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Gandhi K, Ferdous S. Tetrad of Narcolepsy Type 1: Treatment and Management. Cureus 2024; 16:e55331. [PMID: 38562323 PMCID: PMC10982127 DOI: 10.7759/cureus.55331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Narcolepsy is a chronic condition that brings about excessive daytime sleepiness. It can be classified into two types: narcolepsy type 1 (presence of cataplexy, which is marked by weakness of muscles) and narcolepsy type 2 (without cataplexy). It is generally underdiagnosed, which results in delayed diagnosis of the condition. It has more prevalence in the United States of America as compared to India. The narcoleptic tetrad consists of excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, and hypnagogic hallucinations. Rapid eye movement (REM) sleep behavior disorder is another characteristic feature. Research about narcolepsy has been carried out for about 145-150 years, but it is only in the last 18-20 years that there has been advancement in the underlying pathophysiology, diagnosis, and, thus, availability of better treatment. Both pharmacological and non-pharmacological methods are preferred in treating narcolepsy, yet there is no cure for it. Since the knowledge regarding this condition is very limited, it is often misunderstood, and dealing with it is mentally and socially draining, often causing anxiety in the patients, feeling of social isolation, and other significant impacts on the quality of living. Raising awareness about narcolepsy is vital to prevent further medical attention delays.
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Affiliation(s)
- Kanishka Gandhi
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Suraiya Ferdous
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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2
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Rosenberg R, Braceras R, Macfadden W, Candler S, Black J, Ruoff C. Implications of Oxybate Dosing Regimen for Sleep, Sleep Architecture, and Disrupted Nighttime Sleep in Patients with Narcolepsy: A Commentary. Neurol Ther 2023; 12:1805-1820. [PMID: 37755650 PMCID: PMC10630177 DOI: 10.1007/s40120-023-00543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Narcolepsy is associated with disrupted nighttime sleep (DNS). Sodium oxybate (SXB; Xyrem®), administered twice nightly, is indicated for the treatment of cataplexy and excessive daytime sleepiness in patients 7 years or older with narcolepsy. Recently, low-sodium oxybate (LXB, Xywav®; for people 7 years of age and older), which contains 92% less sodium than SXB and is dosed twice nightly, and sodium oxybate for extended release (SXB-ER; Lumryz™; for adults), which contains equal sodium to SXB and is dosed once nightly, have also been approved to treat cataplexy or excessive daytime sleepiness in narcolepsy. This paper reviews the evidence regarding the overall impact of oxybate administration, and impact of different oxybate dosing regimens (once nightly, SXB-ER; twice nightly, SXB), on DNS in narcolepsy utilizing polysomnographic data from five clinical trials (three assessing SXB in adults [referred to here as SXB trials 1, 2, and 3], one assessing SXB in children [referred to as the pediatric SXB trial], and one assessing SXB-ER in adults [REST-ON]). Both once-nightly and twice-nightly oxybate regimens similarly improved symptoms of DNS. Regardless of dosing regimen, people with narcolepsy treated with oxybate experience roughly 42-53 arousals and 9-38 awakenings each night, with one of these awakenings on twice-nightly oxybate being due to the second dosing requirement in studies of SXB. Additionally, for SXB, but not SXB-ER, polysomnographic data has been analyzed by half of the night, demonstrating a greater positive impact on sleep architecture in the second half of the night, which might be related to its nonlinear pharmacokinetic profile. We conclude that while once-nightly and twice-nightly oxybate dosing regimens differ in their pharmacokinetic profiles, both improve DNS in patients with narcolepsy to a similar degree.
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Affiliation(s)
| | | | | | | | - Jed Black
- Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | - Chad Ruoff
- Division of Pulmonary Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA.
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3
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Sampat AC, Avidan AY. Multiple Sleep Latency Test/Maintenance of Wakefulness Test and Central Hypersomnias: Evolving Diagnostic and Therapeutic Approaches. J Clin Neurophysiol 2023; 40:203-214. [PMID: 36872499 DOI: 10.1097/wnp.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
SUMMARY Central disorders of hypersomnolence include a spectrum of conditions, such as narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome, in which excessive daytime sleepiness is the primary feature. Subjective testing with tools, such as sleep logs and sleepiness scales, are often helpful in the evaluation of these disorders but do not necessarily correlate well with objective testing, such as polysomnography and multiple sleep latency test and maintenance of wakefulness test. The most recent International Classification of Sleep Disorders-Third Edition has incorporated biomarkers, such as cerebrospinal fluid hypocretin level, into the diagnostic criteria and have restructured the classification of conditions based on our evolved understanding of their underlying pathophysiologic mechanisms. Therapeutic approaches largely consist of behavioral therapy, with a focus on optimizing sleep hygiene, optimizing opportunity for sleep, and strategic napping, along with judicious use of analeptic and anticataleptic agents when necessary. Emerging therapy has revolved around hypocretin-replacement therapy, immunotherapy, and nonhypocretin agents, with the goal of better targeting the underlying pathophysiology of these disorders rather than addressing symptoms. The most novel treatments have targeted the histaminergic system (pitolisant), dopamine reuptake transmission (solriamfetol), and gamma-aminobutyric acid modulation (flumazenil and clarithromycin) to promote wakefulness. Continued research is required for a more solid understanding of the biology of these conditions to develop a more robust armamentarium of therapeutic options.
