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Šonka K, Feketeová E, Nevšímalová S, Horvat EM, Příhodová I, Dostálová S, Galušková K, Milata M, Bušková J, Susta M. Idiopathic hypersomnia years after the diagnosis. J Sleep Res 2024; 33:e14011. [PMID: 37572055 DOI: 10.1111/jsr.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
Little attention has been paid to the long-term development of idiopathic hypersomnia symptoms and idiopathic hypersomnia comorbidities. The aim of this study was to describe the general health of patients with idiopathic hypersomnia years after the initial diagnosis, focusing on current subjective hypersomnolence and the presence of its other possible causes. Adult patients diagnosed with idiopathic hypersomnia ≥ 3 years ago at sleep centres in Prague and Kosice were invited to participate in this study. A total of 60 patients were examined (age 47.3 ± SD = 13.2 years, 66.7% women). In all participants, their hypersomnolence could not be explained by any other cause but idiopathic hypersomnia at the time of diagnosis. The mean duration of follow-up was 9.8 + 8.0 years. Fifty patients (83%) reported persisting hypersomnolence, but only 33 (55%) had no other disease that could also explain the patient's excessive daytime sleepiness and/or prolonged sleep. In two patients (3%), the diagnosis in the meantime had changed to narcolepsy type 2, and 15 patients (25%) had developed a disease or diseases potentially causing hypersomnolence since the initial diagnosis. Complete hypersomnolence resolution without stimulant treatment lasting longer than 6 months was reported by 10 patients (17%). To conclude, in a longer interval from the diagnosis of idiopathic hypersomnia, hypersomnolence may disappear or may theoretically be explained by another newly developed disease, or the diagnosis may be changed to narcolepsy type 2. Thus, after 9.8 years, only 55% of the examined patients with idiopathic hypersomnia had a typical clinical picture of idiopathic hypersomnia without doubts about the cause of the current hypersomnolence.
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Affiliation(s)
- Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Feketeová
- Department of Neurology, Faculty of Medicine, University of P.J. Šafárik and University Hospital of L. Pasteur, Košice, Slovak Republic
| | - Soňa Nevšímalová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eszter Maurovich Horvat
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Iva Příhodová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostálová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolína Galušková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Milata
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jitka Bušková
- National Institute of Mental Health, Klecany and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Susta
- St. Elisabeth University, Bratislava, Slovak Republic
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Roth T, Dauvilliers Y, Bogan RK, Plazzi G, Black J. Effects of oxybate dose and regimen on disrupted nighttime sleep and sleep architecture. Sleep Med 2024; 114:255-265. [PMID: 38244463 DOI: 10.1016/j.sleep.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
Many components of sleep are disrupted in patients with narcolepsy, including sleep quality, sleep architecture, and sleep stability (ie, frequent awakenings/arousals and frequent shifts from deeper to lighter stages of sleep). Sodium oxybate, dosed twice nightly, has historically been used to improve sleep, and subsequent daytime symptoms, in patients with narcolepsy. Recently, new formulations have been developed to address the high sodium content and twice-nightly dosing regimen of sodium oxybate: low-sodium oxybate and once-nightly sodium oxybate. To date, no head-to-head trials have been conducted to compare the effects of each oxybate product. This review aims to give an overview of the existing scientific literature regarding the impact of oxybate dose and regimen on sleep architecture and disrupted nighttime sleep in patients with narcolepsy. Evidence from 5 key clinical trials, as well as supporting evidence from additional studies, suggests that sodium oxybate, dosed once- and twice-nightly, is effective in improving sleep, measures of sleep architecture, and disrupted nighttime sleep in patients with narcolepsy. Direct comparison of available efficacy and safety data between oxybate products is complicated by differences in trial designs, outcomes assessed, and statistical analyses; future head-to-head trials are needed to better understand the advantage and disadvantages of each agent.
