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Wang M, Wang H, Feng Z, Wu S, Li B, Han F, Xiao F. Predicting Depression Among Chinese Patients with Narcolepsy Type 1: A Machine-Learning Approach. Nat Sci Sleep 2024; 16:1419-1429. [PMID: 39318394 PMCID: PMC11420898 DOI: 10.2147/nss.s468748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 09/10/2024] [Indexed: 09/26/2024] Open
Abstract
Objective Depression is a common psychiatric issue among patients with narcolepsy type 1 (NT1). Effective management requires accurate screening and prediction of depression in NT1 patients. This study aims to identify relevant factors for predicting depression in Chinese NT1 patients using machine learning (ML) approaches. Methods A total of 203 drug-free NT1 patients (aged 5-61), diagnosed based on the ICSD-3 criteria, were consecutively recruited from the Sleep Medicine Center at Peking University People's Hospital between September 2019 and April 2023. Depression, daytime sleepiness, and impulsivity were assessed using the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) or the Self-Rating Depression Scale (SDS), the Epworth Sleepiness Scale for adult or children and adolescents (ESS or ESS-CHAD), and the Barratt Impulse Scale (BIS-11). Demographic characteristics and objective sleep parameters were also analyzed. Three ML models-Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM)-were used to predict depression. Model performance was evaluated using receiver operating curve (AUC), accuracy, precision, recall, F1 score, and decision curve analysis (DCA). Results The LR model identified hallucinations (OR 2.21, 95% CI 1.01-4.90, p = 0.048) and motor impulsivity (OR 1.10, 95% CI 1.02-1.18, p = 0.015) as predictors of depression. Among the ML models, SVM showed the best performance with an AUC of 0.653, accuracy of 0.659, sensitivity of 0.727, and F1 score of 0.696, reflecting its effectiveness in integrating sleep-related and psychosocial factors. Conclusion This study highlights the potential of ML models for predicting depression in NT1 patients. The SVM model shows promise in identifying patients at high risk of depression, offering a foundation for developing a data-driven, personalized decision-making tool. Further research should validate these findings in diverse populations and include additional psychological variables to enhance model accuracy.
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Affiliation(s)
- Mengmeng Wang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Huanhuan Wang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, People's Republic of China
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Zhaoyan Feng
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Shuai Wu
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Bei Li
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, People's Republic of China
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Fang Han
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Fulong Xiao
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, People's Republic of China
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Simoncini Malucelli G, Mercante A, Pizza F, Brunetti V, Biscarini F, Vandi S, Mazzoni A, Franceschini C, Della Marca G, Vollono C, Chieffo DPR, Plazzi G. Exploring the emotional and behavioural profile in paediatric narcolepsy type 1: A case-control study. J Sleep Res 2024; 33:e14064. [PMID: 37872846 DOI: 10.1111/jsr.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/25/2023]
Abstract
Narcolepsy type 1 (NT1) is a central disorder of hypersomnolence often arising in childhood and adolescence. NT1 has a significant, but poorly defined, psychological impact. We aimed to investigate the psycho-social functioning of children and adolescents with NT1. We performed a cross-sectional, child and parent-reported questionnaire survey in 37 children and adolescents (6-17 years) with NT1, compared with age- and sex-matched controls. Questionnaires (SSHS, ESS-CHAD, CDI, MASC, CBCL, CRS-R, and SNAP-IV) evaluated various aspects of behavioural and emotional profiles, sleep habits, and daytime sleepiness. Subsequently, NT1 intra-group analysis was performed to investigate the effect of sex (males vs females) and pharmacological treatment (treated vs non-treated) on psychological features. The NT1 questionnaires total scores were then correlated with the clinical characteristics (age, body mass index [BMI], ESS-CHAD score, cerebrospinal hypocretin-1 [Hcrt-1] levels, and diagnostic delay). Patients with NT1 showed a higher tendency to depressive symptoms, anxiety, somatisation, inattention, hyperactivity, oppositional/defiant problems, and other maladaptive behaviours compared with controls. Among NT1 patients, females showed a higher propensity to anxiety, and non-treated patients displayed higher depressive symptoms. Psychological symptoms increased with age, BMI, and daytime sleepiness in patients with NT1, while a younger age was associated with more frequent somatisation symptoms. Lower cerebrospinal Hcrt-1 levels correlated with poorer social competencies, daily activities, and inattention. Diagnostic delay was associated with a higher impact of depressive symptoms and behavioural problems. NT1 in children and adolescents is associated with poorer functioning in multiple psychological domains calling for a multidisciplinary approach and monitoring to reduce disease burden and to prevent psychiatric consequences.
