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Ren J, Zhao X, Su C, Li X, Zhou J. ADHD in narcolepsy: A closer look at prevalence and ties. Neurosci Biobehav Rev 2024; 156:105471. [PMID: 38030099 DOI: 10.1016/j.neubiorev.2023.105471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
The reported prevalence of attention deficit hyperactivity disorder (ADHD) in narcolepsy varies considerably, while the associated factors remain inadequately established. A systematic search of studies published in PubMed, EMBASE, and the Cochrane Library was performed from inception to March 2023. Ten studies with 839 patients with narcolepsy were included in the study. Utilizing a random effects model, the pooled prevalence of ADHD in narcolepsy was 25% (95% CI, 14-38%). Notably, patients with narcolepsy type 2 showed a significantly higher prevalence of ADHD than that of narcolepsy type 1 (46% vs. 20%, p = 0.045). Furthermore, the rate of ADHD was notably elevated in narcolepsy compared with the healthy controls (odds ratio 9.59, 95% CI, 4.06-22.63, p < 0.001). Several factors such as excessive daytime sleepiness (EDS), fatigue, insomnia severity, and the quality of life were significantly associated with ADHD in narcolepsy (all ps < 0.05). These findings highlight the importance of monitoring and managing ADHD in narcolepsy, and provide a clue to help reducing ADHD by intervening in these associated factors.
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Affiliation(s)
- Jiafeng Ren
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xianchao Zhao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Changjun Su
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao Li
- Department of Psychology, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region, China.
| | - Junying Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Li B, Gao Z, He Y, Tian Y, Shen Y, Yu G, Geng X, Kou C. Narcolepsy and psychiatric disorders: A bidirectional Mendelian randomization study. J Psychiatr Res 2024; 169:42-48. [PMID: 38000183 DOI: 10.1016/j.jpsychires.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/09/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Since the introduction of the concept of narcolepsy, there has been a proliferation of discussions about its association with psychiatry. To elucidate the causal role of narcolepsy in the three psychiatric disorders [i.e., schizophrenia (SCZ), major depressive disorder (MDD), and attention-deficit hyperactivity disorder (ADHD)], we applied a bidirectional Mendelian randomization study using two stages (discovery stage and validation stage) and data from three different genome-wide association studies of narcolepsy. The estimates from different stages were combined using fixed-effects meta-analysis. Our findings suggest that narcolepsy is associated with an increased risk of SCZ. Conversely, MDD may be causally related to narcolepsy. A causal relationship between narcolepsy and ADHD was excluded.
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Affiliation(s)
- Biao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Zibo Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yuyang Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Yuxuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Ge Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Xiaohan Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, No.1163 Xinmin Street, Changchun, Jilin, 130021, China.
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Li C, Spruyt K, Xie L, Zhang C, Xu Z, Han F. Development and validation of the narcolepsy severity scale in school aged children. Sleep Med 2023; 110:17-24. [PMID: 37517284 DOI: 10.1016/j.sleep.2023.07.010] [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: 03/07/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To develop and psychometrically test the pediatric narcolepsy severity scale (P-NSS) for pediatric with narcolepsy type 1 (NT1). METHODS Item pool was formed based on literature review, clinical judgement of the expert panel and input of the narcoleptic patients and their parents. Psychometric properties were evaluated after applying the P-NSS in a sample of 200 patients (8-18 years age) with narcolepsy. Analyses included item analysis, validity analysis and reliability analysis. RESULTS P-NSS consisted four factors with a total of 17 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) revealed four distinct and theoretically coherent factors, explaining 63.4% of the total variance. The fitting results of the CFA model were χ2/dƒ = 2.235, GFI = 0.876, AGFI = 0.822, RMSEA = 0.079, TLI = 0.908, CFI = 0.927. P-NSS score is correlated with Pediatric Daytime Sleepiness Scale (r = 0.512, P < 0.01), Epworth Sleepiness Scale for Children and Adolescents (r = 0.355, P < 0.01) and Narcolepsy quality-of-life instrument with 21 questions (r = -0.512, P < 0.01). Cronbach's α coefficient for P-NSS and four dimensions were from 0.732 to 0.915. The split-half reliability was 0.882 (P < 0.01). CONCLUSION P-NSS is proved to be a reliable and valid measure for Chinese children with NT1. It may serve in China as a valuable and easily accessible outcome measure for using in narcolepsy trials, the clinic with improved responsiveness and long term follow-up.
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Affiliation(s)
- Chenyang Li
- Capital Medical University School of Nursing, Beijing, China; Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Karen Spruyt
- NeuroDiderot INSERM, Université de Paris, Paris, France
| | - Liang Xie
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Chi Zhang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Zhifei Xu
- Respiratory Department, Beijing Children's Hospital, Beijing, China
| | - Fang Han
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China.
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Dodson C, Spruyt K, Considine C, Thompson E, Ipsiroglu OS, Bagai K, Silvestri R, Couvadelli B, Walters AS. Hyperactivity in patients with narcolepsy and idiopathic hypersomnia: an exploratory study. SLEEP SCIENCE AND PRACTICE 2023; 7:6. [PMID: 37701170 PMCID: PMC10494784 DOI: 10.1186/s41606-023-00088-y] [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: 07/08/2022] [Accepted: 06/22/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction Patients with either Idiopathic Hypersomnia or Narcolepsy demonstrate excessive daytime somnolence (EDS) with resultant inattention mimicking Attention Deficit Hyperactivity Disorder (ADHD). Patients with ADHD also often express sleep problems including EDS. Thus, patients with ADHD and patients with idiopathic hypersomnia or narcolepsy may share inattention and daytime drowsiness as common features. However, it is not known whether EDS patients with idiopathic hypersomnia or narcolepsy also have increased movement (hyperactivity) like ADHD patients, the determination of which is the purpose of this study. Methods We studied 12 patients (7 Narcolepsy type 2 and 5 Idiopathic Hypersomnia) with EDS as shown by Multiple Sleep Latency Test which served as the gold standard for entry into the study. Twelve subjects without symptoms of EDS served as the control group. None of the participants had a previous history of ADHD. Each participant underwent a one-hour session laying at 45 degrees with surveys about the need to move and actigraphy as an objective measure of movement. Results Sleep-disordered patients with EDS reported more symptoms of inattention and hyperactivity on the ADHD Self-Report Scale. At each of the time points patients with EDS had a clear trend to express the need to move more than controls on the Suggested Immobilization Test (SIT). For the total 60 minutes, a large effect size for the need to move during the SIT test was found between patients and controls (Cohen's d = 0.61, p=0.01). Patients with EDS did not express a need to move more to combat drowsiness than controls, nor did actigraphy show any difference in objective movement between patients and controls during the SIT. Conclusion Patients with EDS express inattention and a need to move more than controls. However, hyperactivity was not verified by objective measurement, nor did the EDS patients express a need to move to combat drowsiness more than controls. Thus, a hypothesis to be further tested, is whether narcolepsy and idiopathic hypersomnia may be more a model of the inattentive form of ADHD rather than the combined or inattentive/hyperactive form of ADHD. Further studies are needed to explore the relationship between EDS and hyperactivity.