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Affiliation(s)
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France; University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France
| | - Richard K Bogan
- Medical University of South Carolina, Charleston, SC, USA; Bogan Sleep Consultants, LLC, Columbia, SC, USA
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Jed Black
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA, USA; Jazz Pharmaceuticals, Palo Alto, CA, USA
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Schneider LD, Morse AM, Strunc MJ, Lee-Iannotti JK, Bogan RK. Long-Term Treatment of Narcolepsy and Idiopathic Hypersomnia with Low-Sodium Oxybate. Nat Sci Sleep 2023; 15:663-675. [PMID: 37621721 PMCID: PMC10445641 DOI: 10.2147/nss.s412793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Narcolepsy and idiopathic hypersomnia are chronic conditions that negatively affect alertness, mental and physical energy, functioning, and quality of life (QoL). Calcium, magnesium, potassium, and sodium oxybates (low-sodium oxybate; LXB) is an oxybate formulation with 92% less sodium than sodium oxybate (SXB; a treatment for narcolepsy) and the same active moiety. LXB is approved in the US for treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age or older with narcolepsy, and idiopathic hypersomnia in adults. In Phase 3 clinical trials, LXB exhibited a safety profile consistent with that of SXB in narcolepsy. Besides continued efficacy in treating symptoms, potential benefits of long-term LXB treatment include flexible optimization of dosing and regimen, improvement of QoL and functioning, weight loss, and (relative to SXB in narcolepsy) health benefits of reduced sodium content. Dosing of LXB is twice nightly (for narcolepsy) or once or twice nightly (for idiopathic hypersomnia) based on patient characteristics and response, and individualized titration can be leveraged over the long term as a patient's life circumstances change. Patients with narcolepsy transitioning from SXB initiate LXB at the same dose, and most patients require no further changes to achieve similar efficacy and tolerability. Improvements in functioning and QoL with LXB treatment could have cascading positive effects in multiple domains, particularly in younger patients. In clinical trials, LXB was associated with weight loss in both narcolepsy (in which obesity is a well-established comorbidity) and idiopathic hypersomnia, only occasionally leading participants to be underweight. As both narcolepsy and idiopathic hypersomnia are associated with increased risk of cardiometabolic and cardiovascular comorbidities, limiting medication-related sodium intake with LXB may have significant health benefits, although this has not yet been verified prospectively due to the prolonged follow-up required. LXB is a promising long-term treatment for narcolepsy and idiopathic hypersomnia.
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Affiliation(s)
- Logan D Schneider
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anne Marie Morse
- Janet Weis Children’s Hospital, Geisinger Medical Center, Danville, PA, USA
| | - Michael J Strunc
- The Center for Pediatric Sleep Medicine, Children’s Hospital of The King’s Daughters, Norfolk, VA, USA
| | - Joyce K Lee-Iannotti
- Department of Neurology, The University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Richard K Bogan
- Department of Pulmonology, University of South Carolina School of Medicine, Columbia, SC, USA
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Blattner M, Maski K. Narcolepsy and Idiopathic Hypersomnia. Sleep Med Clin 2023; 18:183-199. [PMID: 37120161 DOI: 10.1016/j.jsmc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Narcolepsy types 1 and 2 and idiopathic hypersomnia are primary Central Nervous System (CNS) disorders of hypersomnolence characterized by profound daytime sleepiness and/or excessive sleep need. Onset of symptoms begins typically in childhood or adolescence, and children can have unique presentations compared with adults. Narcolepsy type 1 is likely caused by immune-mediated loss of orexin (hypocretin) neurons in the hypothalamus; however, the causes of narcolepsy type 2 and idiopathic hypersomnia are unknown. Existing treatments improve daytime sleepiness and cataplexy but there is no cure for these disorders.
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Affiliation(s)
- Margaret Blattner
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Kiran Maski
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, BCH3443, Boston, MA 02115, USA.
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Miglis MG. Autonomic Dysfunction in the Central Nervous System Hypersomnias. CURRENT SLEEP MEDICINE REPORTS 2023. [DOI: 10.1007/s40675-023-00247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Bušková J, Novák T, Miletínová E, Králová R, Košt′álová J, Kliková M, Veldová K. Self-reported symptoms and objective measures in idiopathic hypersomnia and hypersomnia associated with psychiatric disorders: a prospective cross-sectional study. J Clin Sleep Med 2022; 18:713-720. [PMID: 34605393 PMCID: PMC8883091 DOI: 10.5664/jcsm.9702] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES In some patients, it is difficult to correctly nosologically classify daytime sleepiness. Clinical manifestations may be nonspecific; on the basis of objective measures it is possible to determine the current severity of sleepiness, but they do not always allow accurate diagnosis. It is especially difficult to distinguish between idiopathic hypersomnia (IH) and hypersomnia associated with a psychiatric disorder (PSY). METHODS To find significant differences between the IH and PSY groups, we included 67 patients (IH, n = 15; PSY, n = 52) in the study, focusing on differences in self-reported symptoms, evaluating current depressive symptoms using the Beck Depression Inventory-II score and personality traits measured by the Temperament and Character Inventory. All of the patients underwent polysomnography, the Multiple Sleep Latency Test, and ad libitum sleep monitoring. RESULTS The patients with IH showed greater difficulty than those in the PSY group with waking up in the morning (P < .001) and complained of memory (P = .04) and attention deficit (P = .006). They also showed higher total sleep time (P < .001) and sleep efficiency (P = .007) and a shorter mean sleep latency on the Multiple Sleep Latency Test (P < .001). Nevertheless, the IH and PSY groups did not differ in Beck Depression Inventory scores or personality characteristics. CONCLUSIONS IH is a syndrome in which depression/external life stressors and personality characteristics also play a role. Patients with IH may benefit from the cooperation of sleep specialists with psychotherapists/psychiatrists. CITATION Bušková J, Novák T, Miletínová E, et al. Self-reported symptoms and objective measures in idiopathic hypersomnia and hypersomnia associated with psychiatric disorders: a prospective cross-sectional study. J Clin Sleep Med. 2022;18(3):713-720.
