Determinants of depressive symptoms in narcoleptic patients with and without cataplexy

Co-occurrence of anxiety and depressive symptoms, suicidal thoughts, and hopelessness in patients with narcolepsy type 1

OBJECTIVE

To assesses the prevalence and co-occurrence of anxiety, depressive symptoms, suicidal thoughts, and hopelessness in patients with narcolepsy type 1 (NT1).

PATIENTS/METHODS

In this cross-sectional study, 127 patients with NT1 (mean age 38.2 ± 15.5 years, 53.5 % female) and 131 controls (mean age 37.4 ± 14.3 years, 59.5 % female) matched for age, sex, and education, filled in the following validated questionnaires: Beck Depression Inventory-II (BDI), State-Trait Anxiety Inventory (STAI), and Beck Hopelessness Scale (BHS). Comparisons between groups and multivariable logistic regression analyses were performed.

RESULTS

Patients with NT1 presented significantly higher scores in BDI, suicidal thoughts (BDI-item-9), STAI-trait, STAI-state, and BHS than controls. Adjusted for age, sex, and educational level, NT1 was significantly associated with depressive symptoms (BDI≥13; OR 3.23, 95%CI 1.71-6.10), trait anxiety symptoms (STAI-trait≥38; OR 1.91, 95%CI 1.14-3.21), co-occurrence of BDI≥13 with STAI-trait≥38 (OR 2.72, 95%CI 1.47-5.05), and with STAI-state≥38 (OR 2.24, 95%CI 1.17-4.30), and moderate to severe hopelessness (BHS≥9; OR 2.95, 95%CI 1.55-5.63).

CONCLUSIONS

Patients with NT1 present a multidimensional psychiatric burden and comorbidity between symptoms of depression and anxiety and suicidal thoughts, a concern that deserves tailored interventions.

Prevalence of Depression or Depressive Symptoms in Patients with Narcolepsy: a Systematic Review and Meta-Analysis

A meta-analysis was conducted to review the prevalence and associated moderators of depression or depressive symptoms in patients with narcolepsy. An extensive search of the literature yielded 1104 articles and abstracts, of which 31 studies were included in the meta-analysis. Meta-analysis revealed that the overall pooled prevalence of depression or depressive symptoms in patients with narcolepsy was 32% (95% Confidence Interval, 28-36%) with high between-study heterogeneity (Q = 249.77, df = 30, p < 0.001, τ² = 0.0087, I² = 88%). An analysis of 13 studies with healthy control groups indicated that narcolepsy was associated with a significantly increased risk of depression or depressive symptoms (Odds Ratio 3.48, 95% Confidence Interval 2.73-4.45; Q = 41.23, df = 12, p < 0.001, τ² = 0.0087, I² = 70.9%). The prevalence of depression or depressive symptoms in patients with narcolepsy was significantly affected by study design (Q = 5.05, p = 0.02) and recruitment setting (Q = 5.98, p = 0.01), and was marginally affected by age group (Q = 3.44, p = 0.06). The results indicate that narcolepsy patients should be closely monitored for depression and depressive symptoms and that early screening should be considered. However, these conclusions should be tempered because of high variability between studies. The estimates across studies are very inconsistent, indicating the need for larger, multicenter studies, with stringent case definitions.

Current and Future Treatment Options for Narcolepsy: A Review

Narcolepsy is a chronic neurological sleep disorder with potentially disabling symptoms ranging from occupational concerns to mental health difficulties. Recent advances related to the neurobiological basis of narcolepsy have led to newer pharmacological treatment options and adjunctive behavioral techniques that support symptom management. This article outlines evidence-based pharmacologic therapies, behavioral techniques, and psychosocial costs related to narcolepsy. Psychosocial factors, although frequently acknowledged, deserve further attention and awareness from researchers and providers. The American Academy of Sleep Medicine's (AASM) Quality Measure Drivers and potential future treatment options are also discussed.

Dual orexin receptor antagonists - promising agents in the treatment of sleep disorders

Insomnia is a serious medical and social problem, its prevalence in the general population ranges from 9 to 35% depending on the country and assessment method. Often, patients are subject to inappropriate and therefore dangerous pharmacotherapies that include prolonged administration of hypnotic drugs, benzodiazepines and other GABAA receptor modulators. This usually does not lead to a satisfactory improvement in patients' clinical states and may cause lifelong drug dependence. Brain state transitions require the coordinated activity of numerous neuronal pathways and brain structures. It is thought that orexin-expressing neurons play a crucial role in this process. Due to their interaction with the sleep-wake-regulating neuronal population, they can activate vigilance-promoting regions and prevent unwanted sleep intrusions. Understanding the multiple orexin modulatory effects is crucial in the context of pathogenesis of insomnia and should lead to the development of novel treatments. An important step in this process was the synthesis of dual antagonists of orexin receptors. Crucially, these drugs, as opposed to benzodiazepines, do not change the sleep architecture and have limited side-effects. This new pharmacological approach might be the most appropriate to treat insomnia.