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Affiliation(s)
- Ajay C Sampat
- Department of Neurology, UC Davis School of Medicine, Sacramento, California, U.S.A.; and
| | - Alon Y Avidan
- Department of Neurology, UCLA School of Medicine; UCLA Sleep Disorders Center, Los Angels, California, U.S.A
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Ingram DG, Jesteadt L, Crisp C, Simon SL. Treatment and care delivery in pediatric narcolepsy: a survey of parents, youth, and sleep physicians. J Clin Sleep Med 2021; 17:875-884. [PMID: 33283753 DOI: 10.5664/jcsm.9054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES To describe the most commonly used treatments in pediatric narcolepsy and their perceived effectiveness, as well as to elicit key stakeholder perspectives on the most optimal manner in which care ought to be delivered to youth with narcolepsy. METHODS A cross-sectional survey of youth with narcolepsy, parents, and sleep physicians. RESULTS Complete survey results were available for 35 youth with narcolepsy, 116 parents, and 30 sleep physicians. Overall there was general agreement among family and physicians regarding most effective treatments, including both pharmacologic (stimulants, sodium oxybate, and modafinil/armodafinil) and nonpharmacologic (sleep schedule, exercise, diet) approaches. There was a stronger interested in cannabidiol oil (CBD) from families compared to physicians. Both families and physicians also endorsed a need for multispecialty care, ideally delivered in a same day setting and including specialists in mental health, social work, and nutrition. Quality measures were felt to be important but are not currently tracked by most sleep physicians. Qualitative responses highlight the value families place on providers who listen well and remain open-minded. CONCLUSIONS Our results suggest strong support by key stakeholders for an interdisciplinary approach to care for youth with narcolepsy.
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Affiliation(s)
| | | | | | - Stacey L Simon
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Weaver TE, Mathias SD, Crosby RD, Bron M, Bujanover S, Menno D, Villa KF, Drake C. Relationship between sleep efficacy endpoints and measures of functional status and health-related quality of life in participants with narcolepsy or obstructive sleep apnea treated for excessive daytime sleepiness. J Sleep Res 2021; 30:e13210. [PMID: 33051943 PMCID: PMC8244115 DOI: 10.1111/jsr.13210] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/20/2022]
Abstract
This study examined the correlation between improvements in excessive daytime sleepiness in participants with obstructive sleep apnea or narcolepsy and changes in functional status, work productivity and health-related quality of life. Data from two 12-week randomized controlled trials of solriamfetol were analyzed. Participants completed the Epworth Sleepiness Scale, 10-item Functional Outcomes of Sleep Questionnaire, Work Productivity and Activity Impairment questionnaire and 36-Item Short Form Health Survey and performed the Maintenance of Wakefulness Test at baseline and weeks 4, 8 and 12. Patient Global Impression of Change was assessed at weeks 4, 8 and 12. Pearson correlations were calculated for change in scores from baseline to week 12. For both studies, changes in the 10-item Functional Outcomes of Sleep Questionnaire were highly correlated (absolute value >0.5) with changes in Epworth Sleepiness Scale scores; changes in multiple domain scores of the 36-Item Short Form Health Survey and Work Productivity and Activity Impairment questionnaire were moderately correlated (0.3-0.5) with changes in Epworth Sleepiness Scale scores in both studies and highly correlated for participants with narcolepsy. Changes in Maintenance of Wakefulness Test scores correlated moderately with changes in Epworth Sleepiness Scale scores in both studies. At week 12, Patient Global Impression of Change ratings correlated highly with Epworth Sleepiness Scale and 10-item Functional Outcomes of Sleep Questionnaire scores for both disorders. Other correlations were low. Self-reported assessments of sleepiness and global improvement appear to be more strongly correlated with measures of functioning and health-related quality of life than objectively assessed sleepiness.
