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Mundt JM, Zee PC, Schuiling MD, Hakenjos AJ, Victorson DE, Fox RS, Dawson SC, Rogers AE, Ong JC. Development of a Mindfulness-Based Intervention for Narcolepsy: A Feasibility Study. Sleep 2024:zsae137. [PMID: 38895897 DOI: 10.1093/sleep/zsae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
STUDY OBJECTIVES Mindfulness-based interventions (MBI) have been shown to improve psychosocial functioning in medical populations but have not been studied in narcolepsy. This study examined the feasibility and acceptability of an MBI that was adapted for narcolepsy, including three variations in program length. METHODS Adults with narcolepsy (N = 60) were randomized to MBI groups of varying durations: brief (4 weeks), standard (8 weeks), or extended (12 weeks). Participants completed assessments at baseline, 4 weeks, 8 weeks, and 12 weeks. To assess feasibility and acceptability, primary outcomes included attendance, meditation practice, and data completeness. Additionally, participants completed measures of mindfulness, self-compassion, mood, sleep, psychosocial functioning, and cognition. An effect size of Cohen's d ≥ 0.5 was used as the pre-specified benchmark for a minimal clinically important difference (MCID). RESULTS The attendance, meditation, and data completeness benchmarks were met by 71.7%, 61.7%, and 78.3% of participants, respectively. Higher proportions of the brief and extended groups met these benchmarks compared to the standard group. All groups met the MCID for mindfulness, self-compassion, self-efficacy for managing emotions, positive psychosocial impact, global mental health, and fatigue. Standard and extended groups met the MCID for anxiety and depression, and extended group met the MCID for additional measures including social and cognitive functioning, daytime sleepiness, hypersomnia symptoms, and hypersomnia-related functioning. CONCLUSION Results suggest that the remote delivery and data collection methods are feasible to employ in future clinical trials, and it appears that the extended MBI provides the most favorable clinical impact while maintaining attendance and engagement in meditation practice.
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Affiliation(s)
- Jennifer M Mundt
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew D Schuiling
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
| | - Alec J Hakenjos
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David E Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Advanced Nursing Practice and Science, University of Arizona College of Nursing, Tucson, AZ, USA
| | - Spencer C Dawson
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, USA
| | - Ann E Rogers
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jason C Ong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Nox Health, Inc., Alpharetta, GA, USA
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Li C, Xie L, Shang S, Dong X, Zhang J, Gao Y, Han F. The Impact of Symptom Severity on Health-Related Quality of Life in People with Narcolepsy Type 1. Behav Sleep Med 2023; 21:13-21. [PMID: 35061552 DOI: 10.1080/15402002.2022.2025805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the impact of symptom severity on health-related quality of life (HRQoL) in people with narcolepsy type 1 (NT1). METHODS A total of 174 people with NT1 were enrolled. They completed the Narcolepsy Severity Scale (NSS) and EQ-5D-3L consisting of five dimensions (EQ-5D utility values) and a visual analog scale (EQ-5D VAS). The relationship between severity of symptoms and HRQoL dimensions was evaluated by Pearson correlation analyses. Logistic regression was used to identify significant predictors of HRQoL. Nomogram was established based on results of independent predictors of factors on logistic regression analyses. RESULTS The mean score for NSS, EQ-5D utility values, and EQ-5D VAS were 29.8 (10.08), 0.78 (0.09), and 64.30 (19.84) in people with NT1, respectively. NSS score showed a significant correlation with self-care (r = 0.157, p < .05), usual activities (r = 0.236, p < .01), pain/discomfort (r = 0.174, p < .05), anxiety/depression (r = 0.2, p < .01), and EQ-5D utility values (r = -.261, p < .01). EDS (excessive daytime sleep), cataplexy, hallucinations, paralysis, and disrupted nocturnal sleep (DNS) were significantly associated to EQ-5D VAS (r ranged from -0.154 to -0.354, p < .05). EDS (OR = -0.297) and DNS (OR = -0.16) were predictors of HRQoL. NSS score (OR = -0.360) and treatment (OR = 0.215) were predictors of the metrics of HRQoL. The C-indices of the nomogram were 0.726. CONCLUSION The severity of symptoms could disrupt self-care and usual activities, and increase pain/discomfort and anxiety/depression. HRQoL might be improved by alleviating symptom severity.
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Affiliation(s)
- Chenyang Li
- School of Nursing, Peking University, Beijing, China
| | - Liang Xie
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shaomei Shang
- School of Nursing, Peking University, Beijing, China
| | - Xiaosong Dong
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Jun Zhang
- Department of Neuromedicine, Peking University People's Hospital, Beijing, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Fang Han
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
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Qu S, Wang P, Wang M, Li C, Dong X, Xu L, Han F. A comparison of mood, quality of life and executive function among narcolepsy type 1 patients with or without ADHD symptoms in China. Sleep Med 2022; 97:47-54. [DOI: 10.1016/j.sleep.2022.05.016] [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: 02/23/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
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Nigam M, Hippolyte A, Dodet P, Gales A, Maranci JB, Al-Youssef S, Leu-Semenescu S, Arnulf I. Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia. J Clin Sleep Med 2022; 18:255-263. [PMID: 34314345 PMCID: PMC8807898 DOI: 10.5664/jcsm.9556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To assess the impact of coronavirus disease 2019 (COVID-19)-related restrictions on narcolepsy type 1 (NT2), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH). METHODS Participants with NT1, NT2, and IH followed in a university hospital completed an online 78-question survey assessing demographic, clinical, and occupational features of the population during the first COVID-19-related lockdown. RESULTS A total of 219 of 851 (25.7%) respondents of the survey reported a mean increase of 1.2 ± 1.9 hours (P < .001) in night sleep time and a mean decrease of 1.0 ± 3.4 points (P < .001) on the Epworth Sleepiness Scale during lockdown. Bedtime was delayed by 46.1% of participants and wakeup time was delayed by 59.6%, driven primarily by participants with IH. Teleworkers (but not in-person workers) reported a mean increase of 0.9 ± 1.2 hours in night sleep (P < .001) and a mean decrease in sleepiness score of 1.6 ± 3.1 (P < .001). Cataplexy improved in 54.1% of participants with NT1. Sleepiness correlated with psychological wellness (r = .3, P < .001). As many as 42.5% enjoyed the lockdown, thanks to reallocation of time usually spent commuting toward longer sleep time, hobbies, and family time, and appreciated a freer napping schedule. Conversely, 13.2% disliked the lockdown, feeling isolation and psychological distress. CONCLUSIONS Extended sleep time, circadian delay (in patients with IH), and teleworking resulted in decreased symptoms of central hypersomnias. These findings suggest that people with IH, NT1, and NT2 may benefit from a decrease in social and professional constraints on sleep-wake habits, and support advocacy efforts aimed at facilitating workplace and schedule accommodations for this population. CITATION Nigam M, Hippolyte A, Dodet P, et al. Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia. J Clin Sleep Med. 2022;18(1):255-263.