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Affiliation(s)
| | - Karen Spruyt
- Université de Paris, NeuroDiderot INSERM, France
| | - Ciaran Considine
- Behavioral & Cognitive Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily Thompson
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Osman S Ipsiroglu
- Sleep Wake-Behavior Clinic, Interdisciplinary Sleep Program, BC Children’s Hospital, University of British Columbia CA
| | - Kanika Bagai
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rosalia Silvestri
- Sleep Medicine Clinic, Department of Clinical and Experimental Medicine, Messina Medical School, AOU G Martino, Messina, Italy
| | - Barbara Couvadelli
- Neuroscience Department, Seton Hall University School of Health and Medical Services, Edison, New Jersey
| | - Arthur S. Walters
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Narcolepsy and emotions: Is there a place for a theory of mind approach? Sleep Med 2023; 102:84-89. [PMID: 36634602 DOI: 10.1016/j.sleep.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Narcolepsy type 1 is a central disorder of hypersomnolence characterized by excessive daytime sleepiness, rapid eye movement sleep-related manifestations, and cataplexy. In the current literature there is general agreement regarding neural correlates of Narcolepsy type 1 that appear to be related to anatomical and functional abnormalities in the hypothalamic region. In the last two decades, researchers shed light on the neurological bases of cataplexy by focusing on the neurobiological correlates of emotions. Although the results of these studies differ, they all point to an impairment in the amygdala and hypothalamus functions that are known to be involved in emotional processing, suggesting an impairment in this domain in narcoleptic patients. Indeed, despite heterogeneous results, several studies showed that narcoleptic patients differed from healthy controls in processing emotional stimuli. From a behavioral point of view, these findings suggest that alterations in emotional processing may be driven, at least in part, by compensatory strategies to avoid or reduce the frequency of cataplexy attacks. Surprisingly, the only study exploring in NT1 the behavioural performances in emotional facial recognition found no differences between NT1 adults and controls. We hypothesize that narcoleptic patients may present an alteration in a more complex socio-cognitive ability that is related to emotional processing, namely Theory of Mind. This review aims to investigate the literature supporting this hypothesis and to propose possible future developments on this topic.
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Bruni O. Approach to a sleepy child: Diagnosis and treatment of excessive daytime sleepiness in children and adolescents. Eur J Paediatr Neurol 2023; 42:97-109. [PMID: 36608412 DOI: 10.1016/j.ejpn.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
The aim of this review is to give updated information to pediatric neurologists on the correct diagnostic approach and treatment of excessive daytime sleepiness (EDS) in children and adolescents. Due to the change in the society habits, EDS is becoming an emerging problem for the health system. At the present there are few articles specifically devoted to the evaluation of EDS. EDS is often reported in several manuscripts as a side effect of other sleep disorders (obstructive sleep apnea, circadian disorders, etc.) or of the use of drugs or of the substance abuse or as a consequence of bad sleep habits and poor sleep hygiene. EDS, especially in children, may manifest with paradoxical symptoms like hyperactivity, inattention, and impulsiveness. However, common sign of EDS in children are the propensity to sleep longer than usual, the difficulty waking up in the morning, and falling asleep frequently during the day in monotonous situation. The diagnosis should include subjective (sleep diaries, questionnaires) and objective (polysomnography, multiple sleep latency test, etc.) instruments to avoid misdiagnosis. Narcolepsy is the most studied central disorder of hypersomnolence, and it is a predominantly pediatric disease with a peak age of onset in prepuberty but the diagnosis is often delayed especially in mild forms. The early and correct treatment of narcolepsy and of other form of EDS is extremely important since late and inappropriate treatments can affect the psychosocial development of the children and adolescents.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Via dei Marsi, 78-00185, Rome, Italy.
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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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8
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Im H, Swan LET. Capacity Building for Refugee Mental Health in Resettlement: Implementation and Evaluation of Cross-Cultural Trauma-Informed Care Training. J Immigr Minor Health 2021; 22:923-934. [PMID: 32088845 PMCID: PMC7223069 DOI: 10.1007/s10903-020-00992-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Refugee mental health needs are heightened during resettlement but are often neglected due to challenges in service provision, including lack of opportunities for building capacity and partnership among providers. We developed and implemented culturally-responsive refugee mental health training, called Cross-Cultural Trauma-Informed Care (CC-TIC) training. We evaluated CC-TIC, using a free listing and semi-structured retrospective pre- and post-training evaluation with five localities in two states in the U.S. The results showed significant improvement in providers’ knowledge of trauma impacts, cultural expressions of trauma/stress-related symptoms, and culturally-responsive trauma-informed care. Trauma-informed care specific to refugee resettlement was regarded as the most helpful topic and community partnership building as the most requested area for future training. This study emphasizes that culturally-responsive trauma-informed approaches can help bridge gaps between mental health care and resettlement services and promote exchanges of knowledge and expertise to build collaborative care and community partnership.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA, 23284, USA.
| | - Laura E T Swan
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA, 23284, USA
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Ballotta D, Talami F, Pizza F, Vaudano AE, Benuzzi F, Plazzi G, Meletti S. Hypothalamus and amygdala functional connectivity at rest in narcolepsy type 1. Neuroimage Clin 2021; 31:102748. [PMID: 34252875 PMCID: PMC8278207 DOI: 10.1016/j.nicl.2021.102748] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION functional and structural MRI studies suggest that the orexin (hypocretin) deficiency in the dorso-lateral hypothalamus of narcoleptic patients would influence both brain metabolism and perfusion and would cause reduction in cortical grey matter. Previous fMRI studies have mainly focused on cerebral functioning during emotional processing. The aim of the present study was to explore the hemodynamic behaviour of spontaneous BOLD fluctuation at rest in patients with Narcolepsy type 1 (NT1) close to disease onset. METHODS Fifteen drug naïve children/adolescents with NT1 (9 males; mean age 11.7 ± 3 years) and fifteen healthy children/adolescents (9 males; mean age 12.4 ± 2.8 years) participated in an EEG-fMRI study in order to investigate the resting-state functional connectivity of hypothalamus and amygdala. Functional images were acquired on a 3 T system. Seed-based functional connectivity analyses were performed using SPM12. Regions of Interest were the lateral hypothalamus and the amygdala. RESULTS compared to controls, NT1 patients showed decreased functional connectivity between the lateral hypothalamus and the left superior parietal lobule, the hippocampus and the parahippocampal gyrus. Decreased functional connectivity was detected between the amygdala and the post-central gyrus and several occipital regions, whereas it was increased between the amygdala and the inferior frontal gyrus, claustrum, insula, and putamen. CONCLUSION in NT1 patients the abnormal connectivity between the hypothalamus and brain regions involved in memory consolidation during sleep, such as the hippocampus, may be linked to the loss of orexin containing neurons in the dorsolateral hypothalamus. Moreover, also functional connectivity of the amygdala seems to be influenced by the loss of orexin-containing neurons. Therefore, we can hypothesize that dysfunctional interactions between regions subserving the maintenance of arousal, memory and emotional processing may contribute to the main symptom of narcolepsy.
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Affiliation(s)
- Daniela Ballotta
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, AUSL of Bologna, Italy
| | | | - Francesca Benuzzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy; IRCCS Istituto delle Scienze Neurologiche, AUSL of Bologna, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy.