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Affiliation(s)
| | - Anna Mercante
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Valerio Brunetti
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Neurologia - Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alice Mazzoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Giacomo Della Marca
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Neurologia - Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Catello Vollono
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Neurofisiopatologia - Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department Women Children and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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3
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Pan Y, Zhang X, Wen X, Yuan N, Guo L, Shi Y, Jia Y, Guo Y, Hao F, Qu S, Chen Z, Yang L, Wang X, Liu Y. Development and validation of a machine learning model for prediction of comorbid major depression disorder among narcolepsy type 1. Sleep Med 2024; 119:556-564. [PMID: 38810481 DOI: 10.1016/j.sleep.2024.05.045] [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: 12/21/2023] [Revised: 05/04/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Major depression disorder (MDD) forms a common psychiatric comorbidity among patients with narcolepsy type 1 (NT1), yet its impact on patients with NT1 is often overlooked by neurologists. Currently, there is a lack of effective methods for accurately predicting MDD in patients with NT1. OBJECTIVE This study utilized machine learning (ML) algorithms to identify critical variables and developed the prediction model for predicting MDD in patients with NT1. METHODS The study included 267 NT1 patients from four sleep centers. The diagnosis of comorbid MDD was based on Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). ML models, including six full models and six compact models, were developed using a training set. The performance of these models was compared in the testing set, and the optimal model was evaluated in the testing set. Various evaluation metrics, such as Area under the receiver operating curve (AUC), precision-recall (PR) curve and calibration curve were employed to assess and compare the performance of the ML models. Model interpretability was demonstrated using SHAP. RESULT In the testing set, the logistic regression (LG) model demonstrated superior performance compared to other ML models based on evaluation metrics such as AUC, PR curve, and calibration curve. The top eight features used in the LG model, ranked by feature importance, included social impact scale (SIS) score, narcolepsy severity scale (NSS) score, total sleep time, body mass index (BMI), education years, age of onset, sleep efficiency, sleep latency. CONCLUSION The study yielded a straightforward and practical ML model for the early identification of MDD in patients with NT1. A web-based tool for clinical applications was developed, which deserves further verification in diverse clinical settings.
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Affiliation(s)
- Yuanhang Pan
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Xinbo Zhang
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Xinyu Wen
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Na Yuan
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Li Guo
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Yifan Shi
- Department of Psychiatry, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Yuanyuan Jia
- Encerebropathy Department, No.2, Baoji Hospital of Traditional Chinese Medicine, Baoji, PR China.
| | - Yanzhao Guo
- Encerebropathy Department, No.10, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, PR China.
| | - Fengli Hao
- Department of Neurology, Xi'an Daxing Hospital, Xi'an, PR China.
| | - Shuyi Qu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Ze Chen
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Lei Yang
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Xiaoli Wang
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, Air Force Medical University, Xi'an, PR China.
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Brunel L, Brossaud E, Lioret J, Jaffiol A, Vanderghote L, Cuisinier L, Peter-Derex L, Ricordeau F, Thieux M, Comajuan M, Plancoulaine S, Guyon A, Franco P. Effectiveness of an intervention program on physical activity in children with narcolepsy type 1. Sleep Med 2024; 116:138-146. [PMID: 38460419 DOI: 10.1016/j.sleep.2024.03.002] [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: 12/28/2023] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES Physical activity (PA) is recommended as part of the management of narcolepsy type 1 (NT1). This study aimed at 1) characterizing PA in children and adolescents treated for NT1 using objective and subjective measurements, 2) evaluating how PA is associated with NT1 symptoms and comorbidities, and 3) evaluating the effects of an Adapted Physical Activity (APA) program on PA and clinical characteristics. PATIENTS/METHODS Patients with NT1 from the National Reference Center of Narcolepsy (Lyon, France) were consecutively included in an APA intervention protocol. Narcolepsy symptoms and comorbidities were collected using standardized questionnaires and sustained attention was evaluated using the Bron-Lyon Attention Stability Test before and after the four-week APA intervention. PA was measured objectively using actigraphy throughout the study. RESULTS Twenty-seven NT1 patients were included (median age 14.7 years [8.3-18.4], cataplexy 88.9%, obesity 37.0%). At baseline, 52.4% of the patients had satisfactory PA levels according to international recommendations. Patients with leisure-time PA (LTPA) showed higher quality of life than patients without. 45% of the patients increased PA during the intervention compared to baseline. These responsive patients had more depressive feelings and tended to have lower objective PA than non-responsive patients at baseline. No significant correlation was found between PA levels before and during the intervention and other clinical data. CONCLUSIONS Most children with NT1 showed satisfying PA levels despite their daytime sleepiness. LTPA engagement was associated with higher quality of life. An APA intervention could be effective in children with narcolepsy, especially for those with depressive feelings.