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Affiliation(s)
- Terri E. Weaver
- Department of Biobehavioral Nursing ScienceCenter for Sleep and Health ResearchCollege of Nursing; Division of Pulmonary, Critical Care, Sleep & Allergy, Department of Medicine, College of MedicineUniversity of Illinois at ChicagoChicagoILUSA
- Division of Pulmonary, Critical Care, Sleep & AllergyDepartment of MedicineCollege of MedicineUniversity of Illinois at ChicagoChicagoILUSA
| | | | - Ross D. Crosby
- Health Outcomes SolutionsWinter ParkFLUSA
- Sanford Center for Bio‐Behavioral ResearchFargoNDUSA
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Trotti LM, Becker LA, Friederich Murray C, Hoque R. Medications for daytime sleepiness in individuals with idiopathic hypersomnia. Cochrane Database Syst Rev 2021; 5:CD012714. [PMID: 34031871 PMCID: PMC8144933 DOI: 10.1002/14651858.cd012714.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Idiopathic hypersomnia is a disorder of excessive daytime sleepiness, often accompanied by long sleep times or pronounced difficulty in awakening, in the absence of a known cause. The optimal treatment strategy for idiopathic hypersomnia is currently unknown. OBJECTIVES To assess the effects of medications for daytime sleepiness and related symptoms in individuals with idiopathic hypersomnia and, in particular, whether medications may: 1. reduce subjective measures of sleepiness; 2. reduce objective measures of sleepiness; 3. reduce symptoms of cognitive dysfunction; 4. improve quality of life; and 5. be associated with adverse events. SEARCH METHODS We searched the following databases on 4 February 2021: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to 1 February 2021), and reference lists of articles. CRS Web includes randomized or quasi-randomized controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the specialized registers of Cochrane Review Groups, including the Cochrane Epilepsy Group. We previously searched the WHO ICTRP separately when loading of ICTRP records into CRS Web was temporarily suspended. SELECTION CRITERIA Randomized studies comparing any medication to placebo, another medication, or a behavioral intervention. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality. We contacted study authors for additional data. We collected data on adverse events from the included trials. MAIN RESULTS We included three trials, with a total of 112 participants. Risk of bias was low for the included studies. Two pharmaceutical company-sponsored trials compared modafinil with placebo, involving 102 participants, nearly all of whom had idiopathic hypersomnia without long sleep time. Modafinil significantly improved self-reported sleepiness on the Epworth Sleepiness Scale by 5.08 points more than placebo (95% confidence interval (CI) 3.01 to 7.16; 2 studies, 101 participants; high-certainty evidence). Modafinil also significantly improved disease severity on the Clinical Global Impression of Severity scale by 1.02 points (95% CI 0.11 to 1.93; 1 study, 30 participants; moderate-certainty evidence) and resulted in a greater proportion of participants who were "much improved" or "very much improved" on the Clinical Global Impression of Change (odds ratio (OR) for improvement 5.14, 95% CI 1.76 to 15.00; 1 study, 70 participants; moderate-certainty evidence). Ability to remain awake on the Maintenance of Wakefulness Test was significantly improved with modafinil, by 4.74 minutes more than with placebo (95% CI 2.46 to 7.01; 2 studies, 99 participants; high-certainty evidence). Ratings of exhaustion and effectiveness/performance were improved with modafinil compared to placebo in one study. Number of naps per week was no different between modafinil and placebo across two studies. Participants receiving modafinil experienced more side effects, although the difference did not reach statistical significance (OR 1.68, 95% CI 0.28 to 9.94; 2 studies, 102 participants; low-certainty evidence). One trial studying 20 participants with different disorders of sleepiness included 10 participants with idiopathic hypersomnia, with or without long sleep time, and compared clarithromycin to placebo. We only included the subset of trial data for those participants with idiopathic hypersomnia, per our protocol. There were no significant differences between clarithromycin and placebo for the Epworth Sleepiness Scale, psychomotor vigilance testing, sleep inertia, other subjective ratings, or side effects. AUTHORS' CONCLUSIONS Modafinil is effective for the treatment of several aspects of idiopathic hypersomnia symptomatology, based on studies predominantly including participants with idiopathic hypersomnia without long sleep times, with low risk of bias, and evidence certainty ranging from high to low. There is insufficient evidence to conclude whether clarithromycin is effective for the treatment of idiopathic hypersomnia. There is a clear need for additional studies testing interventions for the treatment of idiopathic hypersomnia.
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Affiliation(s)
- Lynn M Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, USA
| | - Lorne A Becker
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Romy Hoque
- Department of Neurology, Emory University School of Medicine, Atlanta, USA
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Yahyaei H, Sharifi S, Shahab S, Sheikhi M, Ahmadianarog M. Theoretical Study of Adsorption of Solriamfetol Drug on Surface of the B12N12 Fullerene: A DFT/TD-DFT Approach. LETT ORG CHEM 2021. [DOI: 10.2174/1570178617999200818104322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
For the first time in the present study, we studied the adsorption effect of the Solriamfetol
(SOF) on the electronic and optical properties of B<sub>12</sub>N<sub>12</sub> fullerene using density functional theory
(DFT) and time-dependent density functional theory (TD-DFT) calculations with the M062X/6-
311++G(d,p) level of theory in the solvent water. The calculated adsorption energies of SOF drug with
the B<sub>12</sub>N<sub>12</sub> fullerene were computed at T= 298.15 K with the M062X functional. The UV/Vis absorption
spectra were computed and investigated for the study of the significant changes in interactions between
SOF and B12N12 fullerene. The IR spectra were also calculated and investigated. The calculated
results indicate that the adsorption of the SOF drug from its internal NH<sub>2</sub> group on the B<sub>12</sub>N<sub>12</sub> fullerene
(configuration B) has the most chemical stability rather than configuration A and C. According to the
NBO results, the SOF molecule and B<sub>12</sub>N<sub>12</sub> fullerene are identified as both electrons donor and acceptor
at the complexes B<sub>12</sub>N<sub>12</sub>-SOF. On the other hand, the charge transfer occurs between the bonding,
anti-bonding, or nonbonding orbitals in the SOF drug and B<sub>12</sub>N<sub>12</sub> fullerene. It is found that the applied
B<sub>12</sub>N<sub>12</sub> fullerene can be suitable as a drug carrier for the delivery of SOF as a drug for the treatment of
excessive sleepiness.