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Fife D, Voss EA, Hardin J, Rofael H, Solomon ID, Ryan PB, Stang P. Medications for attention-deficit/hyperactivity disorder in Japan: A retrospective cohort study of label compliance. Neuropsychopharmacol Rep 2021; 41:385-392. [PMID: 34180161 PMCID: PMC8411317 DOI: 10.1002/npr2.12191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/03/2021] [Accepted: 06/13/2021] [Indexed: 12/27/2022] Open
Abstract
Aim To assess label compliance in prescription of medications approved for treatment of attention‐deficit/hyperactivity disorder (ADHD) in Japan at the time of this study: methylphenidate (MPH), atomoxetine, and guanfacine. Methods Retrospective descriptive study was conducted in prevalent‐user cohorts from the Japan Medical Data Center database. Patients who were prescribed a study drug between January 1, 2013 and September 30, 2018 and were in the database for ≥30 days were included. A prescription was considered compliant if all 4 criteria were satisfied: appropriate age, daily dose not exceeding the approved maximum, no contraindicated concurrent medications, and no contraindicated conditions. Results Among 17 418 patients who were prescribed a study drug during 2013‐2018, 73% were male and 53% were children (aged <18 years). Fewer than 2% of prescriptions were for patients outside the approved age, 10%‐13% of patients in the atomoxetine and MPH cohorts received ≥1 prescription exceeding maximum approved dose, no patients were co‐prescribed a contraindicated medication, and 16%–18% of patients in the MPH cohorts had ≥1 contraindicated condition. During their first 500 days of use, for approximately 73%‐86% of patients, all prescriptions were compliant with all label requirements. Conclusions Among patients exposed to ADHD medications in Japan during 2013‐2018, nearly all prescriptions for these medications were label‐compliant for age. For >85% of patients, all prescriptions were label‐compliant for dose, and for approximately 80%, all prescriptions were label‐compliant for contraindicated conditions. We did not find evidence of widespread abuse or noncompliant use of prescribed ADHD medications. To assess label compliance in prescription of medications approved for the treatment of ADHD in Japan at the time of this study (2013‐2018), a retrospective descriptive cohort study was conducted in patients from the JMDC database who were prescribed a study drug (methylphenidate, atomoxetine, or guanfacine) and were in the database for at least 30 days. Among 17 418 patients eligible for the study, nearly all prescriptions were label‐compliant for age; for more than 85% of patients, all prescriptions were label‐compliant for dose, and for approximately 80%, all prescriptions were label‐compliant for contraindicated conditions. We did not find evidence of widespread abuse or noncompliant use of prescribed ADHD medications.![]()
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Affiliation(s)
- Daniel Fife
- Department of Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Erica A Voss
- Department of Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Jill Hardin
- Department of Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Hany Rofael
- Established Products, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Ira D Solomon
- Established Products, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Patrick B Ryan
- Department of Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Paul Stang
- Department of Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, USA
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Quaedackers L, Pillen S, Overeem S. Recognizing the Symptom Spectrum of Narcolepsy to Improve Timely Diagnosis: A Narrative Review. Nat Sci Sleep 2021; 13:1083-1096. [PMID: 34262379 PMCID: PMC8273742 DOI: 10.2147/nss.s278046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Narcolepsy is a chronic sleep disorder with a strong negative impact on quality of life, especially when untreated. Diagnostic delay is a persistent problem, with obvious detrimental effects on patients. A diagnosis of narcolepsy may be delayed because of its broad symptom presentation which is much more encompassing than the classical "tetrad" of sleepiness, cataplexy, hallucinations, and sleep paralysis. Furthermore, symptoms can vary over time. Presentation of symptoms can also be markedly different between children and adults. Finally, common sleep-related comorbidities increase the risk of narcolepsy being masked by overlapping symptoms or treatment. In this review, we provide a detailed description of the broad and dynamic symptom spectrum of narcolepsy, with specific attention to the different manifestations in both adults and children. The overarching goal is to help not only sleep specialists, but general practitioners, pediatricians, and other caregivers with early recognition and prompt diagnosis of this severe but treatable disorder.
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Affiliation(s)
| | - Sigrid Pillen
- Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands
| | - Sebastiaan Overeem
- Biomedical Diagnostics Laboratory, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Hansen BH, Juvodden HT, Nordstrand SH, Viste R, Thorsby PM, Swanson D, Nilsen KB, Nærland T, Knudsen-Heier S. High prevalence of ADHD symptoms in unmedicated youths with post-H1N1 narcolepsy type 1. Sleep Med 2020; 75:171-180. [DOI: 10.1016/j.sleep.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
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13
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Im H, Swan LET. Capacity Building for Refugee Mental Health in Resettlement: Implementation and Evaluation of Cross-Cultural Trauma-Informed Care Training. J Immigr Minor Health 2020; 22:923-934. [DOI: https:/link.springer.com/article/10.1007%2fs10903-020-00992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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14
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Bioulac S, Sagaspe P, Micoulaud-Franchi JA, Altena E, Taillard J, Schröder C, Bouvard MP, Fabrigoule C, Philip P. Objective Level of Alertness and Inhibitory Control Predict Highway Driving Impairment in Adults With ADHD. J Atten Disord 2020; 24:1475-1486. [PMID: 27009924 DOI: 10.1177/1087054716633751] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: It remains unclear whether daytime impairments in ADHD patients are better explained by an altered level of alertness and/or by cognitive deficits. The aim of this study was to determine the respective contribution of these factors on driving performance in ADHD adults. Method: ADHD adults (n = 39) and healthy controls (n = 18) underwent a nocturnal polysomnography (PSG) followed by a Maintenance of Wakefulness Test (MWT), a simulated driving task, and a neuropsychological evaluation. Results: ADHD patients had shorter mean sleep latency on the MWT and worse driving performance than controls. They also made more errors on attention and executive functioning tests. Logistic regression analyses showed that inhibition deficits and objective daytime sleepiness predicted highway driving performance in ADHD. Conclusion: Our study shows that not only inhibitory control deficits but also pathological level of alertness independently contribute to highway driving impairment in ADHD patients, providing a better understanding of the pathophysiological mechanisms involved in ADHD.
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Affiliation(s)
- Stéphanie Bioulac
- Pôle Universitaire Psychiatrie Enfants et Adolescents, Bordeaux, France.,Université de Bordeaux, France.,Unité de Service et de Recherche du Centre National de la Recherche Scientifique 3413 (USR CNRS 3413), Sommeil, Attention et Neuropsychiatrie (SANPSY), Bordeaux, France
| | - Patricia Sagaspe
- Université de Bordeaux, France.,Unité de Service et de Recherche du Centre National de la Recherche Scientifique 3413 (USR CNRS 3413), Sommeil, Attention et Neuropsychiatrie (SANPSY), Bordeaux, France.,Centre Hospitalier Universitaire (CHU) Pellegrin, Clinique du Sommeil, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Université de Bordeaux, France.,Unité de Service et de Recherche du Centre National de la Recherche Scientifique 3413 (USR CNRS 3413), Sommeil, Attention et Neuropsychiatrie (SANPSY), Bordeaux, France.,Centre Hospitalier Universitaire (CHU) Pellegrin, Clinique du Sommeil, Bordeaux, France
| | - Ellemarije Altena
- Université de Bordeaux, France.,Unité de Service et de Recherche du Centre National de la Recherche Scientifique 3413 (USR CNRS 3413), Sommeil, Attention et Neuropsychiatrie (SANPSY), Bordeaux, France
| | - Jacques Taillard
- Université de Bordeaux, France.,Unité de Service et de Recherche du Centre National de la Recherche Scientifique 3413 (USR CNRS 3413), Sommeil, Attention et Neuropsychiatrie (SANPSY), Bordeaux, France.,Centre Hospitalier Universitaire (CHU) Pellegrin, Clinique du Sommeil, Bordeaux, France
| | - Carmen Schröder
- University of Strasbourg, France.,Institute for Cellular and Integrative Neuroscience, Strasbourg, France
| | | | - Colette Fabrigoule
- Université de Bordeaux, France.,Unité de Service et de Recherche du Centre National de la Recherche Scientifique 3413 (USR CNRS 3413), Sommeil, Attention et Neuropsychiatrie (SANPSY), Bordeaux, France
| | - Pierre Philip
- Université de Bordeaux, France.,Unité de Service et de Recherche du Centre National de la Recherche Scientifique 3413 (USR CNRS 3413), Sommeil, Attention et Neuropsychiatrie (SANPSY), Bordeaux, France.,Centre Hospitalier Universitaire (CHU) Pellegrin, Clinique du Sommeil, Bordeaux, France
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15
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Abstract
PURPOSE OF REVIEW The complex nature of narcolepsy symptoms, along with the use of stimulants and anticataplectic medications, poses diagnostic difficulties in terms of underlying neuropsychiatric comorbidities. This study reviews recent evidence for the association between narcolepsy and neuropsychiatric disorders. We also critically analyze studies that have addressed the neuropsychiatric correlates of patients with narcolepsy, with a discussion of the possible pathophysiological mechanisms linking narcolepsy and neuropsychiatric disorders. RECENT FINDINGS Neuropsychiatric manifestations are common among patients with narcolepsy as narcolepsy and some neuropsychiatric disorders share common clinical features. This may create challenges in making the correct diagnosis, and hence result in a delay in starting appropriate treatment. Comorbid neuropsychiatric manifestations in patients with narcolepsy include depression, anxiety, psychosis, rapid eye movement (REM) sleep behavior disorder, and cognitive impairment. Although hypocretin deficiency has been proposed as a pathophysiological mechanism underlying both narcolepsy and neuropsychiatric disorders, further research is necessary to identify the exact mechanisms. Narcolepsy patients often manifest comorbid neuropsychiatric symptoms, which makes the diagnosis difficult. Therefore, it is essential to address neuropsychiatric symptoms in the clinical care of patients with narcolepsy.