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Affiliation(s)
- Lisa Brunel
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Enzo Brossaud
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Julien Lioret
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France; Clinical Research Unit, Médipôle, 158 Rue Léon Blum, 69100, Villeurbanne, France
| | - Antoine Jaffiol
- Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Louison Vanderghote
- E-HÔP Project, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Léa Cuisinier
- E-HÔP Project, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Laure Peter-Derex
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue, 69004, Lyon, France
| | - François Ricordeau
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande Rue, 69004, Lyon, France
| | - Marine Thieux
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Marion Comajuan
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Sabine Plancoulaine
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Bâtiment Leriche, 16 Avenue Paul Vaillant-Couturier, 94800, Villejuif, France
| | - Aurore Guyon
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France
| | - Patricia Franco
- INSERM U1028/ CNRS UMR 5292, Lyon Neuroscience Research Center (CRNL), University Lyon 1, CH Le Vinatier - Bâtiment 462, 95 boulevard Pinel, 69500, Bron, France; Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France.
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5
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Tadrous R, O'Rourke D, Murphy N, Quinn G, Quinn C, Slattery L, Broderick J. Exploring exercise, physical wellbeing and the role of physiotherapy: perspectives from people with narcolepsy. J Sleep Res 2024; 33:e14007. [PMID: 37621198 DOI: 10.1111/jsr.14007] [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: 05/19/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
Narcolepsy is associated with reduced quality of life and physical performance. The study aimed to explore the attitudes of people with Type 1 narcolepsy towards exercise and physical activity, their physical wellbeing, and the potential role of physiotherapy. Semi-structured interviews were conducted with 22 people with narcolepsy attending a dedicated outpatient narcolepsy clinic located in Dublin, Ireland. Transcripts were iteratively coded; a thematic analysis was undertaken, and key themes were identified. Four themes were identified: 'Barriers and Facilitators to Exercising', 'Social Concerns', 'Health Concerns' and 'Suggestions for the Role of Physiotherapy'. Future research should explore the potential role of exercise to help manage narcolepsy-related symptoms in this population.
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Affiliation(s)
- Ragy Tadrous
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Niamh Murphy
- Department of Physiotherapy, St. James's Hospital, Dublin, Ireland
| | - Gillian Quinn
- Department of Physiotherapy, St. James's Hospital, Dublin, Ireland
| | - Caitriona Quinn
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lisa Slattery
- Department of Neurology, St. James's Hospital, Dublin, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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6
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Quaedackers L, Van Gilst MM, Van Den Brandt I, Vilanova A, Lammers GJ, Markopoulos P, Overeem S. The Burden of Narcolepsy in Adults: A Population Sampling Study Using Personal Media. Behav Sleep Med 2024; 22:179-189. [PMID: 37246794 DOI: 10.1080/15402002.2023.2217971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To obtain insight in the spectrum of narcolepsy symptoms and associated burden in a large cohort of patients. METHODS We used the Narcolepsy Monitor, a mobile app, to easily rate the presence and burden of 20 narcolepsy symptoms. Baseline measures were obtained and analyzed from 746 users aged between 18 and 75 years with a reported diagnosis of narcolepsy. RESULTS Median age was 33.0 years (IQR 25.0-43.0), median Ullanlinna Narcolepsy Scale 19 (IQR 14.0-26.0), 78% reported using narcolepsy pharmacotherapy. Excessive daytime sleepiness (97.2%) and lack of energy were most often present (95.0%) and most often caused a high burden (79.7% and 76.1% respectively). Cognitive symptoms (concentration 93.0%, memory 91.4%) and psychiatric symptoms (mood 76.8%, anxiety/panic 76.4%) were relatively often reported to be present and burdensome. Conversely, sleep paralysis and cataplexy were least often reported as highly bothersome. Females experienced a higher burden for anxiety/panic, memory, and lack of energy. CONCLUSIONS This study supports the notion of an elaborate narcolepsy symptom spectrum. Each symptom's contribution to the experienced burden varied, but lesser-known symptoms did significantly add to this as well. This emphasizes the need to not only focus treatment on the classical core symptoms of narcolepsy.
