by a selective search in PubMed (Medline) and on the guide- lines of the German Society for Sleep Medicine, the German Neurological Society, and the German Association for Psychiatry, Psychotherapy and Psychosomatics. RESULTS A pragmatic classification of sleep disorders by their three chief complaints-insomnia, daytime somnolence, and sleep-associated motor phenomena-enables tentative diagnoses that are often highly accurate. Some of these disorders can be treated by primary care physicians, while others call for referral to a neurologist or psychiatrist with special experience in sleep medicine. For patients suffering from insomnia as a primary sleep disorder, rather than a symptom of another disease, meta-analyses have shown the efficacy of cognitive behavioral therapy, with high average effect sizes. These patients, like those suffering from secondary sleep disorders, can also benefit from drug treatment for a limited time. Studies have shown marked improvement of sleep latency and sleep duration from short-term treatment with benzodiazepines and Z-drugs (non- benzodiazepine agonists such as zolpidem and zopiclone), but not without a risk of tolerance and dependence. For sleep disorders with the other two main manifestations, specific drug therapy has been found to be beneficial. CONCLUSION Sleep disorders in neurology and psychiatry are a heterogeneous group of disorders with diverse manifestations. Their proper diagnosis and treatment can help prevent secondary diseases and the worsening of concomitant conditions. Care structures for the treatment of sleep disorders should be further developed.
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Affiliation(s)
- Jan Rémi
- Department of Neurology, Medical Center of the Ludwig-Maximilians–University of Munich (LMU), Germany
| | | | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Medical Faculty, University of Freiburg, Germany
| | - Claudia Trenkwalder
- Center of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany and Department of Neurosurgery, University Medical Center Göttingen, Germany
| | - Peter Young
- Specialized Clinic for Therapies in Neurology, Medical Park Reithofpark, Bad Feilnbach, Germany
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31
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Nallu S, Guerrero GY, Lewis-Croswell J, Wittine LM. Review of Narcolepsy and Other Common Sleep Disorders in Children. Adv Pediatr 2019; 66:147-159. [PMID: 31230690 DOI: 10.1016/j.yapd.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sagarika Nallu
- Department of Pediatrics, University of South Florida, Morsani College of Medicine, 17 Davis Blvd. Suite#200, Tampa, FL 33606, USA.
| | - Giselle Y Guerrero
- University of South Florida, 17 Davis Blvd. Suite#200, Tampa, FL 33606, USA
| | | | - Lara M Wittine
- University of South Florida, Morsani Center for Advanced Healthcare, 13330 USF Laurel Drive, Tampa, FL 33612-4799, USA
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32
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Bårdsen K, Gjerstad MD, Partinen M, Kvivik I, Tjensvoll AB, Ruoff P, Omdal R, Brede C. Considerably Lower Levels of Hypocretin-1 in Cerebrospinal Fluid Is Revealed by a Novel Mass Spectrometry Method Compared with Standard Radioimmunoassay. Anal Chem 2019; 91:9323-9329. [DOI: 10.1021/acs.analchem.9b02710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Kjetil Bårdsen
- Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Michaela D. Gjerstad
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
| | - Ingeborg Kvivik
- Research Department, Stavanger University Hospital, Stavanger, Norway
| | | | - Peter Ruoff
- Centre for Organelle Research (CORE), Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Cato Brede
- Department of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
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33
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Yang J, Gao J. Solriamfetol for the treatment of excessive daytime sleepiness associated with narcolepsy. Expert Rev Clin Pharmacol 2019; 12:723-728. [PMID: 31215815 DOI: 10.1080/17512433.2019.1632705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Junyi Yang
- Department of Pharmaceutical, Central Hospital of Linyi City, Yishui, Shandong, China
| | - Junfa Gao
- Laboratory Department, Central Hospital of Linyi City, Yishui, Shandong, China
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34
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Luo G, Lin L, Jacob L, Bonvalet M, Ambati A, Plazzi G, Pizza F, Leib R, Adams CM, Partinen M, Jean-Marie Mignot E. Correction: Absence of anti-hypocretin receptor 2 autoantibodies in post pandemrix narcolepsy cases. PLoS One 2019; 14:e0214340. [PMID: 30921380 PMCID: PMC6438471 DOI: 10.1371/journal.pone.0214340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0187305.].