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Affiliation(s)
- Milan Nigam
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France,Centre for Advanced Research in Sleep Medicine, Sacré-Coeur Hospital, Montreal, Quebec, Canada,Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada,Sorbonne University, Paris, France
| | - Amandine Hippolyte
- Sorbonne University, Paris, France,Faculté des Sciences, Université de Montpellier, Montpellier, France
| | - Pauline Dodet
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Ana Gales
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Jean-Baptiste Maranci
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France,Sorbonne University, Paris, France
| | - Saba Al-Youssef
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Smaranda Leu-Semenescu
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France
| | - Isabelle Arnulf
- Sleep Disorders Unit, University Hospital Pitié-Salpêtrière, APHP-Sorbonne, Paris, France,Sorbonne University, Paris, France,Institut du Cerveau et de la Moelle (Paris Brain Institute), Paris, France,Address correspondence to: Isabelle Arnulf, MD, PhD, Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, 47-83 Bd de l’Hôpital, 75013 Paris; Tel: 33 (0) 1 42 16 77 04; Fax: 33 (0) 1 42 16 77 00;
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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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Wasling HB, Bornstein A, Wasling P. Quality of life and procrastination in post-H1N1 narcolepsy, sporadic narcolepsy and idiopathic hypersomnia, a Swedish cross-sectional study. Sleep Med 2020; 76:104-112. [PMID: 33152582 DOI: 10.1016/j.sleep.2020.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE/BACKGROUND A cross-sectional study of health-related quality of life (HRQoL), procrastination and the relation to sleepiness, depression and fatigue in post-H1N1 narcolepsy type 1 (NT1), sporadic NT1 and idiopathic hypersomnia (IH). PATIENTS/METHODS Participants with NT1 and IH were enrolled from the Department of Neurology, Sahlgrenska University Hospital in Gothenburg (Sweden). All participants completed questionnaires about medication, employment, studies, transfer income, sleepiness, HRQoL, depression, fatigue and three questionnaires for procrastination. RESULTS Post-H1N1, sporadic NT1 and IH all scored higher than healthy controls on Epworth Sleepiness Scale (ESS), Patient Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS), whereas EQ-5D-5L index and VAS was lower than for healthy individuals, but with no difference between groups. Post-H1N1 NT1 had a larger proportion of participants prescribed with sodium oxybate (44% vs. 9%, p = 0.003) and dexamphetamine (62% vs. 17%, p = 0.03) compared to sporadic NT1. The latter also in significantly higher doses than in sporadic NT1 (46 ± 12 vs. 25 ± 10 and 47.5 ± 21 mg, p < 0.0001). Post-H1N1 NT1 also had significantly higher scores on Pure Procrastination Scale (PPS), Irrational Procrastination Scale (IPS) and Susceptibility to Temptation Scale (STS), indicating a higher degree of procrastination. Multivariate analysis showed that depression, and to some extent fatigue, were predictors in NT1 for both HRQoL and procrastination. CONCLUSIONS The results show that health-related quality of life is impaired and tendency to procrastinate is higher in patients suffering from NT1 and both attributes can in part be explained by depressive symptoms. These findings highlight the impact of symptoms other than sleep and wakefulness regulation in patients with NT1.
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Affiliation(s)
- Helena Backlund Wasling
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Axel Bornstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pontus Wasling
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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7
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Barker EC, Flygare J, Paruthi S, Sharkey KM. Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns. Nat Sci Sleep 2020; 12:453-466. [PMID: 32765142 PMCID: PMC7371435 DOI: 10.2147/nss.s162762] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022] Open
Abstract
Narcolepsy is a neurological disorder of the sleep-wake cycle characterized by excessive daytime sleepiness (EDS), cataplexy, nighttime sleep disturbances, and REM-sleep-related phenomena (sleep paralysis, hallucinations) that intrude into wakefulness. Dysfunction of the hypocretin/orexin system has been implicated as the underlying cause of narcolepsy with cataplexy. In most people with narcolepsy, symptom onset occurs between the ages of 10 and 35 years, but because the disorder is underrecognized and testing is complex, delays in diagnosis and treatment are common. Narcolepsy is treated with a combination of lifestyle modifications and medications that promote wakefulness and suppress cataplexy. Treatments are often effective in improving daytime functioning for individuals with narcolepsy, but side effects and/or lack of efficacy can result in suboptimal management of symptoms and, in many cases, significant residual impairment. Additionally, the psychosocial ramifications of narcolepsy are often neglected. Recently two new pharmacologic treatment options, solriamfetol and pitolisant, have been approved for adults, and the indication for sodium oxybate in narcolepsy has been expanded to include children. In recent years, there has been an uptick in patient-centered research, and promising new diagnostic and therapeutic options are in development. This paper summarizes current and prospective pharmacological therapies for treating both EDS and cataplexy, discusses concerns specific to children and reproductive-age women with narcolepsy, and reviews the negative impact of health-related stigma and efforts to address narcolepsy stigma.
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Affiliation(s)
- Emily C Barker
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA
| | | | - Shalini Paruthi
- Sleep Medicine and Research Center, St. Luke’s Hospital, St. Louis, MO, USA
- Saint Louis University School of Medicine, Departments of Medicine and Pediatrics, St. Louis, MO, USA
| | - Katherine M Sharkey
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry & Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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Cremaschi RC, Hirotsu C, Tufik S, Coelho FM. Health-related quality of life in patients with narcolepsy types 1 and 2 from a Sleep Center in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:488-493. [PMID: 32627808 DOI: 10.1590/0004-282x20200032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Narcolepsy patients have higher prevalence of comorbidities, such as obesity, depression, and pain. Narcolepsy symptoms and concomitant medical conditions can impact the daily activities of patients. The objective of this study is to describe the quality of life in a sample of patients with narcolepsy, and the influence of the nutritional status in health domains. METHODS At Unifesp, two groups of 33 patients (narcolepsy types 1 and 2 meeting 2014 criteria, concerning hypocretin-1) and 33 controls without sleepiness, matched by age and sex, filled out the SF-36. RESULTS Narcolepsy groups, regardless of their nutritional status, had significantly lower scores in all domains, compared to controls, mainly in Role-physical, Role-emotional, and Energy/Fatigue. Role-physical score was lower in type 1 than in type 2 and controls (37.8±1.0 vs. 50.0±1.2 vs. 85.6±1.6; p<0.0001). Obese with type 2 narcolepsy scored lower than type 1 in physical scales. CONCLUSION In a Sleep Center in São Paulo, Brazil, physical and mental health were impaired in narcolepsy types 1 and 2. The first report of the poor health status in Brazilians with narcolepsy type 2 suggests that obesity negatively affects physical domains.
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Affiliation(s)
- Renata Carvalho Cremaschi
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Camila Hirotsu
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Lausanne University Hospital, Centre d'investigation et de recherche sur le sommeil, Lausanne, Switzerland
| | - Sergio Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
| | - Fernando Morgadinho Coelho
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
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Abstract
Narcolepsy is a chronic disorder characterized by symptoms of excessive daytime sleepiness, irresistible sleep attacks that may be accompanied by cataplexy brought on by emotions, sleep paralysis, and hypnagogic hallucinations. This is a review of 32 empirical articles on health-related quality of life (HRQoL) published in peer-reviewed journals over the past 37 years. Deleterious implications on education, recreation, driving, sexual life, and personality are associated with the disease with a consequent negative psychosocial impact. Sleepiness has an important influence on HRQoL, more than the other symptoms of this disorder that have disrupting roles, too. Therefore, patients with narcolepsy need assistance not only for medication prescription but also in terms of psychological and social support. It is also of importance to assess patients with narcolepsy carefully in terms of depressive symptoms because they may have a major impact on HRQoL with important clinical implications.