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Affiliation(s)
- L Quaedackers
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M M Van Gilst
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - I Van Den Brandt
- Department of Mathematics and Computer Science, Algorithms and Visualization W&I, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - A Vilanova
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Mathematics and Computer Science, Algorithms and Visualization W&I, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Intelligence Systems, Electrical Engineering, Mathematics, and Computer Science, Delft University of Technology, Delft, The Netherlands
| | - G J Lammers
- Sleep-Wake Center SEIN, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Markopoulos
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Overeem
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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7
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Li B, Gao Z, He Y, Tian Y, Shen Y, Yu G, Geng X, Kou C. Narcolepsy and psychiatric disorders: A bidirectional Mendelian randomization study. J Psychiatr Res 2024; 169:42-48. [PMID: 38000183 DOI: 10.1016/j.jpsychires.2023.11.034] [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: 07/27/2023] [Revised: 10/09/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Since the introduction of the concept of narcolepsy, there has been a proliferation of discussions about its association with psychiatry. To elucidate the causal role of narcolepsy in the three psychiatric disorders [i.e., schizophrenia (SCZ), major depressive disorder (MDD), and attention-deficit hyperactivity disorder (ADHD)], we applied a bidirectional Mendelian randomization study using two stages (discovery stage and validation stage) and data from three different genome-wide association studies of narcolepsy. The estimates from different stages were combined using fixed-effects meta-analysis. Our findings suggest that narcolepsy is associated with an increased risk of SCZ. Conversely, MDD may be causally related to narcolepsy. A causal relationship between narcolepsy and ADHD was excluded.
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Affiliation(s)
- Biao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Zibo Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yuyang Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yuxuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Ge Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Xiaohan Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
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8
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Zhou ES, Revette A, Heckler GK, Worhach J, Maski K, Owens JA. Building a deeper understanding of social relationship health in adolescents with narcolepsy disorder. J Clin Sleep Med 2023; 19:491-498. [PMID: 36468655 PMCID: PMC9978442 DOI: 10.5664/jcsm.10372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Common symptoms for patients with narcolepsy can have a significant impact on social health. As one peak for symptom onset is adolescence, these symptoms impact social relationships during a critical developmental period. Much of the existing literature in this domain has relied on broad questionnaires, with less insight into the nuances of patients' potential social struggles. METHODS Adolescents (aged 12-17 years) with narcolepsy and their parents individually completed a semistructured interview (n = 14 dyads). Interview transcripts were analyzed using a multistage thematic analysis. RESULTS An overarching theme was the difficulty adolescents experienced trying to balance narcolepsy symptom management with engaging in social activities in a meaningful way. Narcolepsy affected social relationships in 3 primary domains: mood, physical activities, and driving. Adolescents reported that they were frustrated with feeling as though narcolepsy sometimes defined their social lives. Adolescents and parents expressed a desire for medical providers to better understand their evolving priorities, to validate their social limitations, and to provide more information around the social implications of narcolepsy and its treatment. CONCLUSIONS Narcolepsy has a significant impact on social relationships in adolescents, one that is not adequately managed in current clinical care models. A routine, structured assessment of social health is a vital first step for providers treating adolescents with narcolepsy. Medical centers and patient organizations can play an important role in facilitating social opportunities for this underserved population. CITATION Zhou ES, Revette A, Heckler GK, Worhach J, Maski K, Owens JA. Building a deeper understanding of social relationship health in adolescents with narcolepsy disorder. J Clin Sleep Med. 2023;19(3):491-498.