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35
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Miskoff JA, Chaudhri M. A Case of Off-label Sodium Oxybate in an 11-Year-Old with Narcolepsy. Cureus 2019; 11:e4057. [PMID: 31016084 PMCID: PMC6464478 DOI: 10.7759/cureus.4057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Narcolepsy is a rare chronic condition which affects sleep architecture. It may manifest in childhood or adolescence by causing excessive daytime sleepiness, sleep attacks, and hallucinations. Research suggests that there is a significant delay in diagnosis with the mean age being 10 to 15 years from onset of symptoms. Although narcolepsy is predominantly associated with loss of hypocretin (orexin), the role of genetics is complementary to the diagnosis. In addition, clinical manifestations of symptoms vary in presentation and severity from case to case. Therefore, this report provides an opportunity to review pediatric narcolepsy including the diagnostic workup and clinical response to sodium oxybate. This particular case describes an 11-year-old boy meeting the clinical and diagnostic criteria for narcolepsy. Clinically, the patient had a very positive response to treatment with sodium oxybate, which at the time of initiating therapy was off-label for patients under the age of 18.
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Affiliation(s)
- Jeffrey A Miskoff
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Moiuz Chaudhri
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
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36
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Plazzi G, Clawges HM, Owens JA. Clinical Characteristics and Burden of Illness in Pediatric Patients with Narcolepsy. Pediatr Neurol 2018; 85:21-32. [PMID: 30190179 DOI: 10.1016/j.pediatrneurol.2018.06.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/19/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Narcolepsy is a chronic and lifelong neurologic disorder with onset commonly occurring in childhood or adolescence, and affecting approximately 0.025% to 0.05% of the general population. The primary symptom is excessive daytime sleepiness, which is accompanied by cataplexy in 70% of patients. Other common symptoms include sleep paralysis, hallucinations upon falling asleep or waking, and disrupted nocturnal sleep. Narcolepsy is associated with a considerable burden of illness (BOI), which has been well characterized in adults, and is exacerbated by delays in symptom recognition, diagnosis, and intervention. METHODS This review describes the specific characteristics and BOI of pediatric narcolepsy, using a wide range of published research data. RESULTS Pediatric narcolepsy presents distinct challenges in diagnosis and management. Narcolepsy symptoms often initially manifest differently in children and adolescents versus adults, which may pose diagnostic dilemmas. Children often respond to sleepiness with irritability, hyperactivity, and poor attention, which may be misinterpreted as misbehavior or neurocognitive sequelae of other conditions. Pediatric cataplexy symptoms may include subtle and unusual facial expressions or choreic-like movements, which are not observed in adults. Insufficient sleep and circadian rhythm disorders presenting with excessive daytime sleepiness are common in adolescents, potentially confounding narcolepsy diagnosis. Pediatric narcolepsy is also associated with comorbidities including rapid weight gain, precocious puberty, and attention deficit hyperactivity disorder, and increased risk for deficits in social functioning, depression, and anxiety. School performance is also typically impaired, requiring special education services. CONCLUSIONS Thus, the discrete BOI of pediatric narcolepsy underscores the need for prompt and accurate diagnosis, and appropriate treatment of this disorder.
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Affiliation(s)
- Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Heather M Clawges
- Department of Pediatrics, Sleep Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WestVirginia
| | - Judith A Owens
- Division of Neurology, Boston Children's Hospital, Harvard Medical School, Waltham, Massachusetts
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Scherrer KS, Relly C, Hackenberg A, Berger C, Paioni P. Case report: narcolepsy type 1 in an adolescent with HIV infection-coincidence or potential trigger? Medicine (Baltimore) 2018; 97:e11490. [PMID: 30045272 PMCID: PMC6078734 DOI: 10.1097/md.0000000000011490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Despite the acknowledged importance of environmental risk factors in the etiology of narcolepsy, there is little research on this topic. HIV as a trigger for narcolepsy has not been systematically investigated. PATIENT CONCERNS We describe a case of narcolepsy type 1 (NT1) in an adolescent with HIV infection presenting with increased daytime sleepiness and excessive weight gain. DIAGNOSES NT1 was diagnosed according to the criteria of the third edition of the International Classification of Sleep Disorders (ICSD-3). INTERVENTIONS Pharmacological treatment with methylphenidate. OUTCOMES Four months after initiation of methylphenidate therapy the increased daytime sleepiness improved and excessive weight gain stopped. LESSONS Diagnosis of NT1 can be challenging at disease onset and is often delayed, especially in the pediatric population, because symptoms usually evolve gradually. The case presented here raises the possibility that the HIV infection may play a role in the pathogenesis of NT1 serving as trigger for autoimmune-mediated destruction of hypocretin-secreting neurons.