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10
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Kayaba M, Sasai-Sakuma T, Inoue Y. Clinical significance of social jetlag in patients with excessive daytime sleepiness. Chronobiol Int 2018; 35:1637-1646. [DOI: 10.1080/07420528.2018.1499666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Momoko Kayaba
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Nueropsychiatry, Tokyo, Japan
| | - Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Nueropsychiatry, Tokyo, Japan
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Nueropsychiatry, Tokyo, Japan
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Bogan RK, Black J, Swick T, Mamelak M, Kovacevic-Ristanovic R, Villa KF, Mori F, Montplaisir J. Correlation of Changes in Patient-Reported Quality of Life With Physician-Rated Global Impression of Change in Patients With Narcolepsy Participating in a Clinical Trial of Sodium Oxybate: A Post Hoc Analysis. Neurol Ther 2017; 6:237-245. [PMID: 28707076 PMCID: PMC5700898 DOI: 10.1007/s40120-017-0076-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Narcolepsy patients report lower health-related quality of life (HRQoL) than the general population, as measured by the Short Form-36 Health Survey (SF-36). This analysis evaluated whether changes in SF-36 correlated with physician-rated Clinical Global Impression of Change (CGI-C). METHODS Data were from 209 of 228 narcolepsy patients participating in an 8-week clinical trial of sodium oxybate. Changes from baseline for SF-36 subscales (Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health) and the summary scores were evaluated for correlation with CGI-C overall and by treatment group. Correlations were calculated using the Pearson product-moment correlation coefficient (r). RESULTS Correlations described an inverse relationship in scores, but a direct relationship in improvement; lower CGI-C scores (i.e., better) were associated with higher SF-36 subscale scores (i.e., improved HRQoL). Moderate and significant correlations were observed for Vitality (r = -0.464; P < 0.0001) and Role Physical (r = -0.310; P < 0.0001) subscales, but weak correlations were observed with other subscales including summary scores. Correlations were stronger at higher sodium oxybate doses for most SF-36 subscales. CONCLUSION Some aspects of HRQoL, measured by the SF-36, may be associated with narcolepsy. In particular, Vitality (indicative of energy and tiredness) and Role Physical (impact of physical function on daily roles) moderately correlated with overall change in status observed by clinicians. However, lack of strong correlations between SF-36 and CGI-C indicates differences in patient and clinician perspectives of disease, and suggest a need for broader assessment of the impact of narcolepsy and its treatment on patients. FUNDING Jazz Pharmaceuticals.
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Affiliation(s)
- Richard K Bogan
- University of South Carolina School of Medicine, Columbia, SC, USA. .,SleepMed, Incorporated, Columbia, SC, USA.
| | - Jed Black
- Stanford Sleep Medicine Center, Redwood City, CA, USA.,Jazz Pharmaceuticals, Inc, Palo Alto, CA, USA
| | - Todd Swick
- University of Texas-Houston School of Medicine, Houston, TX, USA
| | | | | | | | - Fannie Mori
- Jazz Pharmaceuticals, Inc, Palo Alto, CA, USA
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Chaplin JE, Szakács A, Hallböök T, Darin N. The development of a health-related quality-of-life instrument for young people with narcolepsy: NARQoL-21. Health Qual Life Outcomes 2017; 15:135. [PMID: 28676060 PMCID: PMC5496267 DOI: 10.1186/s12955-017-0707-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Narcolepsy is a lifelong sleep disorder with a prevalence of between 0.03% and 0.06% and onset at around puberty. It is associated with psychiatric comorbidities and cognitive difficulties. No valid and reliable condition-specific health-related quality-of-life (HrQoL) instrument has been developed for this population. METHODS A questionnaire based on four mixed-gender age-defined focus group discussions and a patient panel analysis was administered to young people with narcolepsy and a control group. External reliability was measured by a test-retest procedure and internal reliability was measured using Cronbach's alpha. Convergent validity with the KIDSCREEN-10 index was assessed using with intraclass correlation coefficients (ICC) and receiver operating characteristic (ROC) curves. Factor analysis techniques were used to identify suitable items and confirm the factor structure. Baseline values were assessed for convergent validity, ceiling effects, agreement and sensitivity. Comparison with KIDSCREEN-10 was made on the basis of area under the curve (AUC). RESULTS One hundred young people with narcolepsy and 95 control subjects returned questionnaires. The factor structure revealed two main factors with five domains and 21 questions, which was confirmed with confirmatory factor analysis. The domains of the NARQoL-21 showed good independence while the floor and ceiling effects were acceptable. The external reliability (0.928), convergent validity (rs = 0.769) and internal consistency (Cronbach's alpha = 0.886) were excellent. A Bland-Altman plot revealed some proportional bias. Good discriminant validity was detected for control/patient (Cohen's d = 2.114). ROC analysis showed significantly better AUC for NARQoL-21 (0.939) than KIDSCREEN (0.877). A cut-off score equivalent to KIDSCREEN-10 for suboptimal HrQoL which maximized sensitivity (84%) and specificity (92%) was found at NARQoL-21 score below 42. CONCLUSIONS Establishing the validity of a disease-specific HrQoL instrument in a population of people with a rare condition poses significant challenges. The mixed-methods approach adopted here has resulted in a questionnaire of 21 items with good discrimination and convergent validity, and excellent internal and external reliability, allowing precise and stable measurements. The cut-off score can be useful to identify patients with very poor HrQoL and thus improve the design of treatment options. Further testing in a longitudinal cohort is recommended in order to establish responsiveness.
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Affiliation(s)
- John E Chaplin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Attila Szakács
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Halland Hospital, Halmstad, Sweden
| | - Tove Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Niklas Darin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Cardiovascular fitness in narcolepsy is inversely related to sleepiness and the number of cataplexy episodes. Sleep Med 2017; 34:7-12. [DOI: 10.1016/j.sleep.2017.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 11/17/2016] [Accepted: 02/16/2017] [Indexed: 12/11/2022]
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Abstract
Sleep disturbances and disorders are common during pregnancy, and they can be risk factors for a number of serious pregnancy-related sleep disorders. These include postpartum depression, pregnancy-induced hypertension, gestational diabetes, and intrauterine growth retardation. In addition, certain chronic sleep disorders, such as narcolepsy, are quite challenging to manage in the context of pregnancy and during lactation, particularly with medications that can be teratogenic. This review discusses 4 common sleep disorders and their impacts on pregnancy, and suggests ways to deal with these disorders that improves maternal and fetal outcomes safely. The review discusses diagnosis and treatment of obstructive sleep apnea, restless legs syndrome, insomnia, and narcolepsy in pregnancy.
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Affiliation(s)
- Margaret Kay-Stacey
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hrayr P. Attarian
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Flores NM, Villa KF, Black J, Chervin RD, Witt EA. The Humanistic and Economic Burden of Narcolepsy. J Clin Sleep Med 2017; 12:401-7. [PMID: 26518705 DOI: 10.5664/jcsm.5594] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/23/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. METHODS This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. RESULTS Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). CONCLUSIONS These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy.