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Affiliation(s)
- Eric S. Zhou
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anna Revette
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gillian K. Heckler
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Jennifer Worhach
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Judith A. Owens
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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Leprotti S, Audetto E, Zenesini C, Vignatelli L, Franceschini C, Pizza F, Plazzi G, Ingravallo F. What, when and by whom? Adolescents' and parents' preferences concerning narcolepsy information. Sleep Med 2023; 101:478-484. [PMID: 36525847 DOI: 10.1016/j.sleep.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To investigate adolescents' and parents' preferences concerning information on narcolepsy. METHODS During a one-year cross-sectional study, adolescents (12-20 years old) with narcolepsy and parents attending the Narcolepsy Center of Bologna (Italy) were invited to fill in a questionnaire including 28 pieces of information regarding narcolepsy, 14 concerning medical issues (i.e., diagnosis, prognosis, treatment, management) and 14 concerning psychosocial issues (i.e., impact on everyday life, relationships, possible support). Participants were asked to indicate: the importance of each item on a 5-point Likert scale; when each piece of information should be provided (diagnostic suspicion, confirmed diagnosis, follow-up visits, upon patient's request); and who should provide it (doctor, nurse, psychologist, parents and/or others). RESULTS Sixty-two adolescents (37% female, mean age 16.4 years) and 96 parents (58% female, mean age 48.2 years) agreed to participate (100% response rate). Parents rated all items as important (score≥4), while, according to adolescents, 11/14 medical and psychosocial issues were important. The moment of diagnosis was considered the right time to give almost all medical information. Regarding psychosocial issues, mothers mainly indicated the time of diagnosis, while fathers also indicated follow-up visits, and some children opted for follow-up visits or information upon request. The doctor was the preferred provider but when information concerned psychosocial issues, adolescents also indicated the parents, and parents also indicated the psychologist. CONCLUSIONS This study suggests that information on narcolepsy should be comprehensive and tailored, and that parents and psychologists may support the doctor in providing information when narcolepsy is diagnosed during adolescence.
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Affiliation(s)
- Sara Leprotti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elena Audetto
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto Delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | | | - Fabio Pizza
- IRCCS Istituto Delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Abenza-Abildua MJ, Suárez-Gisbert E, Lores-Gutiérrez V, Algarra-Lucas C, Gómez-Aceña Á, Navacerrada-Barrero FJ, González-Martín L, Pérez-Villena A, Pérez-López C. Anxiety and depression in patients with narcolepsy. J Sleep Res 2022:e13812. [PMID: 36564940 DOI: 10.1111/jsr.13812] [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: 08/20/2022] [Revised: 11/10/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
We analysed the co-existence of psychopathology in patients with narcolepsy at our centre. We performed an observational retrospective descriptive analysis of patients with a diagnosis of narcolepsy, with and without psychopathology, who attended our sleep disorders unit from October 2012 to October 2021. A total of 51patients with narcolepsy (mean [SD] age 41.10 [14.71] years; 23 [45.1%] males and 28 [54.90%] females) were included. In all, 27 patients (52.94%) and 24 patients (47.06%) had narcolepsy with and without cataplexy, respectively. Of the total, 18 (33.33%) had a mood disorder: 18 with anxiety disorder (33.33%). Of these patients 14 (27.45%) had major depression, two (4%) had attempted suicide, one (2%) had manic outbreak, and one (2%) had substance abuse. Of the 18 patients with anxiety and depression, 10 (55.55%) and eight (44.44%) had narcolepsy with and without cataplexy, respectively. In the comparative analysis, a statistically significant relationship was found between younger age and the presence of anxiety. The prevalence of anxiety and depression in patients with narcolepsy was triple that of the general population, especially in younger patients. Psychopathology precedes the diagnosis of narcolepsy in most patients, not being reactive to diagnosis. This high prevalence suggests a possible biological relationship between both disorders, which should be assessed with larger studies.