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Affiliation(s)
- Jitka Bušková
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic,Address correspondence to: Jitka Bušková, MD, PhD, Department of Sleep Medicine, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic;
| | - Tomáš Novák
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva Miletínová
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radana Králová
- National Institute of Mental Health, Klecany, Czech Republic
| | - Jana Košt′álová
- National Institute of Mental Health, Klecany, Czech Republic
| | - Monika Kliková
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolina Veldová
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med 2022; 18:289-304. [PMID: 34463249 PMCID: PMC8807887 DOI: 10.5664/jcsm.9638] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES This review aimed to summarize current knowledge about disrupted nighttime sleep (DNS) and sleep instability in narcolepsy, including self-reported and objective assessments, potential causes of sleep instability, health consequences and functional burden, and management. METHODS One hundred two peer-reviewed publications from a PubMed search were included. RESULTS DNS is a key symptom of narcolepsy but has received less attention than excessive daytime sleepiness and cataplexy. There has been a lack of clarity regarding the definition of DNS, as many sleep-related symptoms and conditions disrupt sleep quality in narcolepsy (eg, hallucinations, sleep paralysis, rapid eye movement sleep behavior disorder, nightmares, restless legs syndrome/periodic leg movements, nocturnal eating, sleep apnea, depression, anxiety). In addition, the intrinsic sleep instability of narcolepsy results in frequent spontaneous wakings and sleep stage transitions, contributing to DNS. Sleep instability likely emerges in the setting of orexin insufficiency/deficiency, but its exact pathophysiology remains unknown. DNS impairs quality of life among people with narcolepsy, and more research is needed to determine its contributions to cardiovascular risk. Multimodal treatment is appropriate for DNS management, including behavioral therapies, counseling on sleep hygiene, and/or medication. There is strong evidence showing improvement in self-reported sleep quality and objective sleep stability measures with sodium oxybate, but rigorous clinical trials with other pharmacotherapies are needed. Treatment may be complicated by comorbidities, concomitant medications, and mood disorders. CONCLUSIONS DNS is a common symptom of narcolepsy deserving consideration in clinical care and future research. CITATION Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med. 2022;18(1):289-304.
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Affiliation(s)
- Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts,Address correspondence to: Kiran Maski, MD, MPH, Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02130; Phone: +01 857-218-5536; Fax: +01 617-730-0282;
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Redwood City, California
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy,IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France,University of Montpellier, INSERM Institute for Neurosciences Montpellier, Montpellier, France
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Abstract
PURPOSE OF REVIEW This article discusses the central disorders of hypersomnolence, a group of disorders resulting in pathologic daytime sleepiness, particularly narcolepsy type 1 and narcolepsy type 2, idiopathic hypersomnia, and Kleine-Levin syndrome. Disease features, diagnostic testing, epidemiology, pathophysiology, and treatment are reviewed. RECENT FINDINGS Increasing evidence implicates autoimmunity in narcolepsy type 1, including a strong association with human leukocyte antigen-DQB1*06:02, association with a polymorphism in the T-cell receptor alpha locus in genome-wide association, and the identification of autoreactive T cells in patients with this type of narcolepsy. In contrast, the cause or causes of narcolepsy type 2 and idiopathic hypersomnia are unknown. Multiple treatment options exist, including two medications approved for the treatment of narcolepsy by the US Food and Drug Administration (FDA) in 2019. These include solriamfetol, a dopamine- and norepinephrine-reuptake inhibitor, and pitolisant, an H3-inverse agonist/antagonist that increases histaminergic neurotransmission. SUMMARY The central disorders of hypersomnolence all cause severe sleepiness but can be differentiated based on ancillary symptoms, diagnostic testing, and pathophysiology. It is important that these disorders are identified because multiple treatments are available to improve functioning and quality of life.
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Miglis MG, Schneider L, Kim P, Cheung J, Trotti LM. Frequency and severity of autonomic symptoms in idiopathic hypersomnia. J Clin Sleep Med 2020; 16:749-756. [PMID: 32039754 DOI: 10.5664/jcsm.8344] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to quantify the symptoms of autonomic nervous system dysfunction in a large online cohort of patients with idiopathic hypersomnia, and to determine how the severity of these symptoms interacts with sleepiness, fatigue, and quality of life. METHODS One hundred thirty-eight patients with idiopathic hypersomnia and 81 age- and sex-matched controls were recruited through the website of the Hypersomnia Foundation, a US-based patient advocacy group. Twenty-four patients with confirmed idiopathic hypersomnia were selected by the study investigators as a comparison group. All participants completed a battery of online sleep, autonomic, and quality of life questionnaires including the composite autonomic symptom score-31 (COMPASS-31). RESULTS Online and confirmed patients reported significantly higher COMPASS-31 scores (median [interquartile range]) (43.6 [33.6-52.7] and 32.9 [21.7-46.8] vs 17.6 [11.7-27.9], P < .001), with the greatest symptom burden in the orthostatic and vasomotor domains. Online and confirmed patients reported more sleepiness (Epworth sleepiness scale), whereas only online patients reported more fatigue (Chalder fatigue scale). Both the Epworth sleepiness scale and Chalder fatigue scale positively correlated with COMPASS-31 scores. Patients reported lower quality of life as reflected by lower scores across all domains of the RAND 36-item health survey, which was negatively correlated with COMPASS-31 scores. CONCLUSIONS Symptoms of autonomic nervous system dysfunction are common in idiopathic hypersomnia. In addition, autonomic nervous system symptom burden was positively correlated with sleepiness and negatively correlated with quality of life.