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Bogan R, Swick T, Mamelak M, Kovacevic-Ristanovic R, Lai C, Black J, Villa KF, Montplaisir J. Evaluation of Quality of Life in Patients With Narcolepsy Treated With Sodium Oxybate: Use of the 36-Item Short-Form Health Survey in a Clinical Trial. Neurol Ther 2016; 5:203-213. [PMID: 27778193 PMCID: PMC5130920 DOI: 10.1007/s40120-016-0053-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Indexed: 12/29/2022] Open
Abstract
Introduction The present post hoc analysis was designed to evaluate health-related quality of life (HRQoL) using the 36-item Short Form Health Status Survey (SF-36) during an 8-week trial of sodium oxybate (SXB). Methods SF-36 was assessed in a phase 3 placebo-controlled trial in patients with narcolepsy (N = 228) randomized to placebo or SXB in doses of 4.5, 6, or 9 g nightly for 8 weeks. Changes from baseline in SF-36 (last observation carried forward) were compared between SXB and placebo, and effect sizes (ES) were estimated. Results Baseline SF-36 values were lower than normative values for the US general population. After 8 weeks of treatment, mean (±standard deviation) improvement from baseline on the Physical Component Summary (PCS) was significantly greater with SXB 9 g/night than placebo (6.3 ± 9.1 vs. 1.5 ± 6.2; p = 0.005), with moderate ES; no significant difference was found between the SXB and placebo groups on the Mental Component Summary. SXB 9 g/night resulted in significantly (p < 0.05) greater improvements than placebo in Physical Functioning (4.4 ± 9.2 vs. 1.0 ± 8.0), General Health (GH; 3.1 ± 7.0 vs. 0.4 ± 6.8), and Social Functioning (6.8 ± 16.8 vs. 1.1 ± 9.6). All SXB doses resulted in significant improvement (p < 0.05) relative to placebo for Vitality, with moderate ES. No significant differences versus placebo were observed for Role–Physical, Role–Emotional, or Mental Health domains. Conclusion Treatment with SXB was associated with a dose-dependent improvement in HRQoL, with the 9-g nightly dose demonstrating a positive impact on PCS and individual SF-36 domains of Vitality, GH, and Physical and Social Functioning. Trial registration NCT00049803. Funding Jazz Pharmaceuticals.
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Affiliation(s)
- Richard Bogan
- Medical University of South Carolina School of Medicine, Charleston, SC, USA.
| | - Todd Swick
- Neurology and Sleep Medicine Consultants of Houston, University of Texas-Houston School of Medicine, Houston, TX, USA
| | - Mortimer Mamelak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - Jed Black
- Jazz Pharmaceuticals, Palo Alto, CA, USA.,Stanford Center for Sleep Research and Medicine, Stanford, CA, USA
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Kapella MC, Berger BE, Vern BA, Vispute S, Prasad B, Carley DW. Health-related stigma as a determinant of functioning in young adults with narcolepsy. PLoS One 2015; 10:e0122478. [PMID: 25898361 PMCID: PMC4405359 DOI: 10.1371/journal.pone.0122478] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/11/2015] [Indexed: 12/04/2022] Open
Abstract
Symptoms of narcolepsy tend to arise during adolescence or young adulthood, a formative time in human development during which people are usually completing their education and launching a career. Little is known about the impact of narcolepsy on the social aspects of health-related quality of life in young adults. The purpose of this study was to examine relationships between health-related stigma, mood (anxiety and depression) and daytime functioning in young adults with narcolepsy compared to those without narcolepsy. Young adults (age 18–35) with narcolepsy (N = 122) and without narcolepsy (N = 93) were mailed a packet that included questionnaires and a self-addressed postage paid envelope. The questionnaire included demographic information and a composite of instruments including the SF 36, Functional Outcomes of Sleep Questionnaire (FOSQ), Fife Stigma Scale (FSS), Epworth Sleepiness Scale (ESS) and Hospital Anxiety and Depression Scale (HADS). Variable associations were assessed using descriptive statistics, ANOVA, Mann-Whitney U Test, correlations, stepwise multiple regression and path analysis. Young adults with narcolepsy perceived significantly more stigma and lower mood and health-related quality of life than young adults without narcolepsy (p<0.01). Health-related stigma was directly and indirectly associated with lower functioning through depressed mood. Fifty-two percent of the variance in functioning was explained by the final model in the young adults with narcolepsy. Health-related stigma in young adults with narcolepsy is at a level consistent with other chronic medical illnesses. Health-related stigma may be an important determinant of functioning in young adults with narcolepsy. Future work is indicated toward further characterizing stigma and developing interventions that address various domains of stigma in people with narcolepsy.
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Affiliation(s)
- Mary C. Kapella
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Barbara E. Berger
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Boris A. Vern
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Pulmonary, Critical Care, Sleep & Allergy, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Sachin Vispute
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Bharati Prasad
- Department of Pulmonary, Critical Care, Sleep & Allergy, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - David W. Carley
- Department of Biobehavioral Health Science, Center for Narcolepsy, Sleep & Health Research, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Ton TGN, Watson NF, Koepsell TD, Longstreth WT. Narcolepsy and the Sickness Impact Profile: A general health status measure. ACTA ACUST UNITED AC 2014; 7:5-12. [PMID: 26483895 PMCID: PMC4521654 DOI: 10.1016/j.slsci.2014.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/14/2013] [Indexed: 11/23/2022]
Abstract
Objective We characterized functional impact of narcolepsy on patients using a general health status measure, the Sickness Impact Profile (SIP). It has 136 items grouped into 12 categories and 2 dimensions. Methods We ascertained patients with physician-diagnosed narcolepsy in King County, Washington using multiple overlapping methods over four years starting July 2001. We recruited 226 patients (mean age 48 years, 65% female) who underwent in-person interviews and completed: Epworth Sleepiness Scale (ESS), Ullanlinna Narcolepsy Scale (UNS), and SIP. Linear regression was used to assess correlations between measures. Results Mean percent of total dysfunction was higher for psychosocial dimension (13.2) and independent categories (13.4) than physical dimension (5.0). Mean percent of total dysfunction in descending order for categories was: Sleep and Rest (23.6), Alertness Behavior (22.6), and Recreation and Pastimes (20.6). Ten items were endorsed by at least a third of all patients but only two of them concerned sleep. Unexpectedly, among the top ten items were, “My sexual activity is decreased,” and “I forget a lot, for example, things that happened recently, where I put things, appointments.” Percent of overall dysfunction on SIP (mean 10.3) was significantly correlated with ESS (r=0.36, p<0.001) and UNS (r=0.47, p<0.001). In this population-based sample, mean percent of total dysfunction on SIP in patients with narcolepsy (10.3) was higher than previously reported in the general population (3.6) and similar to that in other chronic disabling conditions. Discussion The SIP correlated with ESS and UNS, and captured unique aspects of the impact of narcolepsy on patients.