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Affiliation(s)
- María José Abenza-Abildua
- Neurology Department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Foundation for Biomedical Research and Innovation of the Infanta Sofía University Hospital and Henares University Hospital, Madrid, Spain
| | - Eugenio Suárez-Gisbert
- Psychiatry Department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Madrid, Spain
| | - Vanesa Lores-Gutiérrez
- Pneumology Department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Madrid, Spain
| | - Carmen Algarra-Lucas
- Neurology Department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Foundation for Biomedical Research and Innovation of the Infanta Sofía University Hospital and Henares University Hospital, Madrid, Spain
| | - Ángeles Gómez-Aceña
- Pneumology Department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Madrid, Spain
| | - Francisco José Navacerrada-Barrero
- Neurology Department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Foundation for Biomedical Research and Innovation of the Infanta Sofía University Hospital and Henares University Hospital, Madrid, Spain
| | - Laura González-Martín
- Neurology Department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Foundation for Biomedical Research and Innovation of the Infanta Sofía University Hospital and Henares University Hospital, Madrid, Spain
| | - Ana Pérez-Villena
- Pediatrics department, Multidisciplinary Sleep Unit, Infanta Sofía University Hospital, Madrid, Spain
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11
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Dhafar HO, BaHammam AS. Body Weight and Metabolic Rate Changes in Narcolepsy: Current Knowledge and Future Directions. Metabolites 2022; 12:1120. [PMID: 36422261 PMCID: PMC9693066 DOI: 10.3390/metabo12111120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 08/26/2023] Open
Abstract
Narcolepsy is a known auto-immune disease that presents mainly in the teenage years with irresistible sleep attacks. Patients with narcolepsy, especially NT1, have been found to have a high prevalence of obesity and other metabolic derangements. This narrative review aimed to address the relationship between narcolepsy and changes in weight and metabolic rate, and discuss potential mechanisms for weight gain and metabolic changes and future research agendas on this topic. This article will provide a balanced, up-to-date critical review of the current literature, and delineate areas for future research, in order to understand the pathophysiological metabolic changes in narcolepsy. Articles using predefined keywords were searched for in PubMed and Google Scholar databases, with predefined inclusion and exclusion criteria. Compared to controls, patients with narcolepsy are more likely to be obese and have higher BMIs and waist circumferences. According to recent research, weight gain in narcolepsy patients may be higher during the disease's outset. The precise mechanisms causing this weight gain remains unknown. The available information, albeit limited, does not support differences in basal or resting metabolic rates between patients with narcolepsy and controls, other than during the time of disease onset. The evidence supporting the role of orexin in weight gain in humans with narcolepsy is still controversial, in the literature. Furthermore, the available data did not show any appreciable alterations in the levels of CSF melanin-concentrating hormone, plasma and CSF leptin, or serum growth hormone, in relation to weight gain. Other mechanisms have been proposed, including a reduction in sympathetic tone, hormonal changes, changes in eating behavior and physical activity, and genetic predisposition. The association between increased body mass index and narcolepsy is well-recognized; however, the relationship between narcolepsy and other metabolic measures, such as body fat/muscle distribution and metabolic rate independent of BMI, is not well documented, and the available evidence is inconsistent. Future longitudinal studies with larger sample sizes are needed to assess BMR in patients with narcolepsy under a standard protocol at the outset of narcolepsy, with regular follow-up.
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Affiliation(s)
- Hamza O. Dhafar
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Family Medicine, Prince Mansour Military Hospital, Taif 26526, Saudi Arabia
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, P.O. Box 2454, Riyadh 11324, Saudi Arabia
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12
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Xiao L, Chen A, Parmar A, Frankel L, Toulany A, Murray BJ, Narang I. Narcolepsy Treatment: Voices of Adolescents. Behav Sleep Med 2022; 20:260-268. [PMID: 33877929 DOI: 10.1080/15402002.2021.1916496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Narcolepsy, characterized by excessive daytime sleepiness, is a debilitating lifelong sleep disorder for which there is no cure. Current pharmacological and nonpharmacological treatments directed toward symptom management may be suboptimal. This qualitative study explores the perspective of adolescents on therapeutic interventions for narcolepsy. METHODS Semi-structured interviews with adolescents with narcolepsy were conducted from May to August 2019 at The Hospital for Sick Children in Toronto, Canada. Qualitative thematic analysis was utilized to generate themes emerging from the data. RESULTS Eighteen adolescents with narcolepsy (age range = 10-17, mean age = 14.4 ± 2.0 years, 72% male) participated and 56% had cataplexy. Four prominent themes arose regarding therapeutic interventions for narcolepsy. Firstly, participants described that pharmacotherapy was moderately effective but did not fully relieve symptoms associated with narcolepsy. Secondly, while medications are the first line treatment for narcolepsy, many participants reported frustration regarding medication dependence and side effects. Thirdly, nonpharmacological strategies including scheduled sleep times and exercise were accepted and often employed. Lastly, adolescents desired more psychosocial support to address mental health sequelae of narcolepsy that were not fully managed by current treatment modalities. CONCLUSIONS Medications were perceived as moderately effective for managing narcolepsy but almost all participants expressed concerns with taking medications due to side effects. Adolescents valued the importance of more holistic care for their narcolepsy treatment such as psychosocial support and nonpharmacological modalities. Further anticipatory guidance regarding pharmacological side effect profiles and better integration with nonpharmacological modalities are needed to improve disease control in adolescent patients.