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Affiliation(s)
- Mitchell G Miglis
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California.,Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Redwood City, California
| | - Logan Schneider
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Redwood City, California.,Stanford/VA Alzheimer's Center, VA Palo Alto Health Care System, Palo Alto, California.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, California
| | - Paul Kim
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Redwood City, California
| | - Joseph Cheung
- Division of Pulmonary and Sleep Medicine, Mayo Clinic, Jacksonville, Florida
| | - Lynn Marie Trotti
- Department of Neurology and Sleep Center, Emory School of Medicine, Atlanta, Georgia
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Kim J, Lee GH, Sung SM, Jung DS, Pak K. Prevalence of attention deficit hyperactivity disorder symptoms in narcolepsy: a systematic review. Sleep Med 2020; 65:84-88. [PMID: 31739230 DOI: 10.1016/j.sleep.2019.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Narcolepsy is characterized by excessive daytime sleepiness and cataplexy. Attention deficit hyperactivity disorder (ADHD) is characterized by hyperactivity, inattention, and impulsivity. However, despite their differences, both narcolepsy and ADHD share the symptoms of sleep disturbance and excessive daytime sleepiness. Recent studies have suggested a link between the two disorders. The objective of systematic review was to assess the prevalence of ADHD symptoms in narcolepsy. METHODS We performed a systematic search of MEDLINE (inception to December 2018) and EMBASE (inception to December 2018) for English publications of human studies using the keywords "narcolepsy" and "ADHD". RESULTS Five studies examining a total of 328 patients met the eligibility criteria for this study examining the prevalence of ADHD symptoms in narcolepsy. The pooled prevalence of ADHD symptoms in narcolepsy was 33.0%. Two studies using the international classification of sleep disorders, second edition (ICSD-2) observed a pooled prevalence of ADHD symptoms in narcolepsy of 25.0%, while two other studies that relied on the ICSD-3 criteria observed a pooled prevalence of ADHD symptoms in narcolepsy of 36.4%. CONCLUSIONS The prevalence of ADHD symptoms was >30%, making it an important comorbidity of narcolepsy. Future studies should be performed to better assess the relationship between ADHD and narcolepsy.
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Lopez R, Doukkali A, Barateau L, Evangelista E, Chenini S, Jaussent I, Dauvilliers Y. Test–Retest Reliability of the Multiple Sleep Latency Test in Central Disorders of Hypersomnolence. Sleep 2017; 40:4584523. [DOI: 10.1093/sleep/zsx164] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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13
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Idiopathic hypersomnia. Sleep Med Rev 2016; 29:23-33. [DOI: 10.1016/j.smrv.2015.08.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
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Kim T, Lee JH, Lee CS, Yoon IY. Different fates of excessive daytime sleepiness: survival analysis for remission. Acta Neurol Scand 2016; 134:35-41. [PMID: 26392230 DOI: 10.1111/ane.12504] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a symptom frequently presented in sleep clinics. Only a paucity of data has addressed clinical courses of sleep disorders with EDS. Therefore, we sought to compare clinical outcomes of patients presenting EDS. METHODS A retrospective observational study was performed in the setting of sleep laboratory and outpatient department in a university hospital. One hundred and eight patients who presented EDS underwent polysomnography and multiple sleep latency test. Each patient was diagnosed as one of the following four categories: (1) narcolepsy with cataplexy (N + C; n = 29); (2) narcolepsy without cataplexy (N - C; n = 22); (3) idiopathic hypersomnia (IH; n = 24); and (4) subjective hypersomnolence (SH; n = 33) with mean sleep latency >8 min. Remission of EDS and treatment response were determined based on clinical evaluation. Kaplan-Meier survival analysis was performed. RESULTS Remission rates were significantly different (P < 0.001, overall log-rank test) among four groups except those between N - C and IH (P = 0.489). While N + C showed no remission, predicted remission rates of N - C and IH group were 44.6% at 5 years and 32.5% at 5.5 years after diagnosis. The predicted remission rate of SH group was 71.7% at 3 years after diagnosis. CONCLUSIONS The similarity of clinical courses between N - C and IH suggests that N - C may be more related to IH compared to N + C. Considering different clinical courses among EDS patients, thorough evaluation of EDS should be warranted before starting treatment.