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Affiliation(s)
- Thanh G N Ton
- University of Washington, Department of Neurology, USA
| | - Nathaniel F Watson
- University of Washington, Department of Neurology, USA ; University of Washington (UW), UW Medicine Sleep Center, USA
| | - Thomas D Koepsell
- University of Washington, Department of Epidemiology, USA ; University of Washington, Department of Health Services, USA ; University of Washington, Department of Medicine, USA
| | - William T Longstreth
- University of Washington, Department of Neurology, Medicine and Epidemiology, USA
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Bayard S, Dauvilliers YA. Reward-based behaviors and emotional processing in human with narcolepsy-cataplexy. Front Behav Neurosci 2013; 7:50. [PMID: 23734110 PMCID: PMC3661950 DOI: 10.3389/fnbeh.2013.00050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/06/2013] [Indexed: 11/13/2022] Open
Abstract
Major advances in the past decade have led a better understanding of the pathophysiology of narcolepsy with cataplexy (NC) caused by the early loss of hypothalamic hypocretin neurons. Although a role for hypocretin in the regulation of sleep/wakefulness state is widely recognized, other functions, not necessarily related to arousal, have been identified. Hence, the hypocretin system enhances signaling in the mesolimbic pathways regulating reward processing, emotion and mood regulation, and addiction. Although studies on hypocretin-deficient mice have shown that hypocretin plays an essential role in reward-seeking, depression-like behavior and addiction, results in human narcolepsy remained subject to debate. Most of studies revealed that hypocretin-deficient narcolepsy patients either drug-free or medicated with psychostimulant had preferences toward risky choices in a decision-making task under ambiguity together with higher frequency of depressive symptoms and binge eating disorder compared to controls. However, human studies mostly reported the lack of association with pathological impulsivity and gambling, and substance and alcohol abuse in the context of narcolepsy-cataplexy. Prospective larger studies are required to confirm these findings in drug-free and medicated patients with narcolepsy. Inclusion of patients with other central hypersomnias without hypocretin deficiency will provide answer to the major question of the role of the hypocretin system in reward-based behaviors and emotional processing in humans.
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Affiliation(s)
- Sophie Bayard
- Department of Neurology, National Reference Network for Narcolepsy, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM U1061, University of Montpellier 1 Montpellier, France
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Heier MS, Gjerstad MD, Knudsen S. Ny kunnskap om narkolepsi hos barn. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:1326-8. [DOI: 10.4045/tidsskr.13.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Excessive daytime sleepiness assessed by the Epworth Sleepiness Scale and its association with health related quality of life: a population-based study in China. BMC Public Health 2012; 12:849. [PMID: 23039935 PMCID: PMC3524046 DOI: 10.1186/1471-2458-12-849] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 09/27/2012] [Indexed: 11/30/2022] Open
Abstract
Background Excessive daytime sleepiness (EDS) is a common condition worldwide that has many negative effects on people who were afflicted with it, especially on their health-related quality of life (HRQOL). The Epworth Sleepiness Scale (ESS) is a commonly used method for evaluating EDS in English-speaking countries. This paper reported the prevalence of subjective EDS in China as assessed by the Mandarin version of the ESS; tested the scale’s response rate, reliability and validity; and investigated the relationship between ESS scores and HRQOL. Methods A population-based sample of 3600 residents was selected randomly in five cities in China. The demographic information was collected, subjective EDS was assessed by the Mandarin version of the ESS (ESS scores >10), and HRQOL was evaluated by the Mandarin version of the 36-item Short Form Health Survey (SF-36). Results The Mandarin version of ESS had very few missing responses, and the average response rate of its eight items was 97.92%. The split-half reliability coefficient and Cronbach’s α coefficient were 0.81 and 0.80, respectively. One factor was identified by factor analysis with an eigenvalue of 2.78. The ESS scores showed positive skewness in the selected sample, with a median (Q1, Q3) of 6 (3, 0). 644 (22.16%) respondents reported subjective EDS, and all of the scores of the eight dimensions of the SF-36 were negatively correlated with ESS scores. Conclusions The Mandarin version of ESS is an acceptable, reliable, and valid tool for measuring EDS. In addition, subjective EDS is common in China, based on the ESS results, and impairs HRQOL.
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Ingravallo F, Gnucci V, Pizza F, Vignatelli L, Govi A, Dormi A, Pelotti S, Cicognani A, Dauvilliers Y, Plazzi G. The burden of narcolepsy with cataplexy: how disease history and clinical features influence socio-economic outcomes. Sleep Med 2012; 13:1293-300. [PMID: 23026503 DOI: 10.1016/j.sleep.2012.08.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 07/23/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate in narcolepsy with cataplexy (NC) patients of working age (18-65 years) the influence of age at onset, age at diagnosis and clinical features on socio-occupational conditions, disease-related economic burden, and quality of life. METHODS One hundred consecutive patients underwent a semistructured interview on socio-occupational aspects, NC-related direct and indirect costs, and NC history. Questionnaires were used to evaluate excessive daytime sleepiness, cataplexy, depressive symptoms, and quality of life. RESULTS NC patients (51 males, mean age 37±11.5 years) had educational and occupational levels similar to those of the Italian population of the same age range, but married less often, especially if NC onset occurred at a young age. Total annual NC-related costs were €9814 ± 10,372 per patient. Multivariate analyses showed that patients with NC onset before the age of 30 years had a higher educational level, married less frequently, and were less frequently unemployed or inactive (retired, housewife). Patients diagnosed before the age of 30 years were less frequently unemployed or inactive, had fewer work changes, and had a better general health perception. Irresistible sleepiness was associated with work absences and higher indirect costs. Depressive symptoms were strongly associated with lower quality-of-life scores. CONCLUSIONS NC age at onset and at diagnosis modulates the disease-related burden. A diagnosis at a young age could improve patients' occupational prognosis, and their general health perception.
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Jennum P, Ibsen R, Petersen ER, Knudsen S, Kjellberg J. Health, social, and economic consequences of narcolepsy: A controlled national study evaluating the societal effect on patients and their partners. Sleep Med 2012; 13:1086-93. [DOI: 10.1016/j.sleep.2012.06.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/01/2012] [Accepted: 06/05/2012] [Indexed: 01/13/2023]
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Comorbidities of Central Nervous System Hypersomnia. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bayard S, Croisier Langenier M, Cochen De Cock V, Scholz S, Dauvilliers Y. Executive control of attention in narcolepsy. PLoS One 2012; 7:e33525. [PMID: 22558075 PMCID: PMC3338809 DOI: 10.1371/journal.pone.0033525] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 02/15/2012] [Indexed: 12/02/2022] Open
Abstract
Background Narcolepsy with cataplexy (NC) is a disabling sleep disorder characterized by early loss of hypocretin neurons that project to areas involved in the attention network. We characterized the executive control of attention in drug-free patients with NC to determine whether the executive deficits observed in patients with NC are specific to the disease itself or whether they reflect performance changes due to the severity of excessive daytime sleepiness. Methodology Twenty-two patients with NC compared to 22 patients with narcolepsy without cataplexy (NwC) matched for age, gender, intellectual level, objective daytime sleepiness and number of sleep onset REM periods (SOREMPs) were studied. Thirty-two matched healthy controls were included. All participants underwent a standardized interview, completed questionnaires, and neuropsychological tests. All patients underwent a polysomnography followed by multiple sleep latency tests (MSLT), with neuropsychological evaluation performed the same day between MSLT sessions. Principal Findings Irrespective of diagnosis, patients reported higher self-reported attentional complaints associated with the intensity of depressive symptoms. Patients with NC performed slower and more variably on simple reaction time tasks than patients with NwC, who did not differ from controls. Patients with NC and NwC generally performed slower, reacted more variably, and made more errors than controls on executive functioning tests. Individual profile analyses showed a clear heterogeneity of the severity of executive deficit. This severity was related to objective sleepiness, higher number of SOREMPs on the MSLT, and lower intelligence quotient. The nature and severity of the executive deficits were unrelated to NC and NwC diagnosis. Conclusions We demonstrated that drug-free patients with NC and NwC complained of attention deficit, with altered executive control of attention being explained by the severity of objective sleepiness and global intellectual level. Further studies are needed to explore whether medications that promote wakefulness can improve the executive functions in narcolepsy.