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16
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Lopez R, Micoulaud-Franchi JA, Camodeca L, Gachet M, Jaussent I, Dauvilliers Y. Association of Inattention, Hyperactivity, and Hypersomnolence in Two Clinic-Based Adult Cohorts. J Atten Disord 2020; 24:555-564. [PMID: 29771183 DOI: 10.1177/1087054718775826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: To assess the relationship between excessive daytime sleepiness (EDS), inattention, and hyperactivity/impulsivity in adults with ADHD and central hypersomnia. Method: Drug-free adult patients with ADHD (n = 100) or hypersomnia (n = 100) were evaluated using a structured clinical interview and self-report questionnaires on ADHD symptoms and EDS. Results: In all, 61% of patients with hypersomnia had clinically significant ADHD symptoms with 25% having an ADHD diagnosis (with both childhood and adulthood ADHD symptoms) and 36% ADHD-like symptoms, without history of childhood ADHD. EDS was reported in 47% of patients with ADHD, among whom 22% had a hypersomnolence disorder. Conclusion: We confirmed the high frequency of ADHD and ADHD-like symptoms in central hypersomnia, and of EDS and hypersomnolence in ADHD in adults. The nature of the link between EDS, inattention, and hyperactivity appears to be complex that may involve either a cause-effect relationship or intrinsic features of a similar neurodevelopmental dysfunction.
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Affiliation(s)
- Régis Lopez
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.,Inserm U1061, Montpellier, France.,Université de Montpellier, France
| | - Jean-Arthur Micoulaud-Franchi
- Unité de Sommeil, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Laura Camodeca
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France
| | - Marie Gachet
- Department of Emergency Psychiatry and Post Acute Care, Hôpital Lapeyronie, Montpellier, France
| | - Isabelle Jaussent
- Inserm U1061, Montpellier, France.,Université de Montpellier, France
| | - Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.,Inserm U1061, Montpellier, France.,Université de Montpellier, France
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17
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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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18
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Bioulac S, Taillard J, Philip P, Sagaspe P. Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder. Front Psychiatry 2020; 11:3. [PMID: 32174847 PMCID: PMC7055535 DOI: 10.3389/fpsyt.2020.00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/02/2020] [Indexed: 12/22/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder in childhood. It is a heterogeneous disorder in terms of clinical presentation that is probably due to the frequent occurrence of comorbidity. Children with ADHD more frequently report sleep disorders (notably delayed sleep phase syndrome) and excessive daytime sleepiness (EDS) than typically developing children. The aim of this article is to propose a narrative review of the assessment of EDS in the context of ADHD with first a summary of the subjective and objective tools used to measure it. Secondly, perspectives in terms of electroencephalogram (EEG) markers and neurofeedback are proposed. Then, possibilities for new kinds of evaluation are discussed (virtual reality, ecological momentary assessment, etc.). Lastly, we discuss specific clinical situations with EDS in the context of ADHD as links with narcolepsy, the comorbidity with other psychiatric disorders, and the context of sluggish cognitive tempo.
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Affiliation(s)
- Stéphanie Bioulac
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France.,Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Jacques Taillard
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Pierre Philip
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France.,Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Patricia Sagaspe
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France.,CNRS, SANPSY, USR 3413, Bordeaux, France
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19
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Quaedackers L, van Gilst MM, van Mierlo P, Lammers GJ, Dhondt K, Amesz P, Peeters E, Hendriks D, Vandenbussche N, Pillen S, Overeem S. Impaired social functioning in children with narcolepsy. Sleep 2019; 42:5203448. [PMID: 30476304 DOI: 10.1093/sleep/zsy228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/17/2022] Open
Abstract
Study Objectives To explore impairments in social functioning in children with narcolepsy compared to healthy children. Methods Parents of 53 pediatric patients with narcolepsy type 1 and 64 matched healthy children completed the Social Responsiveness Scale (SRS) and the Child Behavior Checklist 6-18 (CBCL 6-18). Results Patients scored significantly higher on the total score of the SRS (median 56, interquartile range [IQR] 23.5) compared to controls (median 44.5, IQR 8.5, U = 797.0, p < 0.001). Patients also scored higher on the sum of the CBCL 6-18 subscales indicative of social functioning (Withdrawn/Depressed, Social Problems, and Thought Problems; median 183, IQR 30.5) compared to controls (median 155, IQR 13, U = 500.0, p < 0.001). A total of 24 patients (45.3%) reported at least mild-to-moderate difficulties in social functioning compared to seven controls (10.9%, χ2 = 17.165, p < 0.001). Eleven patients (20.8%) and only one control (1.6%) had T scores above 75, which points to severely impaired social functioning (χ2 = 11.602, p = 0.001). Within the patient group, girls reported mild-to-moderate difficulties in social functioning significantly more often compared to boys on the SRS (77.8% versus 28.6%, χ2 = 17.560, p < 0.001). Conclusions Impaired social functioning is common in children with narcolepsy type 1, especially in girls. Questionnaires such as the SRS and the CBCL 6-18 may help in early detection of social problems in pediatric narcolepsy. Recognition of these problems could be valuable in the management of young people with narcolepsy.