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Affiliation(s)
- Hooriye Yahyaei
- Department of Chemistry, Zanjan Branch, Islamic Azad University, Zanjan,Iran
| | - Shamsa Sharifi
- Department of Chemistry, Robat Karim Branch, Islamic Azad University, Robat Karim,Iran
| | | | - Masoome Sheikhi
- Young Researchers and Elite Club, Gorgan Branch, Islamic Azad University, Gorgan,Iran
| | - Mahin Ahmadianarog
- Department of Chemistry, Malekan Branch, Islamic Azad University, Malekan,Iran
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Postiglione E, Pizza F, Ingravallo F, Vignatelli L, Filardi M, Mangiaruga A, Antelmi E, Moresco M, Oriolo C, Pagotto U, Plazzi G. Impact of COVID-19 pandemic lockdown on narcolepsy type 1 management. Brain Behav 2021; 11:e01955. [PMID: 33247632 PMCID: PMC7744913 DOI: 10.1002/brb3.1955] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/02/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022] Open
Abstract
STUDY OBJECTIVES Narcolepsy type 1 (NT1) is a chronic rare hypersomnia of central origin requiring a combination of behavioral and pharmacological treatments. During the coronavirus disease 2019 (COVID-19) pandemic, in Italy the population was forced into a lockdown. With this study, we aimed to describe the lockdown impact on NT1 symptom management, according to different patients' working schedule. METHODS In the period between 10 April and 15 May 2020, we performed routine follow-up visits by telephone (as recommended during the COVID-19 emergency) to 50 patients >18 years old (40% males) under stable long-term treatment. We divided patients into three groups: unchanged working schedule, forced working/studying at home, and those who lost their job ("lost occupation"). Current sleep-wake habit and symptom severity were compared with prelockdown assessment (six months before) in the three patient groups. RESULTS At assessment, 20, 22, and eight patients belonged to the unchanged, working/studying at home, and lost occupation groups, respectively. While in the lost occupation group, there were no significant differences compared with prepandemic assessment, the patients with unchanged schedules reported more nocturnal awakenings, and NT1 patients working/studying at home showed an extension of nocturnal sleep time, more frequent daytime napping, improvement of daytime sleepiness, and a significant increase in their body mass index. Sleep-related paralysis/hallucinations, automatic behaviors, cataplexy, and disturbed nocturnal sleep did not differ. CONCLUSIONS Narcolepsy type 1 patients working/studying at home intensified behavioral interventions (increased nocturnal sleep time and daytime napping) and ameliorated daytime sleepiness despite presenting with a slight, but significant, increase of weight.
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Affiliation(s)
- Emanuela Postiglione
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Anastasia Mangiaruga
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Monica Moresco
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Claudia Oriolo
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Policlinic, University of Bologna, Bologna, Italy
| | - Uberto Pagotto
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Policlinic, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
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Franceschini C, Pizza F, Cavalli F, Plazzi G. A practical guide to the pharmacological and behavioral therapy of Narcolepsy. Neurotherapeutics 2021; 18:6-19. [PMID: 33886090 PMCID: PMC8061157 DOI: 10.1007/s13311-021-01051-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 01/19/2023] Open
Abstract
Narcolepsy is a rare, chronic, and disabling central nervous system hypersomnia; two forms can be recognized: narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). Its etiology is still largely unknown, but studies have reported a strong association between NT1 and HLA, as well as a pathogenic association with the deficiency of cerebrospinal hypocretin-1. Thus, the most reliable pathogenic hypothesis is an autoimmune process destroying hypothalamic hypocretin-producing cells. A definitive cure for narcolepsy is not available to date, and although the research in the field is highly promising, up to now, current treatments have aimed to reduce the symptoms by means of different pharmacological approaches. Moreover, overall narcolepsy symptoms management can also benefit from non-pharmacological approaches such as cognitive behavioral therapies (CBTs) and psychosocial interventions to improve the patients' quality of life in both adult and pediatric-affected individuals as well as the well-being of their families. In this review, we summarize the available therapeutic options for narcolepsy, including the pharmacological, behavioral, and psychosocial interventions.
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Affiliation(s)
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Francesca Cavalli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy.
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Abstract
Sleep telemedicine practitioners must ensure their practice complies with all applicable institutional, state, and federal regulations. Providers must be licensed in any state in which they provide care, have undergone credentialing and privileging procedures at outside facilities, and avoid real or perceived conflicts of interest while providing that care. Internet-based prescribing remains limited to certain circumstances. Whether or not a malpractice insurance policy covers telemedicine depends on the insurer, especially if interstate care is provided. All telemedicine programs must protect patient health information. Similarly, bioethical principles of autonomy, beneficence, nonmaleficence, and justice apply to both in-person and telemedicine-based care.