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Affiliation(s)
- T. Kim
- Department of Neuropsychiatry; Seoul National University Bundang Hospital; Gyeonggi-do Korea
- Department of Psychiatry; Kyung Hee University Hospital at Gangdong; Seoul Korea
| | - J. H. Lee
- Department of Neuropsychiatry; Seoul National University Bundang Hospital; Gyeonggi-do Korea
| | - C. S. Lee
- Department of Neuropsychiatry; Seoul National University Bundang Hospital; Gyeonggi-do Korea
| | - I. Y. Yoon
- Department of Neuropsychiatry; Seoul National University Bundang Hospital; Gyeonggi-do Korea
- Department of Psychiatry; Seoul National University College of Medicine; Seoul Korea
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Sowa NA. Idiopathic Hypersomnia and Hypersomnolence Disorder: A Systematic Review of the Literature. PSYCHOSOMATICS 2016; 57:152-64. [DOI: 10.1016/j.psym.2015.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 01/26/2023]
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Khan Z, Trotti LM. Central Disorders of Hypersomnolence: Focus on the Narcolepsies and Idiopathic Hypersomnia. Chest 2015; 148:262-273. [PMID: 26149554 DOI: 10.1378/chest.14-1304] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The central disorders of hypersomnolence are characterized by severe daytime sleepiness, which is present despite normal quality and timing of nocturnal sleep. Recent reclassification distinguishes three main subtypes: narcolepsy type 1, narcolepsy type 2, and idiopathic hypersomnia (IH), which are the focus of this review. Narcolepsy type 1 results from loss of hypothalamic hypocretin neurons, while the pathophysiology underlying narcolepsy type 2 and IH remains to be fully elucidated. Treatment of all three disorders focuses on the management of sleepiness, with additional treatment of cataplexy in those patients with narcolepsy type 1. Sleepiness can be treated with modafinil/armodafinil or sympathomimetic CNS stimulants, which have been shown to be beneficial in randomized controlled trials of narcolepsy and, quite recently, IH. In those patients with narcolepsy type 1, sodium oxybate is effective for the treatment of both sleepiness and cataplexy. Despite these treatments, there remains a subset of hypersomnolent patients with persistent sleepiness, in whom alternate therapies are needed. Emerging treatments for sleepiness include histamine H3 antagonists (eg, pitolisant) and possibly negative allosteric modulators of the gamma-aminobutyric acid-A receptor (eg, clarithromycin and flumazenil).
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Affiliation(s)
- Zeeshan Khan
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA
| | - Lynn Marie Trotti
- Emory Sleep Center, Emory University School of Medicine, Atlanta, GA.
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Sasai-Sakuma T, Inoue Y. Differences in electroencephalographic findings among categories of narcolepsy-spectrum disorders. Sleep Med 2015; 16:999-1005. [PMID: 26026626 DOI: 10.1016/j.sleep.2015.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/08/2014] [Accepted: 01/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To clarify the differences in quantitative electroencephalographic (EEG) measures and their relation to clinical symptoms among narcolepsy-spectrum disorders. METHODS The enrolled patients were: 28 with narcolepsy with cataplexy (NA-CA); 16 with NA without cataplexy (NA w/o CA) and HLA-DRB1*1501/DQB1*0602 positive (NA w/o CA HLA+); 22 with NA w/o CA and HLA negative (NA w/o CA HLA-); and 22 with idiopathic hypersomnia without long sleep time (IHS w/o LST). Nocturnal polysomnography (n-PSG) and quantitative EEG evaluation, as well as the Multiple Sleep Latency test (MSLT), were conducted for all patients. RESULTS Patients with NA-CA or NA w/o CA HLA+ showed lower alpha power, higher delta and theta power during wakefulness, and higher alpha and beta power during rapid eye movement (REM) sleep, compared to those with NA w/o CA HLA- or IHS w/o LST. The former two groups also showed lower sleep efficiency and a higher rate of positivity of REM-related symptoms than the other two groups. CONCLUSIONS In narcolepsy, the presence of cataplexy and HLA positivity are associated with EEG slowing during wakefulness and increased fast EEG activity during REM sleep, REM-related symptoms and disrupted nocturnal sleep in narcolepsy.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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Narcolepsy with and without cataplexy, idiopathic hypersomnia with and without long sleep time: a cluster analysis. Sleep Med 2015; 16:225-31. [DOI: 10.1016/j.sleep.2014.09.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/26/2014] [Accepted: 09/09/2014] [Indexed: 11/22/2022]