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Affiliation(s)
- Sophie Bayard
- National Reference Network for Narcolepsy, Department of Neurology, Hôpital Gui-de-Chauliac, CHU Montpellier, Montpellier, France.
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Health-related quality of life in Portuguese patients with narcolepsy. Sleep Med 2012; 13:273-7. [DOI: 10.1016/j.sleep.2011.06.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/02/2011] [Accepted: 06/17/2011] [Indexed: 11/17/2022]
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Ozaki A, Inoue Y, Hayashida K, Nakajima T, Honda M, Usui A, Komada Y, Kobayashi M, Takahashi K. Quality of life in patients with narcolepsy with cataplexy, narcolepsy without cataplexy, and idiopathic hypersomnia without long sleep time: Comparison between patients on psychostimulants, drug-naïve patients and the general Japanese population. Sleep Med 2012; 13:200-6. [DOI: 10.1016/j.sleep.2011.07.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/27/2011] [Accepted: 07/29/2011] [Indexed: 10/14/2022]
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Abstract
The present prospective study assesses depressive symptoms in narcoleptic patients with (NC+) and without (NC-) cataplexy (46 women, 40 men) and age- and sex- matched healthy controls. Seventy patients were under treatment with stimulants and/or anticataplectics. All subjects completed the Beck Depression Inventory (BDI), the Zung Self-Rating Depression Scale (SDS), the Global Impression of Severity of Depression (GSD), the Profile of Mood States (POMS) and Epworth Sleepiness Scale. Patients with narcolepsy were more depressed than controls (higher scores in BDI, GSD, SDS, and POMS [in the total score and in all subscale scores]); however, between the NC+ and NC- patient groups, no differences were found. Our study shows that the women and the patients using antidepressants and stimulants (combination) have a higher probability for depressive symptoms independent of the presence of cataplexy. The lack of difference between NC+ and NC- in the level of depression supports the assumption that the major psychosocial burden in narcolepsy is not necessarily associated with the presence of cataplexy.
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Abstract
Narcolepsy is a lifelong sleep disorder characterized by a classic tetrad of excessive daytime sleepiness with irresistible sleep attacks, cataplexy (sudden bilateral loss of muscle tone), hypnagogic hallucination, and sleep paralysis. There are two distinct groups of patients, ie, those having narcolepsy with cataplexy and those having narcolepsy without cataplexy. Narcolepsy affects 0.05% of the population. It has a negative effect on the quality of life of its sufferers and can restrict them from certain careers and activities. There have been advances in the understanding of the pathogenesis of narcolepsy. It is thought that narcolepsy with cataplexy is secondary to loss of hypothalamic hypocretin neurons in those genetically predisposed to the disorder by possession of human leukocyte antigen DQB1*0602. The diagnostic criteria for narcolepsy are based on symptoms, laboratory sleep tests, and serum levels of hypocretin. There is no cure for narcolepsy, and the present mainstay of treatment is pharmacological treatment along with lifestyle changes. Some novel treatments are also being developed and tried. This article critically appraises the evidence for diagnosis and treatment of narcolepsy.
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Vignatelli L, Plazzi G, Peschechera F, Delaj L, D'Alessandro R. A 5-year prospective cohort study on health-related quality of life in patients with narcolepsy. Sleep Med 2010; 12:19-23. [PMID: 20851047 DOI: 10.1016/j.sleep.2010.07.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/19/2010] [Accepted: 07/21/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the 5-year variation of health-related quality of life (HRQoL) and mood symptoms in a cohort of patients with narcolepsy. METHODS Adults attending the Sleep Centre of the Department of Neurological Sciences, University of Bologna in 1997 and meeting the International Classification of Sleep Disorders-Revised criteria for the diagnosis of narcolepsy were eligible. Included patients self-administered the Medical Outcome Short Form-36 (SF-36) and the Zung depression scale (ZDS) prospectively in 1998 and 2003. RESULTS There was no significant difference between 1998 and 2003 measures of SF-36 and ZDS in the 54 patients included. About 25% of them showed moderate or severe mood symptoms in both observations. ZDS score (inversely) and duration of disease (directly) explained a percentage of variance of role physical, vitality (VT), social functioning (SF) and role emotional. At the second observation VT and SF had a further percentage of variance explained by excessive daytime sleepiness (EDS) and age at onset. Self-reported diabetes frequency doubled after 5 years (from 7% to 17%). CONCLUSIONS Patients with narcolepsy show a stable impairment of HRQoL in a 5-year period with respect to Italian normative data. Mood status and EDS negatively influence their HRQoL while disease duration has a positive influence.
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Affiliation(s)
- Luca Vignatelli
- Ambulatorio di Neurologia, Polo Sanitario Barberini di Crevalcore, AUSL di Bologna, Bologna, Italy.
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Abstract
OBJECTIVES In the absence of socio-economical consequences of hypersomnia this study addresses the factual indirect and direct costs. METHODS Two thousand two hundred and eight patients with a hypersomnia diagnosis from 1998 to 2005 were identified in the Danish national patient registry (NPR), each compared with 4 age and gender adjusted, randomly chosen citizens selected from the Civil Registration System Statistics. The health cost was decomposed in direct and indirect yearly costs, including labor supply and social transfer payments. Direct costs included frequencies and costs of discharges and outpatient use by cost weights according to diagnosis related groups and specific outpatient prices based on data from The Danish Ministry of Health. The use of and costs of drugs was based on data from the Danish Medicines Agency. The frequencies and costs from primary sectors were based on data from The National Health Security. Indirect costs were based on income data from the coherent social statistics (CSS). RESULTS Patients with hypersomnia presented significant higher health related contact rate, expenses and medication use. No differences were identified in employment and income. The yearly sum of direct and indirect costs were yearly euro3402 vs. euro1212 in controls (P < 0.001), corresponding to a yearly excess costs euro2190. The patients presented higher transfer income, total euro889. CONCLUSION Hypersomnia patient present higher health and medication uses, and social transfer income and thus represent a significant socio-economical burden.