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Affiliation(s)
- Laury Quaedackers
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Merel M van Gilst
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | | | - Karlien Dhondt
- Department of Psychiatry, Child and Adolescent Psychiatry, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium
| | | | - Els Peeters
- Department of Child Neurology, Juliana Children's Hospital-Haga Teaching Hospital, The Hague, The Netherlands
| | - Danielle Hendriks
- Sleeping Center, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Nele Vandenbussche
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Sigrid Pillen
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Sebastiaan Overeem
- Center for Sleep Medicine, Kempenhaeghe, Heeze, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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20
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Miano S, Amato N, Foderaro G, Pezzoli V, Ramelli GP, Toffolet L, Manconi M. Sleep phenotypes in attention deficit hyperactivity disorder. Sleep Med 2019; 60:123-131. [PMID: 30377038 DOI: 10.1016/j.sleep.2018.08.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 01/17/2023]
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21
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Pizza F, Filardi M, Moresco M, Antelmi E, Vandi S, Neccia G, Mazzoni A, Plazzi G. Excessive daytime sleepiness in narcolepsy and central nervous system hypersomnias. Sleep Breath 2019; 24:605-614. [DOI: 10.1007/s11325-019-01867-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023]
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22
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Nordstrand SEH, Hansen BH, Rootwelt T, Karlsen TI, Swanson D, Nilsen KB, Knudsen S. Psychiatric symptoms in patients with post-H1N1 narcolepsy type 1 in Norway. Sleep 2019; 42:5288677. [DOI: 10.1093/sleep/zsz008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/21/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebjørg Elizabeth Hesla Nordstrand
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Berit Hjelde Hansen
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
- Division of Mental Health, Akershus University Hospital, Lorenskog, Norway
| | - Terje Rootwelt
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
| | - Tor-Ivar Karlsen
- Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - David Swanson
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Kristian Bernhard Nilsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology, Section for Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Stine Knudsen
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
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23
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Snitselaar MA, Smits MG, Spijker J. ADHD symptoms in adults with delayed sleep phase disorder. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0188-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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24
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Nordstrand SH, Hansen BH, Kamaleri Y, Nilsen KB, Rootwelt T, Karlsen TI, Knudsen S. Changes in quality of life in individuals with narcolepsy type 1 after the H1N1-influenza epidemic and vaccination campaign in Norway: a two-year prospective cohort study. Sleep Med 2018; 50:175-180. [DOI: 10.1016/j.sleep.2018.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/11/2018] [Accepted: 05/25/2018] [Indexed: 01/10/2023]
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25
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Prihodova I, Dudova I, Mohaplova M, Hrdlicka M, Nevsimalova S. Childhood narcolepsy and autism spectrum disorders: four case reports. Sleep Med 2018; 51:167-170. [PMID: 30216768 DOI: 10.1016/j.sleep.2018.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Childhood narcolepsy is associated with various emotional, behavioural and cognitive dysfunctions as well as with psychiatric and neurodevelopmental disorders: anxiety, depression, attention deficit hyperactivity disorder and psychosis. A relationship between these conditions is unclear - comorbidity or similar pathophysiological mechanisms can be suggested. OBJECTIVE We reported four children with narcolepsy type 1 (NT1) and autism spectrum disorder (ASD) - Asperger syndrome (AS). RESULTS AND CONCLUSION To the best of our knowledge co-occurrence of NT1 and AS has not been described in the literature as noted in this report.
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26
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The clinical spectrum of childhood narcolepsy. Sleep Med Rev 2018; 38:70-85. [DOI: 10.1016/j.smrv.2017.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 12/19/2022]
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27
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Narcolepsy and Psychiatric Disorders: Comorbidities or Shared Pathophysiology? Med Sci (Basel) 2018; 6:medsci6010016. [PMID: 29462876 PMCID: PMC5872173 DOI: 10.3390/medsci6010016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 01/08/2023] Open
Abstract
Narcolepsy and psychiatric disorders have a significant but unrecognized relationship, which is an area of evolving interest, but unfortunately, the association is poorly understood. It is not uncommon for the two to occur co-morbidly. However, narcolepsy is frequently misdiagnosed initially as a psychiatric condition, contributing to the protracted time to accurate diagnosis and treatment. Narcolepsy is a disabling neurodegenerative condition that carries a high risk for development of social and occupational dysfunction. Deterioration in function may lead to the secondary development of psychiatric symptoms. Inversely, the development of psychiatric symptoms can lead to the deterioration in function and quality of life. The overlap in pharmaceutical intervention may further enhance the difficulty to distinguish between diagnoses. Comprehensive care for patients with narcolepsy should include surveillance for psychiatric illness and appropriate treatment when necessary. Further research is necessary to better understand the underlying pathophysiology between psychiatric disease and narcolepsy.
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28
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Vogel SWN, Bijlenga D, Benjamins JS, Beekman ATF, Kooij JJS, Van Someren EJW. Attention deficit hyperactivity disorder symptom severity and sleep problems in adult participants of the Netherlands sleep registry. Sleep Med 2017; 40:94-102. [PMID: 29221785 DOI: 10.1016/j.sleep.2017.09.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/28/2017] [Accepted: 09/08/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined whether current overall attention deficit hyperactivity disorder (ADHD), inattention, or hyperactivity symptom severities are associated with the current presence and persistent history of sleep problems. METHODS N = 942 participants of the Netherlands Sleep Registry filled out online several validated questionnaires. Regression analyses were performed to assess the association between (1) current overall ADHD symptom severity and the current presence of sleep problems, (2) current ADHD symptom-severity groups and the persistent history of sleep problems, and (3) current inattention or hyperactivity symptom severities and the current presence of sleep problems. RESULTS (1) Current overall ADHD symptom severity was associated with the odds of suffering from probable obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), insomnia disorder (ID) with predominant difficulties initiating sleep (DIS) and maintaining sleep (DMS), but not with the odds of suffering from narcolepsy or ID with predominant early-morning awakening (EMA). Current overall ADHD symptom severity was also associated with an extreme evening chronotype but not with short sleep. (2) The group with the most severe current ADHD symptoms was more likely to have a history of persistent OSAS, RLS, and ID. (3) The severity of symptoms of hyperactivity, but not of inattention, was specifically associated with probable RLS, PLMD, ID with DIS or DMS, and short sleep. Inattention symptom severity was only related to the probability of being an extreme evening chronotype. CONCLUSION ADHD severity, especially the severity of hyperactivity, is associated with the current presence and persistent history of sleep problems.
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Affiliation(s)
- Suzan W N Vogel
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 The Hague HR, The Netherlands.
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 The Hague HR, The Netherlands
| | - Jeroen S Benjamins
- Department of Social, Health and Organisational Psychology, Department of Experimental Psychology, Utrecht University, Heidelberglaan 1, 3584 Utrecht CH, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, A. J. Ernststraat 1187, 1081 Amsterdam HL, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 The Hague HR, The Netherlands; Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, A. J. Ernststraat 1187, 1081 Amsterdam HL, The Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 Amsterdam BA, The Netherlands; Departments of Psychiatry and Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Center, De Boelelaan 1187, 1081 Amsterdam HV, The Netherlands
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29
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Attention impairments and ADHD symptoms in adult narcoleptic patients with and without hypocretin deficiency. PLoS One 2017; 12:e0182085. [PMID: 28763482 PMCID: PMC5538711 DOI: 10.1371/journal.pone.0182085] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/12/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Attentional complaints are common in narcolepsy patients and can overlap with daytime sleepiness features. Few studies attempted to characterize attentional domains in narcolepsy leading to controversial results. We aimed to assess the impact of hypocretin deficiency on attentional functioning by comparing performances on the attention network test (ANT) of narcoleptic patients with hypocretin deficiency (narcolepsy type 1-NT1) versus patients without hypocretin deficiency (narcolepsy type 2-NT2) and healthy controls. We also addressed frequency and severity of psychopathological symptoms and their influence on performances on ANT. METHODS Twenty-one NT1 patients, fifteen NT2 patients and twenty-two healthy controls underwent the ANT, which allows assessing three separate attentional processes (alerting, orienting and executive control), and a psychometric assessment including questionnaires on attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, anxiety and depression symptoms. RESULTS NT1 and NT2 patients presented with slower reaction times compared to controls. NT1 patients exhibited an impairment of alerting network relative to NT2 and healthy controls, while orienting and executive control networks efficiency were comparable between groups. NT1 and NT2 displayed higher severity of ADHD inattentive domain than controls, NT1 patients also displayed higher severity of ADHD hyperactive domain and depressive symptoms. In NT1, ADHD and depressive symptoms were positively correlated. CONCLUSIONS Despite a shared slowing of reaction times in both NT1 and NT2, a selective impairment of alerting network was present only in hypocretin deficient patients. Clinicians should carefully consider attentional deficits and psychopathological symptoms, including ADHD symptoms, in the clinical assessment and management of patients with narcolepsy.