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Idiopathic Hypersomnia. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Roth T, Dauvilliers Y, Mignot E, Montplaisir J, Paul J, Swick T, Zee P. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med 2013; 9:955-65. [PMID: 23997709 PMCID: PMC3746724 DOI: 10.5664/jcsm.3004] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVES Characterize disrupted nighttime sleep (DNS) in narcolepsy, an important symptom of narcolepsy. METHODS A panel of international narcolepsy experts was convened in 2011 to build a consensus characterization of DNS in patients with narcolepsy. A literature search of the Medline (1965 to date), Medline In-Process (latest weeks), Embase (1974 to date), Embase Alert (latest 8 weeks), and Biosis (1965 to date) databases was conducted using the following search terms: narcolepsy and disrupted nighttime sleep, disturbed nighttime sleep, fragmented sleep, consolidated sleep, sleep disruption, and narcolepsy questionnaire. The purpose of the literature search was to identify publications characterizing the nighttime sleep of patients with narcolepsy. The panel reviewed the literature. Nocturnal sleep can also be disturbed by REM sleep abnormalities such as vivid dreaming and REM sleep behavior disorder; however, these were not reviewed in the current paper, as we were evaluating for idiopathic sleep disturbances. RESULTS The literature reviewed provide a consistent characterization of nighttime sleep in patients with narcolepsy as fragmented, with reports of frequent, brief nightly awakenings with difficulties returning to sleep and associated reports of poor sleep quality. Polysomnographic studies consistently report frequent awakenings/arousals after sleep onset, more stage 1 (S1) sleep, and more frequent shifts to S1 sleep or wake from deeper stages of sleep. The consensus of the International Experts' Panel on Narcolepsy was that DNS can be distressing for patients with narcolepsy and that treatment of DNS warrants consideration. CONCLUSIONS Clinicians involved in the management of patients with narcolepsy should investigate patients' quality of nighttime sleep, give weight and consideration to patient reports of nighttime sleep experience, and consider DNS a target for treatment.
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Affiliation(s)
- Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI 48202, USA.
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Abstract
PURPOSE OF REVIEW This review discusses the various causes of primary hypersomnias with emphasis on clinical recognition, diagnosis, and treatment options. RECENT FINDINGS Narcolepsy is probably the most fascinating syndrome causing excessive daytime sleepiness. With increasing understanding of the hypocretin/orexin pathways and the neurotransmitters that subserve the role of wakefulness and sleep, newer therapeutic modalities with promising results are being investigated and opening new frontiers in the treatment of this rare but devastating disease. SUMMARY This article reviews the primary hypersomnias of central origin. Where possible, clinical cases that highlight and explain the clinical syndromes are included. Treatment modalities and future directions are also discussed to help the clinician identify and treat the underlying disorder.
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Affiliation(s)
- Samit Malhotra
- Stanford University Center for Human Sleep Research, 780 Welch Rd, Suite 203, Palo Alto, CA 94304, USA
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Plazzi G, Moghadam KK, Maggi LS, Donadio V, Vetrugno R, Liguori R, Zoccoli G, Poli F, Pizza F, Pagotto U, Ferri R. Autonomic disturbances in narcolepsy. Sleep Med Rev 2011; 15:187-96. [PMID: 20634114 DOI: 10.1016/j.smrv.2010.05.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 05/14/2010] [Accepted: 05/21/2010] [Indexed: 11/24/2022]
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Vernet C, Leu-Semenescu S, Buzare MA, Arnulf I. Subjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness. J Sleep Res 2011; 19:525-34. [PMID: 20408941 DOI: 10.1111/j.1365-2869.2010.00824.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with idiopathic hypersomnia never feel fully alert despite a normal or long sleep night. The spectrum of the symptoms is insufficiently studied. We interviewed 62 consecutive patients with idiopathic hypersomnia (with a mean sleep latency lower than 8 min or a sleep time longer than 11 h) and 50 healthy controls using a questionnaire on sleep, awakening, sleepiness, alertness and cognitive, psychological and functional problems during daily life conditions. Patients slept 3 h more on weekends, holidays and in the sleep unit than on working days. In the morning, the patients needed somebody to wake them, or to be stressed, while routine, light, alarm clocks and motivation were inefficient. Three-quarters of the patients did not feel refreshed after short naps. During the daytime, their alertness was modulated by the same external conditions as controls, but they felt more sedated in darkness, in a quiet environment, when listening to music or conversation. Being hyperactive helped them more than controls to resist sleepiness. They were more frequently evening-type and more alert in the evening than in the morning. The patients were able to focus only for 1 h (versus 4 h in the controls). They complained of attention and memory deficit. Half of them had problems regulating their body temperature and were near-sighted. Mental fatigability, dependence on other people for awakening them, and a reduced benefit from usually alerting conditions (except being hyperactive or stressed) seem to be more specific of the daily problems of patients with idiopathic hypersomnia than daytime sleepiness.
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Affiliation(s)
- Cyrille Vernet
- Sleep Disorders Unit, National Reference Center for Narcolepsy and Hypersomnia, Pitié-Salpêtrière Hospital, Inserm UMRS_975, Paris 6 University, France.