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Lim DC, Mazzotti DR, Sutherland K, Mindel JW, Kim J, Cistulli PA, Magalang UJ, Pack AI, de Chazal P, Penzel T. Reinventing polysomnography in the age of precision medicine. Sleep Med Rev 2020; 52:101313. [PMID: 32289733 PMCID: PMC7351609 DOI: 10.1016/j.smrv.2020.101313] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
For almost 50 years, sleep laboratories around the world have been collecting massive amounts of polysomnographic (PSG) physiological data to diagnose sleep disorders, the majority of which are not utilized in the clinical setting. Only a small fraction of the information available within these signals is utilized to generate indices. For example, the apnea-hypopnea index (AHI) remains the primary tool for diagnostic and therapeutic decision-making for obstructive sleep apnea (OSA) despite repeated studies showing it to be inadequate in predicting clinical consequences. Today, there are many novel approaches to PSG signals, making it possible to extract more complex metrics and analyses that are potentially more clinically relevant for individual patients. However, the pathway to implement novel PSG metrics/analyses into routine clinical practice is unclear. Our goal with this review is to highlight some of the novel PSG metrics/analyses that are becoming available. We suggest that stronger academic-industry relationships would facilitate the development of state-of-the-art clinical research to establish the value of novel PSG metrics/analyses in clinical sleep medicine. Collectively, as a sleep community, it is time to reinvent how we utilize the polysomnography to move us towards Precision Sleep Medicine.
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Affiliation(s)
- Diane C Lim
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States.
| | - Diego R Mazzotti
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States
| | - Kate Sutherland
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Jesse W Mindel
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Wexner Medical Center, United States
| | - Jinyoung Kim
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Wexner Medical Center, United States
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States
| | - Philip de Chazal
- Charles Perkins Centre and School of Electrical and Information Engineering, Faculty of Engineering, University of Sydney, Australia
| | - Thomas Penzel
- Center for Sleep Medicine, Charite Universitätsmedizin, Berlin, Germany; Saratov State University, Saratov, Russia
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12
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Hershner S, Kakkar R, Chung F, Singh M, Wong J, Auckley D. Narcolepsy, Anesthesia, and Sedation: A Survey of the Perioperative Experience of Patients With Narcolepsy. Anesth Analg 2020; 129:1374-1380. [PMID: 30540615 DOI: 10.1213/ane.0000000000003954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with narcolepsy may be at increased perioperative risk due to the interactions among anesthesia, narcolepsy, and narcolepsy medications. This study sought to determine the perioperative experience of narcoleptic patients undergoing anesthesia or sedation, the frequency of perioperative counseling, and self-reported surgical complications. METHODS A 22-question survey was developed by expert consensus and distributed by the Narcolepsy Network. Recruitment was via the Narcolepsy Network's list-serve and a Facebook link to the survey. One thousand and twenty respondents reported a diagnosis of narcolepsy and 1 or more procedures under anesthesia or sedation. Descriptive, comparative statistics and logistic regression were utilized. RESULTS Respondents were mostly women (79.5%) and Caucasian (84.9%), with a mean age of 45 ± 16 years. Most respondents did not receive counseling regarding the possibility of increased sleepiness (70%), cataplexy (90%), or drowsy driving (59%) postanesthesia. More than half of respondents reported adverse events (medication withdrawal symptoms, inadequate pain relief, increased cataplexy). Subjects with cataplexy more frequently reported surgical complications (70% vs 31%; P = .03) and medication withdrawal symptoms (stimulant medications: odds ratio, 3.0 [95% CI, 1.9, 3.06]; P > .001 and antidepressant medications: odds ratio, 6.5 [95% CI, 2.1-19.5]; P = .001). Of the total sample, 18% indicated surgical complications. Undergoing 5 or more separate surgeries or procedures was associated with a 2-fold increase in self-reported complications (odds ratio, 2.2 [95% CI, 1.3-3.4]; P = .001), difficulty waking (odds ratio, 2.1 [95% CI, 1.45-3.06]; P = .001), and inadequate pain relief (odds ratio, 1.77 [95% CI, 1.01-3.13]; P < .05). CONCLUSIONS Most narcoleptic patients report not receiving counseling regarding potential worsening of narcolepsy symptoms postanesthesia or an increased risk of drowsy driving. Enhanced education of perioperative providers about potential narcolepsy-related issues is essential. Respondents frequently self-report adverse events in the perioperative period. Future studies should clarify the perioperative risk associated with narcolepsy to optimize the care and safety of narcoleptic patients.
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Affiliation(s)
- Shelley Hershner
- From the Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Rahul Kakkar
- Narcolepsy Network Inc, North Kingstown, Rhode Island.,Prana Health, Doral, Florida
| | - Frances Chung
- Department of Anesthesia, University Health Network - University of Toronto, Toronto, Ontario, Canada
| | - Mandeep Singh
- Department of Anesthesia, University Health Network - University of Toronto, Toronto, Ontario, Canada.,Toronto Sleep and Pulmonary Centre, Toronto, Ontario, Canada
| | - Jean Wong
- Department of Anesthesia, University Health Network - University of Toronto, Toronto, Ontario, Canada
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Cleveland, Ohio
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Aguilar AC, Frange C, Pimentel Filho LH, Reis MJ, Tufik S, Coelho FMS. Lisdexamfetamine to improve excessive daytime sleepiness and weight management in narcolepsy: a case series. ACTA ACUST UNITED AC 2019; 42:314-316. [PMID: 31859793 PMCID: PMC7236164 DOI: 10.1590/1516-4446-2019-0544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/05/2019] [Indexed: 11/22/2022]
Abstract
Objective: To report the successful use of lisdexamfetamine in the management of narcolepsy. Methods: Five narcoleptic patients received lisdexamfetamine, at different dosages and for different periods, for management of excessive daytime sleepiness and weight control. Results: All patients experienced improvement of excessive daytime sleepiness and lost weight without side effects. Conclusion: Lisdexamfetamine appears promising for the treatment of two of the most common symptoms of narcolepsy: excessive daytime sleepiness and weight gain.