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30
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Reducing the Clinical and Socioeconomic Burden of Narcolepsy by Earlier Diagnosis and Effective Treatment. Sleep Med Clin 2017; 12:61-71. [PMID: 28159098 DOI: 10.1016/j.jsmc.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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31
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Rocca FL, Finotti E, Pizza F, Ingravallo F, Gatta M, Bruni O, Plazzi G. Psychosocial Profile and Quality of Life in Children With Type 1 Narcolepsy: A Case-Control Study. Sleep 2016; 39:1389-98. [PMID: 27166243 DOI: 10.5665/sleep.5970] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/25/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To investigate behavioral aspects and quality of life in children and adolescents with type 1 narcolepsy (NT1). METHODS We performed a case-control study comparing 29 patients with NT1 versus sex- and age-matched patients with idiopathic epilepsy (n = 39) and healthy controls (n = 39). Behavior and quality of life were evaluated by self-administered questionnaires (Child Behavior Checklist, Pediatric Quality of Life Inventory). Patient groups were contrasted and scale results were correlated with clinical and polysomnographic parameters, and cerebrospinal fluid hypocretin-1 levels. RESULTS Young patients with NT1 showed increased internalizing problems associated with aggressive behavior. Emotional profile in patients with NT1 positively correlated with age at onset, diagnostic delay, and subjective sleepiness, whereas treatment and disease duration were associated with fewer behavioral problems (attention problems, aggressive behavior, and attention deficit/hyperactivity disorder). Psychosocial health domains of pediatric NT1 were worse than in healthy controls, whereas the physical health domains were comparable. CONCLUSIONS Young NT1 patients show a discrete pattern of altered behavioral, thought, and mood profile in comparison with healthy controls and with idiopathic epilepsy patients thus suggesting a direct link with sleepiness. Further studies investigating behavior in patients with idiopathic hypersomnia or type 2 narcolepsy are needed to disentangle the role of REM sleep dysfunction and hypocretin deficiency in psychiatric disorders. Symptoms of withdrawal, depression, somatic complaints, thought problems, and aggressiveness were common, NT1 children perceived lower school competencies than healthy children, and their parents also reported worse psychosocial health. Our data suggest that early effective treatment and disease self-awareness should be promoted in NT1 children for their positive effect on behavior and psychosocial health.
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Affiliation(s)
| | - Elena Finotti
- Department of Rehabilitation, Child and Adolescent Neuropsychiatry Unit, ULSS 6 Vicenza, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences, ASL di Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Michela Gatta
- Department of Woman and Child Health, University of Padua, Italy
| | - Oliviero Bruni
- Department of Developmental Neurology and Psychiatry, Centre for Pediatric Sleep Disorders, Sapienza University, Rome, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences, ASL di Bologna, Bologna, Italy
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Miano S, Esposito M, Foderaro G, Ramelli GP, Pezzoli V, Manconi M. Sleep-Related Disorders in Children with Attention-Deficit Hyperactivity Disorder: Preliminary Results of a Full Sleep Assessment Study. CNS Neurosci Ther 2016; 22:906-914. [PMID: 27255788 DOI: 10.1111/cns.12573] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/10/2016] [Accepted: 05/05/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND METHODS We present the preliminary results of a prospective case-control sleep study in children with a diagnosis of attention-deficit hyperactivity disorder (ADHD). A deep sleep assessment including sleep questionnaires, sleep habits, a video-polysomnographic recording with full high-density electroencephalography (EEG) and cardiorespiratory polygraphy, multiple sleep latency test, and 1-week actigraphic recording were performed to verify whether children with ADHD may be classified into one of the following five phenotypes: (1) hypoarousal state, resembling narcolepsy, which may be considered a "primary" form of ADHD; (2) delayed sleep onset insomnia; (3) sleep-disordered breathing; (4) restless legs syndrome and/or periodic limb movements; and (5) sleep epilepsy and/or EEG interictal epileptiform discharges. RESULTS Fifteen consecutive outpatients with ADHD were recruited (two female, mean age 10.6 ± 2.2, age range 8-13.7 years) over 6 months. The narcolepsy-like sleep phenotype was observed in three children, the sleep onset insomnia phenotype was observed in one child, mild obstructive sleep apnea was observed in three children, sleep hyperkinesia and/or PLMs were observed in five children, while IEDs and or nocturnal epilepsy were observed in three children. Depending on the sleep phenotype, children received melatonin, iron supplementation, antiepileptic drugs, or stimulants. CONCLUSIONS Our study further highlights the need to design an efficient sleep diagnostic algorithm for children with ADHD, thereby more accurately identifying cases in which a full sleep assessment is indicated.
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Affiliation(s)
- Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe Foderaro
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, Bellinzona, Switzerland
| | - Valdo Pezzoli
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
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Lamb F, Ploner A, Fink K, Maeurer M, Bergman P, Piehl F, Weibel D, Sparén P, Dahlström LA. No Evidence for Disease History as a Risk Factor for Narcolepsy after A(H1N1)pdm09 Vaccination. PLoS One 2016; 11:e0154296. [PMID: 27120092 PMCID: PMC4847913 DOI: 10.1371/journal.pone.0154296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/12/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy. METHODS Case-control study in Sweden. Cases included persons referred for a Multiple Sleep Latency Test between 2009 and 2010, identified through diagnostic sleep centres and confirmed through independent review of medical charts. Controls, selected from the total population register, were matched to cases on age, gender, MSLT-referral date and county of residence. Disease history (prescriptions and diagnoses) and vaccination history was collected through telephone interviews and population-based healthcare registers. Conditional logistic regression was used to investigate disease history before A(H1N1)pdm09 vaccination as a risk-factor for narcolepsy. RESULTS In total, 72 narcolepsy cases and 251 controls were included (range 3-69 years mean19-years). Risk of narcolepsy was increased in individuals with a disease history of nervous system disorders (OR range = 3.6-8.8) and mental and behavioural disorders (OR = 3.8, 95% CI 1.6-8.8) before referral. In a second analysis of vaccinated individuals only, nearly all initial associations were no longer statistically significant and effect sizes were smaller (OR range = 1.3-2.6). A significant effect for antibiotics (OR = 0.4, 95% CI 0.2-0.8) and a marginally significant effect for nervous system disorders was observed. In a third case-only analysis, comparing cases referred before vaccination to those referred after; prescriptions for nervous system disorders (OR = 26.0 95% CI 4.0-170.2) and ADHD (OR = 35.3 95% CI 3.4-369.9) were statistically significant during the vaccination period, suggesting initial associations were due to confounding by indication. CONCLUSION The findings of this study do not support disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy.