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Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Anna Chen
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Arpita Parmar
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lucy Frankel
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alene Toulany
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian J Murray
- University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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13
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Parmar A, Esser K, Barreira L, Miller D, Morinis L, Chong YY, Smith W, Major N, Church P, Cohen E, Orkin J. Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158205. [PMID: 34360497 PMCID: PMC8345967 DOI: 10.3390/ijerph18158205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022]
Abstract
Context: Acceptance and Commitment Therapy (ACT) is an emerging treatment for improving psychological well-being. Objective: To summarize research evaluating the effects of ACT on psychological well-being in children with special health care needs (SHCN) and their parents. Data Sources: An electronic literature search was conducted in PubMed, Web of Science, Ovid/EMBASE and PsycINFO (January 2000–April 2021). Study Selection: Included were studies that assessed ACT in children with SHCN (ages 0–17y) and/or parents of children with SHCN and had a comparator group. Data Extraction: Descriptive data were synthesized and presented in a tabular format, and data on relevant outcomes (e.g., depressive symptoms, stress, avoidance and fusion) were used in the meta-analyses to explore the effectiveness of ACT (administered independently with no other psychological therapy) compared to no treatment. Results: Ten studies were identified (child (7) and parent (3)). In children with SHCN, ACT was more effective than no treatment at helping depressive symptoms (standardized mean difference [SMD] = −4.27, 95% CI: −5.20, −3.34; p < 0.001) and avoidance and fusion (SMD = −1.64, 95% CI: −3.24, −0.03; p = 0.05), but not stress. In parents of children with SHCN, ACT may help psychological inflexibility (SMD = −0.77, 95% CI: −1.07, −0.47; p < 0.01). Limitations: There was considerable statistical heterogeneity in three of the six meta-analyses. Conclusions: There is some evidence that ACT may help with depressive symptoms in children with SHCN and psychological inflexibility in their parents. Research on the efficacy of ACT for a variety of children with SHCN and their parents is especially limited, and future research is needed.
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Affiliation(s)
- Arpita Parmar
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Kayla Esser
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Lesley Barreira
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Douglas Miller
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Leora Morinis
- Institute of Health, Policy, Management & Evaluation, Univeristy of California San Francisco, San Francisco, CA 94143, USA;
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Wanda Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Nathalie Major
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Paige Church
- Divison of Neonatology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - Eyal Cohen
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Institute of Health, Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P7, Canada
| | - Julia Orkin
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P7, Canada
- Correspondence: ; Tel.: +416-813-7654
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14
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Ingram DG, Jesteadt L, Crisp C, Simon SL. Perceived challenges in pediatric narcolepsy: a survey of parents, youth, and sleep physicians. J Clin Sleep Med 2021; 17:13-22. [PMID: 32895119 DOI: 10.5664/jcsm.8774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To clarify the most common and problematic symptoms, psychosocial challenges, and comorbidities among youth with narcolepsy based on input from key stakeholders. METHODS A nationwide cross-sectional survey of youth with narcolepsy, parents, and sleep physicians. RESULTS Overall, 116 parents, 35 youth, and 30 providers completed the entire survey. Symptoms that were rated as most common and problematic by both parents and youth were (in descending order) as follows: daytime sleepiness, disturbed nighttime sleep, mood challenges, cataplexy, sleep-related hallucinations, and sleep paralysis. Most of the 18 queried psychosocial concerns were identified as substantial challenges by both adults and youth, including difficulty focusing and memory, school, worry and anxiety, diet and nutrition, lack of motivation, mood problems, and relationship problems. In contrast, while physicians did recognize some of these challenges, they rated medication side effects and driver's license issues as relatively greater challenges. CONCLUSIONS These data highlight the high prevalence of psychosocial challenges, discordance between physician and family ratings of challenges, and a high rate of medical comorbidities in youth with narcolepsy and support the application of a biopsychosocial framework in the assessment and treatment of pediatric narcolepsy.
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Affiliation(s)
| | | | | | - Stacey L Simon
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
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15
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Tadrous R, O'Rourke D, Mockler D, Broderick J. Health-related quality of life in narcolepsy: A systematic review and meta-analysis. J Sleep Res 2021; 30:e13383. [PMID: 34036640 DOI: 10.1111/jsr.13383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
To date, there has been no systematic analysis of the literature regarding health-related quality of life in narcolepsy. This systematic review aimed to examine the impact of narcolepsy on health-related quality of life, measured through standardised health-related quality of life questionnaires such as the Short Form 36 and Functional Outcome of Sleep Questionnaire. The following databases: Medline, Embase, Cinahl, and Web of Science were searched for studies that investigated health-related quality of life in adults with narcolepsy. Studies were reviewed independently by two reviewers, and a random-effects meta-analysis was performed. A total of 30 studies were eligible for inclusion in the review. Additionally, meta-analyses were conducted for the Short Form 36 and the EQ5D. The Short Form 36 meta-analysis identified that the pooled mean scores for the Physical Component Summary (45.91) were less affected than the Mental Component Summary (42.98). People with narcolepsy experience substantially lower health-related quality of life when compared with the general population norms of the USA, UK, France and Norway, as well as compared with people with chronic diseases such as multiple sclerosis, diabetes, hypertension and epilepsy. Further research is warranted to identify the longitudinal effects of narcolepsy on health-related quality of life, and to develop a narcolepsy-specific health-related quality of life tool.