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Affiliation(s)
- Ana C Aguilar
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Cristina Frange
- Departamento de Neurologia e Neurocirurgia, UNIFESP, São Paulo, SP, Brazil
| | - Lucio H Pimentel Filho
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria J Reis
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernando M S Coelho
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Neurologia e Neurocirurgia, UNIFESP, São Paulo, SP, Brazil
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14
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Update on the Treatment of Idiopathic Hypersomnia. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
Idiopathic hypersomnia is an incapacitating disorder with a profound impact on daytime performance and quality of life. The most commonly used treatment modalities are lifestyle advice and pharmacological therapy. We present an update on the evidence concerning treatment options for idiopathic hypersomnia.
Recent Findings
Evidence for non-pharmacological interventions is lacking; improvement in symptoms on introducing these interventions is often less pronounced than in narcolepsy. Additional pharmacological treatment is therefore usually initiated. The few treatment studies that have been performed are hampered by small sample sizes and the use of variable and often insufficiently validated outcome parameters for the whole spectrum of idiopathic hypersomnia symptoms.
Conclusion
Evidence on treatment is scarce. Since the efficacy of modafinil is consistently described and there is much experience with this substance, it is reasonable to start with modafinil as a first choice treatment. Methylphenidate and dexamphetamine are good alternatives. In the future, newer drugs such as sodium oxybate, pitolisant, and solriamfetol might be authorized for use in idiopathic hypersomnia.
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15
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Likhachev SA, Chechyk NM, Haliyeuskaya OV, Rushkevich YN. [Psychogenically induced narcolepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:99-104. [PMID: 31626225 DOI: 10.17116/jnevro201911909199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Based on own clinical experience in diagnostics and treatment of 4 patients, the authors describe main clinical presentations of narcolepsy. A case report of a 20-year female patient with psychogenic narcolepsy induced by a conflict in the family is described in details. According to polysomnography and Multiple Sleep Latency Test, a reduction in latency to sleep is 22 sec - 3 min 30 sec and the time of occurrence of REM sleep is 7 min 30 sec. The diagnosis is made on the basis of diagnostic criteria of narcolepsy. On average, it takes about 7-10 years to diagnose narcolepsy that reduces the quality of life of patients and leads to social and household maladaptation. Physicians should be wary of early identification of this disease for dynamic monitoring, the appointment of symptomatic therapy, prevention of anxiety and depression and the generation of behavior algorithm in the patient and his relatives in order to maximize social and household adaptation.
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Affiliation(s)
- S A Likhachev
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic Belarus
| | - N M Chechyk
- Republican Clinical Medical Center of the Presidential Administration of the Republic Belarus, Minsk, Republic Belarus
| | - O V Haliyeuskaya
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic Belarus
| | - Yu N Rushkevich
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic Belarus
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16
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Franceschini C, Pizza F, Antelmi E, Folli MC, Plazzi G. Narcolepsy treatment: pharmacological and behavioral strategies in adults and children. Sleep Breath 2019; 24:615-627. [PMID: 31290083 DOI: 10.1007/s11325-019-01894-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 11/27/2022]
Abstract
Narcolepsy is a disabling, rare, and chronic sleep disorder, currently classified as distinct central nervous system hypersomnia in narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). Although today a reliable pathogenic hypothesis identifies the cause of NT1 as an autoimmune process destroying hypocretin-producing cells, there is no cure for narcolepsy, and the symptomatic pharmacological available treatments are not entirely effective for all symptoms. Behavioral therapies play a synergistic role in the disease treatment. We here review the available therapeutic options for narcolepsy, including symptomatic pharmacological treatments as well as behavioral and psychosocial interventions that could help clinicians improve the quality of life of patients with narcolepsy in adulthood and childhood.
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Affiliation(s)
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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17
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Miskoff JA, Chaudhri M. A Case of Off-label Sodium Oxybate in an 11-Year-Old with Narcolepsy. Cureus 2019; 11:e4057. [PMID: 31016084 PMCID: PMC6464478 DOI: 10.7759/cureus.4057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Narcolepsy is a rare chronic condition which affects sleep architecture. It may manifest in childhood or adolescence by causing excessive daytime sleepiness, sleep attacks, and hallucinations. Research suggests that there is a significant delay in diagnosis with the mean age being 10 to 15 years from onset of symptoms. Although narcolepsy is predominantly associated with loss of hypocretin (orexin), the role of genetics is complementary to the diagnosis. In addition, clinical manifestations of symptoms vary in presentation and severity from case to case. Therefore, this report provides an opportunity to review pediatric narcolepsy including the diagnostic workup and clinical response to sodium oxybate. This particular case describes an 11-year-old boy meeting the clinical and diagnostic criteria for narcolepsy. Clinically, the patient had a very positive response to treatment with sodium oxybate, which at the time of initiating therapy was off-label for patients under the age of 18.