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Affiliation(s)
- Karin Sofia Scherrer
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford, UK
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zürich, Zürich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
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38
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Büchele F, Baumann CR, Poryazova R, Werth E, Valko PO. Remitting narcolepsy? Longitudinal observations in a hypocretin-deficient cohort. Sleep 2018; 41:5032742. [PMID: 29868885 DOI: 10.1093/sleep/zsy118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fabian Büchele
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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39
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Abstract
Narcolepsy is a sleep disorder that can manifest in childhood or adolescence by causing excessive sleepiness, hallucinations, sleep attacks, or cataplexy. There is often a significant delay in diagnosis with the mean time being 15 years from the onset of symptoms, which may lead to further exacerbations and a high comorbidity burden. Although narcolepsy is predominantly associated with loss of hypocretin (orexin), the role of genetics is poorly understood and, therefore, is complementary to the diagnosis but not confirmatory. We present the case of a child who was misdiagnosed as suffering from schizophrenia only to later uncover narcolepsy with cataplexy. Even though she did not meet strict criteria for narcolepsy type 1, her history and objective data were consistent enough to make an official diagnosis. In addition, her clinical response to treatment was very positive, further supporting narcolepsy as the most likely underlying condition. This presentation highlights the importance of continued education and research to reduce the risk of delay in diagnosis or misdiagnosis.
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Affiliation(s)
| | - Moiuz Chaudhri
- Medicine, Jersey Shore University Medical Center, Neptune City, USA
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40
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Poyraz Çökmüş F, Aydın O, Sücüllüoğlu Dikici D, Yalın Sapmaz Ş. Quickly diagnosed and treated prepubertal Type 1 narcolepsy case. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1408230] [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: 10/18/2022] Open
Affiliation(s)
| | - Orkun Aydın
- Faculty of Arts and Social Sciences, Department of Psychology, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Şermin Yalın Sapmaz
- Child and Adolescent Psychiatry Department, Manisa Celal Bayar University Hospital, Manisa, Turkey
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41
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Denton EJ, Barnes M, Churchward T, Jackson M, Collins A, Naughton MT, Dabscheck E. Mood disorders are highly prevalent in patients investigated with a multiple sleep latency test. Sleep Breath 2017; 22:305-309. [PMID: 28993975 DOI: 10.1007/s11325-017-1572-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/10/2017] [Accepted: 09/12/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Excessive daytime sleepiness (EDS) is a debilitating symptom which occurs commonly in both primary sleep and mood disorders. The prevalence of mood disorders in patients with EDS, evaluated objectively with a mean sleep latency test (MSLT), has not been reported. We hypothesize that mood disorders are highly prevalent in patients being investigated for EDS. This study aims to report the prevalence of mood disorder in the MSLT population and investigate the association between mood disorder and objective and subjective scores of sleepiness. METHODS A retrospective multicenter study of adults with a MSLT and Hospital Anxiety and Depression Score (HADS) identified over a 3-year period. The HADS is a validated questionnaire in detecting depression (HADS-D ≥ 8) and anxiety (HADS-A ≥ 11) in the sleep clinic population. Data collected included demographics, medical, and sleep study information. Mood disorder prevalence was compared to the general sleep clinic population. Correlation between measures of sleepiness and mood was performed. RESULTS Two hundred twenty patients were included with mean age 41.1 ± 15.7 years, mean body mass index 28.6 kg/m2 of whom 30% had anxiety (HADS-A > 11) and 43% depression (HADS-D > 8). Mean results for the cohort are ESS 13.7, mean sleep latency 11.5 min, HADS-A 8.2, and HADS-D 7. There was no significant correlation between objective sleepiness, as measured by the mean sleep latency, and either HADS-A (-0.006, p = 0.93) or HADS-D score (0.002, p = 0.98). There was, however, a weak correlation between subjective sleepiness, as measured by the ESS, and the mean sleep latency (-0.25, p < 0.01), HADS-A (0.15, p = 0.03), and HADS-D (0.2, p = 0.004). There was no significant association between diagnosis of hypersomnia disorders and presence of anxiety (p = 0.71) or depression (p = 0.83). CONCLUSIONS Mood disorders are highly prevalent in the MSLT population. There was a weak correlation found between subjective measures of sleepiness and mood disorders, but not between objective measures of sleepiness and mood disorders. Routine screening for mood disorders in patients with hypersomnolence should be considered.
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Affiliation(s)
- Eve J Denton
- Respiratory Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia. .,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia.
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Tom Churchward
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Melinda Jackson
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Allison Collins
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
| | - Matthew T Naughton
- Respiratory Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
| | - Eli Dabscheck
- Respiratory Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, 3004, Australia
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