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Fortuyn HAD, Lappenschaar MA, Furer JW, Hodiamont PP, Rijnders CAT, Renier WO, Buitelaar JK, Overeem S. Anxiety and mood disorders in narcolepsy: a case-control study. Gen Hosp Psychiatry 2010; 32:49-56. [PMID: 20114128 DOI: 10.1016/j.genhosppsych.2009.08.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 08/21/2009] [Accepted: 08/31/2009] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Narcolepsy is a primary sleeping disorder with excessive daytime sleepiness and cataplexy as core symptoms. There is increasing interest in the psychiatric phenotype of narcolepsy. Although many authors suggest an overrepresentation of mood disorders, few systematic studies have been performed and conflicting results have been reported. Anxiety disorders in narcolepsy have only received little attention. METHODS We performed a case-control study in 60 narcolepsy patients and 120 age- and sex-matched controls from a previous population study. The Schedules for Clinical Assessment in Neuropsychiatry were used to assess symptoms and diagnostic classifications of mood and anxiety disorders. RESULTS Symptoms of mood disorders were reported by about one third of patients. However, the prevalence of formal mood disorder diagnoses - including major depression - was not increased. In contrast, more than half of the narcolepsy patients had anxiety or panic attacks. Thirty-five percent of the patients could be diagnosed with anxiety disorder (odds ratio=15.6), with social phobia being the most important diagnosis. There was no influence of age, sex, duration of illness or medication use on the prevalence of mood or anxiety symptoms and disorders. DISCUSSION Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Although symptoms of mood disorders are present in many patients, the prevalence of major depression is not increased. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling. As hypocretin neurotransmission is also involved in stress regulation and addiction, this raises the possibility that mood and anxiety symptoms are primary disease phenomena in narcolepsy.
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Affiliation(s)
- H A Droogleever Fortuyn
- Department of Psychiatry, Nijmegen Centre for Evidence-Based Practice, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Heier MS, Evsiukova T, Wilson J, Abdelnoor M, Hublin C, Ervik S. Prevalence of narcolepsy with cataplexy in Norway. Acta Neurol Scand 2009; 120:276-80. [PMID: 19456307 DOI: 10.1111/j.1600-0404.2009.01166.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Narcolepsy is a lifelong disabling disorder that may be alleviated by relevant treatment. Patients frequently report 10-15 years from the first symptoms to the time they get the diagnosis and treatment can be started. In order to offer a sufficient diagnostic and therapeutic service to this patient group, a reliable estimation of the prevalence of the disorder is important. A study of the prevalence of narcolepsy with cataplexy in Norway was therefore undertaken. MATERIALS AND METHODS The Ullanlinna Narcolepsy scale (UNS) was sent to 14548 randomly selected Norwegians between 20 and 60 years. Additionally, the study included telephone interviews and clinical evaluation of responders with >or=14 points on the UNS, and in those with suspected narcolepsy, polygraphic sleep recordings and human leucocyte antigen (HLA)-typing. RESULTS A total of 8992 responders answered the questionnaire (response rate 61.8%), 267 had >or=14 points on the UNS, 156 were interviewed and 15 had sleep recordings. In two HLADQB1*0602-positive patients sleep recordings were compatible with narcolepsy. CONCLUSIONS The results indicate a prevalence of 0.022% and approximately 1000 patients with narcolepsy with cataplexy in Norway.
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Affiliation(s)
- M S Heier
- Norwegian Resource Center for AD/HD, Tourettes Syndrome and Narcolepsy, Ullevål University Hospital, Oslo, Norway.
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Mamelak M. Narcolepsy and depression and the neurobiology of gammahydroxybutyrate. Prog Neurobiol 2009; 89:193-219. [PMID: 19654034 DOI: 10.1016/j.pneurobio.2009.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/24/2009] [Accepted: 07/28/2009] [Indexed: 12/23/2022]
Abstract
A voluminous literature describes the relationship between disturbed sleep and depression. The breakdown of sleep is one of the cardinal features of depression and often also heralds its onset. Frequent arousals, periods of wakefulness and a short sleep onset REM latency are typical polysomnographic features of depression. The short latency to REM sleep has been attributed to the combination of a monoaminergic deficiency and cholinergic supersensitivity and these irregularities have been proposed to form the biological basis of the disorder. A similar imbalance between monoaminergic and cholinergic neurotransmission has been found in narcolepsy, a condition in which frequent awakenings, periods of wakefulness and short sleep onset REM latencies are also characteristic findings during sleep. In many cases of narcolepsy, this imbalance appears to result from a deficiency of hypocretin but once established, whether in depression or narcolepsy, this disequilibrium sets the stage for the dissociation or premature appearance of REM sleep and for the dissociation of the motor inhibitory component of REM sleep or cataplexy. In the presence of this monoaminergic/cholinergic imbalance, gammahydroxybutyrate (GHB) may acutely further reduce the latency of REM sleep and induce cataplexy, in both patients with narcolepsy or depression. On the other hand, the repeated nocturnal application of GHB in patients with narcolepsy improves the continuity of sleep, prolongs the latency to REM sleep and prevents cataplexy. Evidence to date suggests that GHB may restore the normal balance between monoaminergic and cholinergic neurotransmission. As such, the repeated use of GHB at night and the stabilization of sleep over time makes GHB an effective treatment for narcolepsy and a potentially effective treatment for depression.
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Affiliation(s)
- Mortimer Mamelak
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Phillips BA, Collop NA, Drake C, Consens F, Vgontzas AN, Weaver TE. Sleep disorders and medical conditions in women. Proceedings of the Women & Sleep Workshop, National Sleep Foundation, Washington, DC, March 5-6, 2007. J Womens Health (Larchmt) 2009; 17:1191-9. [PMID: 18710367 DOI: 10.1089/jwh.2007.0561] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sleep disorders affect women differently than they affect men and may have different manifestations and prevalences. With regard to obstructive sleep apnea (OSA), variations in symptoms may cause misdiagnoses and delay of appropriate treatment. The prevalence of OSA appears to increase markedly after the time of menopause. Although OSA as defined by the numbers of apneas/hypopneas may be less severe in women, its consequences are similar and perhaps worse. Therapeutic issues related to gender should be factored into the management of OSA. The prevalence of insomnia is significantly greater in women than in men throughout most of the life span. The ratio of insomnia in women to men is approximately 1.4:1.0, but the difference is minimal before puberty and increases steadily with age. Although much of the higher prevalence of insomnia in women may be attributable to the hormonal or psychological changes associated with major life transitions, some of the gender differences may result from the higher prevalence of depression and pain in women. Insomnia's negative impact on quality of life is important to address in women, given the high relative prevalence of insomnia as well as the comorbid disorders in this population. Gender differences in etiology and symptom manifestation in narcolepsy remain understudied in humans. There is little available scientific information to evaluate the clinical significance and specific consequences of the diagnosis of narcolepsy in women. Restless legs syndrome (RLS) is characterized by an urge to move the legs or other limbs during periods of rest or inactivity and may affect as much as 10% of the population. This condition is more likely to afflict women than men, and its risk is increased by pregnancy. Although RLS is associated with impaired quality of life, highly effective treatment is available.
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Affiliation(s)
- Barbara A Phillips
- Division of Pulmonary, Critical Care and Sleep Medicine, Division of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0298, USA.