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Affiliation(s)
- Jeffrey A Miskoff
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Moiuz Chaudhri
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
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18
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Baladi MG, Forster MJ, Gatch MB, Mailman RB, Hyman DL, Carter LP, Janowsky A. Characterization of the Neurochemical and Behavioral Effects of Solriamfetol (JZP-110), a Selective Dopamine and Norepinephrine Reuptake Inhibitor. J Pharmacol Exp Ther 2018; 366:367-376. [PMID: 29891587 DOI: 10.1124/jpet.118.248120] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022] Open
Abstract
Excessive sleepiness (ES) is associated with several sleep disorders, including narcolepsy and obstructive sleep apnea (OSA). A role for monoaminergic systems in treating these conditions is highlighted by the clinical use of US Food and Drug Administration-approved drugs that act on these systems, such as dextroamphetamine, methylphenidate, modafinil, and armodafinil. Solriamfetol (JZP-110) is a wake-promoting agent that is currently being evaluated to treat ES in patients with narcolepsy or OSA. Clinical and preclinical data suggest that the wake-promoting effects of solriamfetol differ from medications such as modafinil and amphetamine. The goal of the current studies was to characterize the mechanism of action of solriamfetol at monoamine transporters using in vitro and in vivo assays. Results indicate that solriamfetol has dual reuptake inhibition activity at dopamine (DA; IC50 = 2.9 μM) and norepinephrine (NE; IC50 = 4.4 μM) transporters, and this activity is associated in vivo with increased extracellular concentration of DA and NE as measured by microdialysis. Solriamfetol has negligible functional activity at the serotonin transporter (IC50 > 100 μM). Moreover, the wake-promoting effects of solriamfetol are probably owing to activity at DA and NE transporters rather than other neurotransmitter systems, such as histamine or orexin. The dual activity of solriamfetol at DA and NE transporters and the lack of significant monoamine-releasing properties of solriamfetol might explain the differences in the in vivo effects of solriamfetol compared with modafinil or amphetamine. Taken together, these data suggest that solriamfetol may offer an important advancement in the treatment of ES in patients with narcolepsy or OSA.
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Affiliation(s)
- Michelle G Baladi
- Jazz Pharmaceuticals, Palo Alto, California (M.G.B., D.L.H., L.P.C.); Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas (M.J.F., M.B.G.); Departments of Pharmacology and Neurology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania (R.B.M.); University of Arkansas for Medical Sciences, Little Rock, Arkansas (L.P.C.); Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon (A.J.); and Departments of Psychiatry and Behavioral Neuroscience, and Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon (A.J.)
| | - Michael J Forster
- Jazz Pharmaceuticals, Palo Alto, California (M.G.B., D.L.H., L.P.C.); Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas (M.J.F., M.B.G.); Departments of Pharmacology and Neurology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania (R.B.M.); University of Arkansas for Medical Sciences, Little Rock, Arkansas (L.P.C.); Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon (A.J.); and Departments of Psychiatry and Behavioral Neuroscience, and Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon (A.J.)
| | - Michael B Gatch
- Jazz Pharmaceuticals, Palo Alto, California (M.G.B., D.L.H., L.P.C.); Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas (M.J.F., M.B.G.); Departments of Pharmacology and Neurology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania (R.B.M.); University of Arkansas for Medical Sciences, Little Rock, Arkansas (L.P.C.); Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon (A.J.); and Departments of Psychiatry and Behavioral Neuroscience, and Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon (A.J.)
| | - Richard B Mailman
- Jazz Pharmaceuticals, Palo Alto, California (M.G.B., D.L.H., L.P.C.); Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas (M.J.F., M.B.G.); Departments of Pharmacology and Neurology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania (R.B.M.); University of Arkansas for Medical Sciences, Little Rock, Arkansas (L.P.C.); Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon (A.J.); and Departments of Psychiatry and Behavioral Neuroscience, and Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon (A.J.)
| | - Danielle L Hyman
- Jazz Pharmaceuticals, Palo Alto, California (M.G.B., D.L.H., L.P.C.); Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas (M.J.F., M.B.G.); Departments of Pharmacology and Neurology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania (R.B.M.); University of Arkansas for Medical Sciences, Little Rock, Arkansas (L.P.C.); Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon (A.J.); and Departments of Psychiatry and Behavioral Neuroscience, and Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon (A.J.)
| | - Lawrence P Carter
- Jazz Pharmaceuticals, Palo Alto, California (M.G.B., D.L.H., L.P.C.); Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas (M.J.F., M.B.G.); Departments of Pharmacology and Neurology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania (R.B.M.); University of Arkansas for Medical Sciences, Little Rock, Arkansas (L.P.C.); Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon (A.J.); and Departments of Psychiatry and Behavioral Neuroscience, and Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon (A.J.)
| | - Aaron Janowsky
- Jazz Pharmaceuticals, Palo Alto, California (M.G.B., D.L.H., L.P.C.); Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas (M.J.F., M.B.G.); Departments of Pharmacology and Neurology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania (R.B.M.); University of Arkansas for Medical Sciences, Little Rock, Arkansas (L.P.C.); Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon (A.J.); and Departments of Psychiatry and Behavioral Neuroscience, and Methamphetamine Abuse Research Center, Oregon Health and Science University, Portland, Oregon (A.J.)