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Vernet C, Arnulf I. Idiopathic hypersomnia with and without long sleep time: a controlled series of 75 patients. Sleep 2009; 32:753-9. [PMID: 19544751 PMCID: PMC2690562 DOI: 10.1093/sleep/32.6.753] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the clinical, psychological, and sleep pattern of idiopathic hypersomnia with and without long sleep time, and provide normative values for 24-hour polysomnography. SETTING University Hospital. DESIGN Controlled, prospective cohort. PARTICIPANTS 75 consecutive patients (aged 34 +/- 12 y) with idiopathic hypersomnia and 30 healthy matched controls. INTERVENTION Patients and controls underwent during 48 hours a face-to-face interview, questionnaires, human leukocyte antigen genotype, a night polysomnography and multiple sleep latency test (MSLT), followed by 24-h ad libitum sleep monitoring. RESULTS Hypersomniacs had more fatigue, higher anxiety and depression scores, and more frequent hypnagogic hallucinations (24%), sleep paralysis (28%), sleep drunkenness (36%), and unrefreshing naps (46%) than controls. They were more frequently evening types. DQB1*0602 genotype was similarly found in hypersomniacs (24.2%) and controls (19.2%). Hypersomniacs had more frequent slow wave sleep after 06:00 than controls. During 24-h polysomnography, the 95% confidence interval for total sleep time was 493-558 min in controls, versus 672-718 min in hypersomniacs. There were 40 hypersomniacs with and 35 hypersomniacs without long ( > 600 min) sleep time. The hypersomniacs with long sleep time were younger (29 +/- 10 vs 40 +/- 13 y, P = 0.0002), slimmer (body mass index: 26 +/- 5 vs 23 +/- 4 kg/m2; P = 0.005), and had lower Horne-Ostberg scores and higher sleep efficiencies than those without long sleep time. MSLT latencies were normal (> 8 min) in 71% hypersomniacs with long sleep time. CONCLUSIONS Hypersomnia, especially with long sleep time, is frequently associated with evening chronotype and young age. It is inadequately diagnosed using MSLT.
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Affiliation(s)
- Cyrille Vernet
- Unité des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France
- Paris 6 University, Paris, France
- Centre de référence national narcolepsie et hypersomnie, France
| | - Isabelle Arnulf
- Unité des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France
- Paris 6 University, Paris, France
- Centre de référence national narcolepsie et hypersomnie, France
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Abstract
PURPOSE OF REVIEW We provide an update on the pathogenesis, diagnosis, assessment (clinical and laboratory), and treatment options for children with narcolepsy and other hypersomnias of central origin in order to raise awareness of these diseases and to highlight the clinical findings that should make the pediatrician suspect the diagnosis. RECENT FINDINGS Narcolepsy is a chronic rapid eye movement sleep disorder. Accumulating evidence indicates that signs of narcolepsy may start during childhood. Recent data suggest that a deficiency in the hypothalamic orexin/hypocretin system underlies the pathogenesis of narcolepsy with cataplexy. Confirmatory tests such as polysomnography, multiple sleep latency test, and actigraphy, along with referral to a sleep physician, maybe necessary in appropriate cases. Laboratory tests such as human leukocyte antigen typing and cerebrospinal fluid hypocretin-1 analysis are useful as adjuncts. Modafinil is now considered the first-line treatment for excessive sleepiness in adult patients with narcolepsy. Sodium oxybate is currently approved by the Food and Drug Administration for the treatment of narcolepsy with cataplexy in patients aged more than 16 years. SUMMARY Awareness of the extent of hypersomnia in children will allow physicians to effectively screen every child; once identified, further assessment should be performed in order to diagnose and treat the underlying cause. Better understanding of pathogenesis, availability of newer therapies with different mechanism of effect, and appropriately designed randomized clinical trials should allow improved management of children with narcolepsy.
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Martínez-Rodríguez JE, Iranzo A, Casamitjana R, Graus F, Santamaria J. [Comparative analysis of patients with narcolepsy-cataplexy, narcolepsy without cataplexy and idiopathic hypersomnia]. Med Clin (Barc) 2007; 128:361-4. [PMID: 17386240 DOI: 10.1157/13099970] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the distribution of clinical, electrophysiological and biological variables, and their relationship with the CSF hypocretin-1 levels, in patients with central hypersomnias diagnosed as narcolepsy-cataplexy (NC), narcolepsy without cataplexy (NnC) and idiopathic hypersomnia (IH) based on the ICSD-2 criteria. PATIENTS AND METHOD We performed in all patients a clinical interview, a nocturnal polysomnogram and a multiple sleep latency test (MSLT), HLA analysis and measurement of CSF Hcrt-1 levels (low < or = 110 pg/mL). RESULTS Out of 51 patients, 31 were classified as NC, 11 as NnC and 8 as IH. 34 patients (66.7%) had low CSF Hcrt-1 levels (29 NC, 3 NnC and 1 IH). In the NC group, 96.1% were HLA DQB1*0602 positive and 91% had low CSF Hcrt-1 levels. The most frequent variables found in NC patients and in those with a low CSF Hcrt-1 levels were cataplexy, fragmented nocturnal sleep, short refreshing naps, automatic behavior, HLA DQB1*0602, and, in the MSLT, a short mean sleep latency, a higher number of REM sleep episodes and a short mean latency of REM sleep episodes. A long nocturnal sleep time and morning sleep drunkenness, 2 variables used in the ICSD-2 for the diagnosis of IH, were not different among the three groups of hypersomnias. CONCLUSIONS Central hypersomnias have a superposition of several clinical, electrophysiological and biological variables that makes sometimes difficult the differential diagnosis. The measurement of CSF Hcrt-1 levels may help in the diagnosis of those patients with unclear clinical or electrophysiological forms.