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Affiliation(s)
- Favelle Lamb
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markus Maeurer
- CAST (Centre for allogenic stem cell transplantation), Karolinska Hospital, Stockholm, Sweden
- Division of Therapeutic Immunology (TIM), LabMed Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lisen Arnheim Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Beyond Daytime Sleepiness: Medical, Behavioral, Psychiatric, and Sleep Co-morbid Conditions Associated with Pediatric Narcolepsy. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0032-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Joseph A, Cloutier M, Guérin A, Nitulescu R, Sikirica V. Treatment outcomes after methylphenidate in adults with attention-deficit/hyperactivity disorder treated with lisdexamfetamine dimesylate or atomoxetine. Patient Prefer Adherence 2016; 10:391-405. [PMID: 27069357 PMCID: PMC4818045 DOI: 10.2147/ppa.s98498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To compare treatment adherence, discontinuation, add-on, and daily average consumption (DACON) among adults with attention-deficit/hyperactivity disorder receiving second-line lisdexamfetamine dimesylate (LDX) or atomoxetine (ATX), following methylphenidate. PATIENTS AND METHODS A retrospective cohort study using US commercial claims databases (Q2/2009-Q3/2013). RESULTS At month 12, the LDX cohort (N=2,718) had a higher adherence level (proportion of days covered: 0.48 versus 0.30, P<0.001) and was less likely to discontinue (Kaplan-Meier estimate: 63% versus 85%, P<0.001) than the ATX cohort (N=674). There were no statistical differences in treatment add-on rates between cohorts (Kaplan-Meier estimate: 26% versus 25%, P=0.297). The LDX cohort had a lower DACON (1.10 versus 1.31, P<0.001) and was less likely to have a DACON >1 (adjusted odds ratio: 0.20, 95% confidence interval: 0.15-0.25, P<0.001) than the ATX cohort. CONCLUSION Adults with attention-deficit/hyperactivity disorder treated with LDX following methylphenidate had a higher treatment adherence and lower discontinuation and DACON relative to those treated with ATX following methylphenidate.
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Affiliation(s)
- Alain Joseph
- Global HEOR and Epidemiology, Shire, Zählerweg, Zug, Switzerland
- Correspondence: Alain Joseph, Global HEOR and Epidemiology, Shire, Zählerweg 10, 6301 Zug, Switzerland, Tel +41 41 288 4390, Fax +41 41 288 4001, Email
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Bioulac S, Micoulaud-Franchi JA, Philip P. Excessive daytime sleepiness in patients with ADHD--diagnostic and management strategies. Curr Psychiatry Rep 2015; 17:608. [PMID: 26122671 DOI: 10.1007/s11920-015-0608-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The links between attention-deficit hyperactivity disorder (ADHD) and sleep disorders remain unclear. Specific sleep disorders are a frequent comorbid condition associated with ADHD according to a categorical approach. However, sleep disorders can also induce ADHD-like symptoms according to a dimensional approach and are thought to be the consequence of excessive daytime sleepiness. It may thus be difficult for clinicians to differentiate the diagnosis of ADHD comorbid with a sleep disorder from sleep disorders with ADHD-like symptoms. This distinction could be important for the appropriate management of patients with dual complaints of trouble maintaining attention and daytime sleepiness. This paper summarizes the main sleep disorders associated with ADHD: sleep-related breathing disorders, sleep-related movement disorders, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence (aka hypersomnias). The history of presenting symptoms should be taken into account since ADHD is a neurodevelopmental disorder whereas ADHD symptoms comorbid with sleep disorder are not. Finally, we propose a model to clarify the links between ADHD, ADHD symptoms, and excessive daytime sleepiness induced by sleep disorders. Clinicians should therefore routinely assess, monitor, and manage the sleep problems of patients with ADHD who have both comorbidities and should search for the presence of ADHD symptoms in subjects with sleep disorders.
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Affiliation(s)
- Stéphanie Bioulac
- Centre Hospitalier Charles Perrens, Pôle de Pédopsychiatrie Universitaire, 121, rue de la Béchade, 33076, Bordeaux, Cedex, France,
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Lecendreux M, Lavault S, Lopez R, Inocente CO, Konofal E, Cortese S, Franco P, Arnulf I, Dauvilliers Y. Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Pediatric Narcolepsy: A Cross-Sectional Study. Sleep 2015; 38:1285-95. [PMID: 26118560 DOI: 10.5665/sleep.4910] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/09/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the frequency, severity, and associations of symptoms of attention-deficit/hyperactivity disorder (ADHD) in children with narcolepsy with and without cataplexy. DESIGN Cross-sectional survey. SETTINGS Four French national reference centers for narcolepsy. PATIENTS One hundred eight consecutively referred children aged younger than 18 y with narcolepsy, with (NwC, n = 86) or without cataplexy (NwoC, n = 22), and 67 healthy controls. INTERVENTIONS The participants, their families, and sleep specialists completed a structured interview and questionnaires about sleep, daytime sleepiness, fatigue, and ADHD symptoms (ADHD-rating scale based upon Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] symptoms), and use of psychostimulants for the treatment of narcolepsy (administered in 68.2%). Polysomnographic measures were collected. MEASUREMENTS AND RESULTS Clinically significant levels of ADHD symptoms were found in 4.8% of controls compared with 35.3% in patients with NwoC (P < 0.001) and 19.7% in patients with NwC (P < 0.01). Total ADHD scores were 6.4 (95% confidence interval [CI]: 4.5, 9.0) in controls compared with 14.2 (95% CI: 10.6, 18.9; P < 0.001), in patients with NwoC and 12.2 (95% CI: 9.8, 15.3; P < 0.01) in patients with NwC; subscores of inattention and hyperactivity/impulsivity were also significantly higher in both narcolepsy groups compared with controls. No difference was found between the NwC and NwoC groups for any ADHD measure. ADHD symptom severity was associated with increased levels of sleepiness, fatigue, and insomnia. Compared with the 34 untreated patients, the 73 patients treated with psychostimulants (modafinil in 91%) showed a trend toward lower narcolepsy symptoms but not lower ADHD symptoms. CONCLUSIONS Pediatric patients with narcolepsy have high levels of treatment-resistant attention-deficit/hyperactivity disorder (ADHD) symptoms. The optimal treatment for ADHD symptoms in these patients warrants further evaluation in longitudinal intervention studies.
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Affiliation(s)
- Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France
| | - Sophie Lavault
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.,AP-HP, Groupe Hospitalier Pitié-Salpétrière, Service des Pathologies du Sommeil & Université Pierre et Marie Curie - Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Inserm U1061, Montpellier, France
| | - Clara Odilia Inocente
- Integrative Physiology of Brain Arousal System, CRNL, University Lyon 1, Lyon, France
| | - Eric Konofal
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.,AP-HP, Groupe Hospitalier Pitié-Salpétrière, Service des Pathologies du Sommeil & Université Pierre et Marie Curie - Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Samuele Cortese
- Department of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.,New York University Child Study Center, New York, NY
| | - Patricia Franco
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.,Integrative Physiology of Brain Arousal System, CRNL, University Lyon 1, Lyon, France.,Pediatric Sleep Unit, Hôpital Femme-Mère Enfant, University Lyon 1, Lyon, France
| | - Isabelle Arnulf
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.,AP-HP, Groupe Hospitalier Pitié-Salpétrière, Service des Pathologies du Sommeil & Université Pierre et Marie Curie - Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, France.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Inserm U1061, Montpellier, France
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Szakács A, Hallböök T, Tideman P, Darin N, Wentz E. Psychiatric comorbidity and cognitive profile in children with narcolepsy with or without association to the H1N1 influenza vaccination. Sleep 2015; 38:615-21. [PMID: 25325473 DOI: 10.5665/sleep.4582] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/31/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate psychiatric comorbidity and the cognitive profile in children and adolescents with narcolepsy in western Sweden and the relationship of these problems to H1N1 vaccination. PATIENTS Thirty-eight patients were included in the study. DESIGN We performed a population-based, cross-sectional study to investigate psychiatric comorbidity using a test battery of semistructured interviews generating Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnoses, including the Development and Well-Being Assessment and the attention deficit hyperactivity disorder rating scale. The Autism Spectrum Screening Questionnaire and the Positive and Negative Syndrome Scale were used to screen for autistic traits and psychotic symptoms, respectively. The cognitive assessments were made by a clinical psychologist using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, the Wechsler Intelligence Scale for Children, Fourth Edition, or the Wechsler Adult Intelligence Scale, Fourth Edition. MEASUREMENTS AND RESULTS In the post-H1N1 vaccination (PHV) narcolepsy group (n = 31), 43% of patients had psychiatric comorbidity, 29% had attention deficit hyperactivity disorder (ADHD) inattentive type, 20% had major depression, 10% had general anxiety disorder, 7% had oppositional defiant disorder (ODD), 3% had pervasive developmental disorder not otherwise specified (i.e., atypical autism), and 3% had eating disorder not otherwise specified (anorectic type). In the non-post-H1N1 vaccination (nPHV) narcolepsy group, one of seven patients had ADHD, inattentive type and ODD. The most frequent psychiatric symptom was temper tantrums, which occurred in 94% of the patients in the PHV group and 71% of the patients in the nPHV narcolepsy group. The cognitive assessment profile was similar in both groups and showed normal results for mean full-scale IQ and perceptual speed but decreased verbal comprehension and working memory. Patients with psychiatric comorbidity had a significantly lower full-scale IQ compared to those without. CONCLUSION Our study indicates increased psychiatric comorbidity in children and adolescents with narcolepsy. The identified cognitive profile with significantly lower verbal comprehension and working memory compared with the normal mean index could have important implications for social relations and schooling. The small numbers of patients with nPHV narcolepsy make it difficult to draw firm conclusions about the possible differences between the two groups of patients.