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Kim SJ, Lyoo IK, Lee YS, Lee JY, Yoon SJ, Kim JE, Kim JH, Hong SJ, Jeong DU. Gray matter deficits in young adults with narcolepsy. Acta Neurol Scand 2009; 119:61-7. [PMID: 18624787 DOI: 10.1111/j.1600-0404.2008.01063.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to investigate gray matter volume changes in narcolepsy. MATERIALS AND METHODS An optimized voxel-based morphometry was conducted for 17 young adults with a sole diagnosis of human leukocyte antigen DQB(1) 0602 positive narcolepsy with cataplexy (26.6 +/- 5.2 years old) and 17 comparison subjects (24.6 +/- 4.9 years old) using 3 Tesla scanner. Gray matter volumes in the bilateral hypothalamic voxel of interests (VOI) were also calculated. RESULTS Compared with the comparison subjects, narcoleptic patients had gray matter volume decrease in the right hypothalamus and other regions including subcortical, prefrontal, limbic and occipital areas. Narcoleptic patients also had lower gray matter volume on predefined VOI at the bilateral hypothalamus, which correlated with the Ullanlinna Narcolepsy Scale score. CONCLUSIONS Current findings suggest that narcoleptic patients have structural abnormalities in hypothalamus, which might be related to the clinical manifestation of narcolepsy with cataplexy.
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Affiliation(s)
- S J Kim
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, South Korea
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Rovere H, Rossini S, Reimão R. Quality of life in patients with narcolepsy: a WHOQOL-bref study. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:163-7. [PMID: 18545775 DOI: 10.1590/s0004-282x2008000200004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 03/05/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the perception of Quality of Life (QL) in Brazilian patients with narcolepsy. METHOD 40 adult patients aged between 20 and 72 years (mean=41.55; SD=14.50); (28 F; 12M), with the diagnosis of chronic narcolepsy were followed up at the outpatient clinic (Patient Group). The Control Group was composed of 40 adults. The instrument utilized was the World Health Organization Quality of Life (WHOQOL-BREF). RESULTS The two groups were homogeneous and no difference was found with regards to age, sex, and demographic characteristics. The perception of QL in physical, psychological and social domains showed lower scores in those patients with narcolepsy than in the control group (p<0.05). Concerning physical domain, all the aspects evaluated were significantly impaired, in patient group, including sleep satisfaction (p<0.001); energy for daily activities (p=0.039); capacity to perform activities (p=0.001); and capacity to work (p=0.001). CONCLUSION The perception of QL showed severe impairment in patients with narcolepsy for physical, psychological and social domains.
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Affiliation(s)
- Heloísa Rovere
- Division of Clinical Neurology, Hospital das Clinicas, Medical School, University of Sao Paulo, Sao Paulo, SP, Brazil
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Dorris L, Zuberi SM, Scott N, Moffat C, McArthur I. Psychosocial and intellectual functioning in childhood narcolepsy. Dev Neurorehabil 2008; 11:187-94. [PMID: 18608355 DOI: 10.1080/17518420802011493] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study reports the psychological assessment of 12 children referred to a narcolepsy clinic, using quantitative methods to describe intellectual and psychosocial functioning in childhood narcolepsy. METHODS The participants were six males and six females aged between 7-16 years (median age 10 years). The protocol included a clinical interview; the Wechsler Intelligence Scale for Children-III-UK; and the Parent version of the Achenbach Child Behaviour Checklist (CBCL). RESULTS Eleven children obtained an IQ in the average range (mean and median =100). However, a significant difference was found between verbal and performance scales in 42% of children, compared to WISC-III normative prevalence rates of 24%. CBCL results revealed that 10/12 children scored in the clinically significant range on the Total Score Index, with 9/12 obtaining scores in the significant range on the Internalizing Index. The majority of children presented with difficulties in discussing and describing distressing physical and psychological symptoms with parents and others. CONCLUSIONS These findings suggest that the psychosocial impact of narcolepsy extends beyond the effects of excessive sleepiness and that symptoms such as hallucinations can lead to significant psychological morbidity.
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Affiliation(s)
- Liam Dorris
- Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Glasgow, UK.
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Abstract
BACKGROUND Narcolepsy is a disorder of the central nervous system, the main symptoms of which are excessive daytime sleepiness (EDS) and cataplexy (an abrupt and reversible decrease in or loss of muscle tone, affecting the limbs or trunk or both, elicited by emotional stimuli). Narcolepsy has an adverse impact on people's quality of life. Together with stimulant drugs (used to control EDS), antidepressants are usually recommended to counteract cataplexy. In addition, some antidepressants are also reported to improve EDS. OBJECTIVES To evaluate the effects of antidepressant drugs on EDS, cataplexy, quality of life, and their side effects in people with narcolepsy. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2007), MEDLINE (1966 to 2007), EMBASE (1980 to 2007), PsycINFO (1872 to 2007), and CINAHL (1981 to 2007). Bibliographies of identified articles were reviewed to find additional references. Unpublished randomised trials were searched for by consulting governmental and non-governmental clinical trial registers, disease-specific websites, investigators and experts in the field, pharmaceutical companies/manufacturers. SELECTION CRITERIA Parallel or cross-over randomised or quasi-randomised controlled trials testing the treatment of narcolepsy with any type of antidepressant drug versus no treatment, placebo, or another antidepressant drug. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS Three cross-over and two parallel trials were included with a total of 246 participants. The methodological quality of all studies was unclear. As the trials tested different comparisons, or had a different design or dealt with different outcome measures, meta-analysis was not performed. In one cross-over trial (10 participants) femoxetine had no significant effect in eliminating or reducing EDS but significantly reduced cataplexy. Mild and transient side effects were reported in the femoxetine treatment period by two participants. In a second cross-over trial (56 participants) viloxazine significantly reduced EDS and cataplexy. In a third cross-over trial the authors inappropriately treated the trial design as a parallel study and no conclusions can be reached in favour of either drug. Two more trials with parallel design tested ritanserin versus placebo without finding differences of effectiveness in reducing EDS or cataplexy. AUTHORS' CONCLUSIONS There was no good quality evidence that antidepressants are effective for narcolepsy or improve quality of life. Despite the clinical consensus recommending antidepressants for cataplexy there is scarce evidence that antidepressants have a positive effect on this symptom. There is a clear need for well-designed randomised controlled trials to assess the effect of antidepressants on narcolepsy.
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Affiliation(s)
- L Vignatelli
- AUSL di Modena, Centro per la Valutazione della Efficacia della Assistenza Sanitaria (CeVEAS), Viale Muratori 201, Modena, Italy, 41100.
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Abstract
(1) Narcolepsy is a rare disorder of unknown aetiology characterized by excessive daytime sleepiness and typically associated with cataplexy. It is extremely incapacitating, and frequently results in impaired psychosocial functioning and reduced work performance. Currently there is no cure for narcolepsy, so treatment focuses on control of symptoms.(2) Although the sympathomimetic stimulants, such as amphetamines or methylphenidate, are effective in improving excessive daytime sleepiness in patients with narcolepsy, they have the potential for dependence, have sometimes disabling sympathomimetic side-effects and are associated with tolerance.(3) To date, there is clear evidence of the efficacy of modafinil, armodafinil and sodium oxybate in patients with narcolepsy. Modafinil and armodafinil improve excessive daytime sleepiness symptoms and have little abuse potential, but have no effect on cataplexy, so other drugs, such as antidepressants, are required to control cataplexy attacks.(4) Sodium oxybate improves both excessive daytime sleepiness and cataplexy. However, there is potential for abuse and possibly dependence.
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