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Affiliation(s)
- José E Martínez-Rodríguez
- Servicio de Neurología, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España
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Abstract
Excessive daytime somnolence is a prevalent problem in medical practice and in society. It exacts a great toll in quality of life, personal and public safety, and productivity. The causes of EDS are myriad, and careful evaluation is needed to determine the cause in each case. Although much progress has been made in discovering the pathophysiology of narcolepsy, much more remains to be understood, and far less is known about other primary conditions of EDS. Several methods have been developed to assess EDS, although each of them has limitations. Treatment is available for the great majority of cases.
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Affiliation(s)
- Jed E Black
- Stanford Sleep Disorders Center, Sleep Medicine Division, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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Abstract
In the absence of a golden standard for the diagnosis of narcolepsy, the clinical spectrum of disorder remains controversial. The aims of this study were (1) to determine frequency and characteristics of sleep-wake symptoms in patients with narcolepsy with cataplexy, (2) to compare clinical characteristics with results of ancillary tests, and (3) to identify factors that discriminate narcolepsy from other conditions with excessive daytime sleepiness (EDS). We prospectively studied 57 narcoleptics with cataplexy, 56 patients with non-narcoleptic hypersomnia (H), and 40 normal controls (No). Based on suggested and published criteria, we differentiated between narcoleptics with definite cataplexy (N) and narcoleptics without definite cataplexy (possible cataplexy, NpC). Assessment consisted of questionnaires [all patients and controls, including the Ullanlinna Narcolepsy Score (UNS)], polysomnography (all patients), multiple sleep latency test (MSLT) and human leukocyte antigen typing (in most narcoleptics). A new narcolepsy score based on five questions was developed. Data were compared with those of 12 hypocretin-deficient narcoleptics (N-hd). There were significant differences between N and NpC (including mean sleep latency on MSLT), but none between N and N-hd. A score of sleep propensity during active situations (SPAS) and the frequency of sleep paralysis/hallucinations at sleep onset, dreams of flying, and history of sleep shouting discriminated N from H and No (P < 0.001). Cataplexy-like symptoms in H (18%) and No (8%) could be discriminated from 'true' cataplexy in N on the basis of topography of motor effects, triggering emotions and triggering situations (P < 0.001). Our narcolepsy score had a similar sensitivity (96% versus 98%) but a higher specificity (98% versus 56%) than the UNS. Analysis of co-occurring symptoms in narcolepsy revealed two symptom complexes: EDS, cataplexy, automatic behaviors; and sleep paralysis, hallucinations, parasomnias. Low/undetectable cerebrospinal fluid hypocretin-1 levels and a history of definite cataplexy identify similar subgroups of narcoleptics. Specific questions on severity of EDS (SPAS score) and characteristics of cataplexy allow the recognition of subgroups of narcoleptics and their differentiation from non-narcoleptic EDS patients, including those reporting cataplexy-like episodes. The existence of co-occurring symptoms supports the hypothesis of a distinct pathophysiology of single narcoleptic symptoms.
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Abstract
In contrast to narcolepsy and the Kleine-Levin syndrome, idiopathic hypersomnia is a recently described sleep disorder. Absence of associated clinical features such as cataplexy or megaphagia and characteristic polysomnographic features such as sleep-onset REM episodes render positive diagnosis more uncertain in idiopathic hypersomnia than in the fwo former conditions. Consequently there has been an unfortunate tendency to label all difficult to classify cases of excessive daytime sleepiness as idiopathic hypersomnia. At present due to the description of new disorders such as upper airway resistance syndrome, narcolepsy without cataplexy, delayed sleep phase syndrome, all of which were formerly confused with idiopathic hypersomnia and the clear identification of a "polysymptomatic" or "classic" form of idiopathic hypersomnia, the limits of the disorder become more precise. Still there are a number of cases of isolated excessive daytime sleepiness with no prolonged night sleep, no difficulty waking up, which lay between narcolepsy and genuine idiopathic hypersomnia. Thus there is a definite need to further develop laboratory investigations to help identify and classify these cases. Moreover pathophysiology and pathogenesis are still in their infancy and efforts have to be pursued in this direction. Treatment has not made consistent progress except for the use of a new wake promoting compound, modafinil, which has not yet been evaluated in controlled studies.
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Affiliation(s)
- M Billiard
- Department of Neurology B, Gui de Chauliac Hospital, Montpellier, France
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