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Affiliation(s)
- Attila Szakács
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden
| | - Tove Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Niklas Darin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Center, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Modestino EJ, Blum K, Oscar-Berman M, Gold MS, Duane DD, Sultan SG, Auerbach SH. Reward Deficiency Syndrome: Attentional/Arousal Subtypes, Limitations of Current Diagnostic Nosology, and Future Research. JOURNAL OF REWARD DEFICIENCY SYNDROME 2015; 1:6-9. [PMID: 26306327 PMCID: PMC4545661 DOI: 10.17756/jrds.2015-002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We theorise that in some cases Attention Deficit Hyperactivity Disorder (ADHD) predisposes to narcolepsy and hypersomnia, and that there may be a shared pathophysiology with various addictions [Reward Deficiency Syndrome (RDS)]. Reticence to acknowledge such connections may be due to a narrow nosological framework. Additionally, we theorise that the development of narcolepsy on a baseline of ADHD/RDS leads to an additional assault on the dopaminergic reward system in such individuals. In this study, we propose to test these hypotheses by using a combination of broad genetic screening, and neuroimaging with and without pharmacological intervention, in those with pure ADHD, pure narcolepsy, and the combined ADHD-narcolepsy phenotype. Results of this proposed study may reveal a common pathophysiology of ADHD, narcolepsy and RDS, and perhaps an additional compromise to the reward system in those with combined ADHD-narcolepsy. If the evidence supports the hypothesis that indeed there is a shared pathophysiology for narcolepsy with RDS and thus its subtype ADHD, early intervention/preventative treatment amongst those with ADHD may be beneficial with the putative dopaminergic compound KB220Z™.
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Affiliation(s)
- Edward Justin Modestino
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston VA Healthcare System, Boston, MA, USA
| | - Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL,USA
- Human Integrated Services Unit University of Vermont Center for Clinical & Translational Science, Department of Psychiatry, College of Medicine, Burlington, VT, USA
- Dominion Diagnostics, LLC, North Kingstown, RI, USA
- Department of Addiction Research & Therapy, Malibu Beach Recovery Center, Malibu Beach, CA, USA
| | - Marlene Oscar-Berman
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Departments of Psychiatry, Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Boston VA Healthcare System, Boston, MA, USA
| | - Mark S. Gold
- Departments of Psychiatry & Behavioral Sciences at the Keck, University of Southern California, School of Medicine, CA, USA
- Director of Research, Drug Enforcement Administration (DEA) Educational Foundation, Washington, D.C, USA
| | - Drake D. Duane
- Institute for Developmental Behavioral Neurology Scottsdale, AZ, USA
- Department of Speech and Hearing Sciences, Arizona State University, Tempe, AZ, USA
- Department of Neurology, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sarah G.S. Sultan
- Department of Psychiatry, St. Mary's Hospital Centre, Montreal, QC, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sanford H. Auerbach
- Departments of Neurology & Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Sleep Disorders Center & Behavioral Neurology, Boston Medical Center, Boston, MA, USA
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Liens entre TDA/H à l’âge adulte et narcolepsie et hypersomnie idiopathique. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.305] [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: 11/19/2022] Open
Abstract
Les hypersomnies centrales (narcolepsie avec cataplexie [NC], narcolepsie sans cataplexie [NSC] et hypersomnie idiopathique [HI]) sont des troubles du sommeil invalidants responsables d’une somnolence diurne excessive (SDE). L’expérience clinique et les données de la littérature suggèrent que les symptômes du Trouble Déficit d’Attention avec ou sans Hyperactivité (TDA/H) sont fréquemment observés dans les hypersomnies centrales.Les hypothèses physiopathologiques concernant cette association sont discutées : s’agit-il de conséquences de la somnolence diurne excessive ou le reflet d’une vulnérabilité commune entre les hypersomnies et le TDA/H.Afin d’amener des pistes de réponse, seront présentées les données préliminaires de travaux portant sur (1) l’évaluation du TDA/H dans une cohorte de sujets souffrant d’hypersomnie centrale ; (2) la fréquence de la somnolence diurne excessive dans une cohorte d’adultes souffrant de TDA/H. Une meilleure compréhension de cette association peut conduire au développement de stratégies thérapeutiques innovantes ciblant les symptômes de TDA/H dans les hypersomnies centrales d’une part, et le déficit de vigilance dans le TDA/H d’autre part.
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Abstract
Narcolepsy is a neurological disorder frequently occurring from childhood and persisting through adolescence and adulthood. Individuals suffering from narcolepsy exhibit excessive daytime somnolence, sleep attacks, cataplexy, dysomnia, metabolic perturbations including weight gain, and problems in social interaction and academic performance. The prevalence of narcolepsy in childhood is not known but can be estimated from adult studies to be greater than 20-60 per 100,000 in Western countries. The 2009 (A) H1N1 vaccination campaign led to an increase of narcoleptic cases both in children and in adults, supporting the autoimmune hypothesis of the disease. This article focuses on the epidemiology, etiology, and particularities of treatment in pediatric narcolepsy and details the effects of the drugs used to treat this condition, including recent trends in the field. Future therapeutic directions are also discussed. At present, medications used to treat children or adolescents have shown efficacy mostly based on clinical experience, given the lack of level 1 evidence-based studies in the pediatric population. Therefore, most compounds used in adult narcolepsy to target clinical symptoms such as wake-promoting or anticataplectic agents are prescribed off-label in pediatric patients. Published research shows the benefit of drug therapy for narcoleptic children, but these must be dispensed with caution in the absence of well conducted clinical trials.
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Affiliation(s)
- Michel Lecendreux
- Pediatric Sleep Center and National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Robert Debre University Hospital, 48 Boulevard Serurier, 75019, Paris, France,
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Thorpy MJ, Krieger AC. Delayed diagnosis of narcolepsy: characterization and impact. Sleep Med 2014; 15:502-7. [PMID: 24780133 DOI: 10.1016/j.sleep.2014.01.015] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/15/2014] [Accepted: 01/31/2014] [Indexed: 02/04/2023]
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