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Zhang R, Gao S, Wang S, Zhang J, Bai Y, He S, Zhao P, Zhang H. Gut Microbiota in Patients with Type 1 Narcolepsy. Nat Sci Sleep 2021; 13:2007-2018. [PMID: 34785965 PMCID: PMC8579944 DOI: 10.2147/nss.s330022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/17/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To explore the characteristics of gut microbiota and its relationship between clinical manifestations in patients with type 1 narcolepsy (NT1). PATIENTS AND METHODS Scale and polysomnography were performed in 20 NT1 patients and 16 healthy controls (HC group) to evaluate the clinical characteristics of NT1. Illumina sequencing was performed on bacterial 16S ribosomal RNA gene using V3-V4 regions to compare the fecal microbiota in all subjects. Associations between clinical characteristics and gut microbiota were analyzed using partial correlation analysis. RESULTS Compared with the HC group, the NT1 group had a significantly higher ESS score, longer total sleep time, increased wakefulness, decreased sleep efficiency, disturbance of sleep structure, shorter mean sleep latency, and increased sleep-onset REM periods (all P < 0.05). No differences in alpha and beta diversity were observed between the two groups. In contrast, there were significant differences at the level of class, order, family, and genus (all P < 0.05). LEfSe analysis showed that the relative abundance of Klebsiella in the NT1 group was higher than that in the HC group (P < 0.05), while the relative abundance of Blautia, Barnesiellaceae, Barnesiella, Phocea, Lactococcus, Coriobacteriia, Coriobacteriales, Ruminiclostridium_5, and Bilophila were lower (all P < 0.05). Partial correlation analysis revealed that partial differential bacteria in the NT1 group were correlated with total sleep time, sleep efficiency, stage 1 sleep, arousal index, and sleep latency (all P < 0.05). CONCLUSION Our data revealed differences in intestinal flora structure between NT1 patients and the normal population, thus providing a theoretical basis for future microecological therapy for narcolepsy. However, future larger sample size studies and different study designs are needed to further clarify the possible pathogenesis and potential causality of intestinal flora in NT1 patients and explore the new treatment strategies.
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Affiliation(s)
- Ruirui Zhang
- Department of Neurology, Henan Provincial People's Hospital Affiliated to Henan University, Zhengzhou, Henan, People's Republic of China
| | - Shanjun Gao
- Microbiome Laboratory, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Shenghui Wang
- Department of Neurology, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jiewen Zhang
- Department of Neurology, Henan Provincial People's Hospital Affiliated to Henan University, Zhengzhou, Henan, People's Republic of China.,Department of Neurology, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yingying Bai
- Department of Neurology, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shuang He
- Department of Neurology, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongju Zhang
- Department of Neurology, Henan Provincial People's Hospital Affiliated to Henan University, Zhengzhou, Henan, People's Republic of China.,Department of Neurology, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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17
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Abstract
PURPOSE OF REVIEW Narcolepsy is a central disorder of hypersomnolence with symptoms of excessive daytime sleepiness, sleep paralysis, and cataplexy. Cataplexy is the sudden loss of muscle tone in either the face, neck, trunk, and/or limbs, leading to a loss of voluntary muscle control. This article reviews recent research on the clinical characteristics of cataplexy. RECENT FINDINGS Longitudinal research in adults suggests that there may be a remission of cataplectic severity after symptom stabilization. First-line treatment options for cataplexy include sodium oxybate and pitolisant, with many drugs such as AXS-12, FT218, and JZP258 under investigation. Patients with cataplexy reported greater limitations of daily activities such as driving and exercise compared to patients without cataplexy. Cataplexy remains a challenge for children and adults with narcolepsy and can interfere with daily activities. There is no cure for narcolepsy, but cataplexy can be well-managed with current and promising new treatment options on the horizon.
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