Comorbidity and mortality of narcolepsy: a controlled retro- and prospective national study

STUDY OBJECTIVES

To identify the factual morbidity and mortality of narcolepsy in a controlled design.

SETTING

National Patient Registry.

PATIENTS

All national diagnosed patients (757) with health information at least 3 years prior to and after diagnose of narcolepsy.

CONTROLS

Randomly selected four citizens (3,013) matched for age, sex, and socioeconomic status from the Danish Civil Registration System Statistics.

RESULTS

Increased morbidity prior to narcolepsy diagnosis included (odds ratio, 95% confidence interval):- diseases of the endocrine, nutritional, and metabolic systems (2.10, 1.32-3.33); nervous system (5.27, 3.65-7.60); musculoskeletal system (1.59, 1.23-2.05); and other abnormal symptoms and laboratory findings (1.66, 1.25-2.22). After the diagnosis, narcolepsy patients experienced diseases of the endocrine, nutritional, and metabolic (2.31, 1.51-3.54), nervous (9.19, 6.80-12.41), musculoskeletal (1.70, 1.28-2.26), eye (1.67, 1.03-2.71), and respiratory systems (1.84, 1.21-2.81). Specific diagnoses were diabetes (2.4, 1,2-4.7, P < 0.01), obesity (13.4, 3.1-57.6, P < 0.001), sleep apnea (19.2, 7.7-48.3, P < 0.001), other sleep disorders (78.5, 11.8-523.3, P < 0.001), chronic obstructive pulmonary disease (2.8, 1.4-5.8, P < 0.01), lower back pain (2.5, 1.4-4.2, P < 0.001), arthrosis/arthritis (2.5, 1.3-4.8, P < 0.01), observation of neurological diseases (3.5, 1.9-6.5, P < 0.001), observation of other diseases (1.7, 1.2-2.5, P < 0.01), and rehabilitation (5.0, 1.5-16.5, P < 0.005). There was a trend towards greater mortality in narcolepsy (P = 0.07).

CONCLUSIONS

Patients with narcolepsy present higher morbidity several years prior to diagnose and even higher thereafter. The mortality rate due to narcolepsy was slightly but not significantly higher.

Role of orexin in the pathophysiology of depression: potential for pharmacological intervention

Depression is a devastating mental disorder with an increasing impact throughout the world, whereas the efficacy of currently available pharmacological treatment is still limited. Growing evidence from preclinical and clinical studies suggests that orexins (neuropeptides that are also known as hypocretins) and their receptors are involved in the physiopathology of depression. Indeed, the orexinergic system regulates functions that are disturbed in depressive states such as sleep, reward system, feeding behavior, the stress response and monoaminergic neurotransmission. Nevertheless, the precise role of orexins in behavioral and neurophysiological impairments observed in depression is still unclear. Both hypoactivity and hyperactivity of orexin signaling pathways have been found to be associated with depression. These discrepancies in the literature prompted the necessity for additional investigations, as the orexinergic system appears to be a promising target to treat the symptoms of depression. This assumption is underlined by recent data suggesting that pharmacological blockade of orexin receptors induces a robust antidepressant-like effect in an animal model of depression. Further preclinical and clinical studies are needed to progress the overall understanding of the orexinergic alterations in depression, which will eventually translate preliminary observations into real therapeutic potential. The aim of this paper is to provide an overview of human and animal research dedicated to the study of the specific involvement of orexins in depression, and to propose a framework in which disturbances of the orexinergic system are regarded as an integral component of the etiology of depression.

Morbidities in rapid eye movement sleep behavior disorder

Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD, RBD without any obvious comorbid major neurological disease), is strongly associated with numerous comorbid conditions. The most prominent is that with neurodegenerative disorders, especially synuclein-mediated disorders, above all Parkinson disease (PD). Idiopathic RBD is an important risk factor for the development of synucleinopathies. Comorbidity studies suggest that iRBD is associated with a number of other potential pre-motor manifestations of synucleinopathies such as, cognitive and olfactory impairment, reduced autonomic function, neuropsychiatric manifestations and sleep complaints. Furthermore, patients with PD and RBD may have worse prognosis in terms of impaired cognitive function and overall morbidity/mortality; in dementia, the presence of RBD is strongly associated with clinical hallmarks and pathological findings of dementia with Lewy bodies. These findings underline the progressive disease process, suggesting involvement of more brain regions in patients with a more advanced disease stage. RBD is also associated with narcolepsy, and it is likely that RBD associated with narcolepsy is a distinct subtype associated with different comorbidities. RBD is also associated with antidepressant medications, autoimmune conditions, and, in rare cases, brainstem lesions.