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19
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Time for a standardized clinical assessment for narcolepsy with obstructive sleep apnea. Sleep Breath 2018. [DOI: 10.1007/s11325-017-1516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Abstract
Idiopathic hypersomnia (IH) is a chronic neurologic disorder of daytime sleepiness, accompanied by long sleep times, unrefreshing sleep, difficulty in awakening, cognitive dysfunction, and autonomic symptoms. The cause is unknown; a genetic predisposition is suggested. Autonomic, inflammatory, or immune dysfunction has been proposed. Diagnosis involves a clinical history and objective testing. There are no approved treatments for IH, but modafinil is typically considered first-line. A substantial fraction of patients with IH are refractory or intolerant to standard treatments, and different treatment strategies using novel therapeutics are necessary. Even with current treatment options, quality of life and safety may remain impaired.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA.
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21
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Trotti LM, Becker LA, Friederich Murray C, Hoque R. Medications for daytime sleepiness in individuals with idiopathic hypersomnia. Hippokratia 2017. [DOI: 10.1002/14651858.cd012714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lynn M Trotti
- Emory University School of Medicine; Department of Neurology; 12 Executive Park Drive NE Atlanta USA 30329
| | - Lorne A Becker
- SUNY Upstate Medical University; Department of Family Medicine; 475 Irving Ave Suite 200 Syracuse New York USA 13210
| | | | - Romy Hoque
- Emory University School of Medicine; Department of Neurology; 12 Executive Park Drive NE Atlanta USA 30329
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22
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Kallweit U, Bassetti CL. Pharmacological management of narcolepsy with and without cataplexy. Expert Opin Pharmacother 2017; 18:809-817. [PMID: 28443381 DOI: 10.1080/14656566.2017.1323877] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ulf Kallweit
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, Narcolepsy-Center, HELIOS Klinik Hagen Ambrock, Hagen, Germany
- Department of Rehabilitation, University of Witten/Herdecke, Witten, Germany
| | - Claudio L. Bassetti
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
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23
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Maski K, Steinhart E, Williams D, Scammell T, Flygare J, McCleary K, Gow M. Listening to the Patient Voice in Narcolepsy: Diagnostic Delay, Disease Burden, and Treatment Efficacy. J Clin Sleep Med 2017; 13:419-425. [PMID: 27923434 DOI: 10.5664/jcsm.6494] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/21/2016] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVES Describe common symptoms, comorbidities, functional limitations, and treatment responsiveness among patients with narcolepsy. Investigate the effect of pediatric onset of narcolepsy symptoms on time to diagnosis of narcolepsy and presence of comorbid depression. METHODS Cross-sectional survey of 1,699 people in the United States with self-reported diagnosis of narcolepsy. We utilized mixed-methods data analyses to report study findings. RESULTS Most participants reported receiving a diagnosis of narcolepsy more than 1 y after symptom onset. We found that the strongest predictor of this delayed diagnosis was pediatric onset of symptoms (odds ratio = 2.4, p < 0.0005). Depression was the most common comorbidity but we detected no association with pediatric onset of narcolepsy symptoms. Overall, participants reported that fatigue and cognitive difficulties were their most burdensome symptoms in addition to sleepiness and cataplexy. The majority of participants reported residual daytime fatigue and/or sleepiness despite treatment. Most participants reported they could not perform at work or school as well as they would like because of narcolepsy symptoms. CONCLUSIONS This study provides unique insight into the narcolepsy disease experience. The study quantifies the problem of diagnostic delay for narcolepsy patients in the United States and highlights that symptoms are more likely to be missed if they develop before 18 y of age. These results suggest that narcolepsy awareness efforts should be aimed at parents, pediatric health care providers, school professionals, and children/adolescents themselves. Disease burden is high because of problems with fatigue, cognition, and persistence of residual symptoms despite treatment.
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Affiliation(s)
- Kiran Maski
- Harvard Medical School, Boston, MA.,Boston Children's Hospital, Boston, MA
| | | | - David Williams
- Harvard Medical School, Boston, MA.,Boston Children's Hospital, Boston, MA
| | - Thomas Scammell
- Harvard Medical School, Boston, MA.,Beth Israel Deaconess Hospital, Boston, MA
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Morgenthaler TI, Deriy L, Heald JL, Thomas SM. The Evolution of the AASM Clinical Practice Guidelines: Another Step Forward. J Clin Sleep Med 2017; 12:129-35. [PMID: 26518707 DOI: 10.5664/jcsm.5412] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 01/08/2023]
Abstract
ABSTRACT One of the goals of the American Academy of Sleep Medicine (AASM) is to provide clear, evidence-based recommendations in our clinical practice guidelines. Periodically, the AASM will assess and update the process by which these guidelines are developed so that it is in line with the standards currently being used for guideline development. The AASM is now taking the next step forward by fully adopting GRADE (Grading of Recommendation Assessment, Development and Evaluation) as the methodology used for evaluating evidence and forming clinical practice guidelines recommendations. Starting this year, AASM recommendations will be based on the following four interdependent domains: 1. quality of evidence; 2. balance of desirable and undesirable consequences; 3. patients' values and preferences; and 4. resource use (when known). AASM strengths of recommendations will be dichotomized into two categories: "Strong" and "Weak," either for or against a patient-care strategy. In an effort to provide clarity and transparency, all AASM recommendations will be actionable statements that include the specific patient population for which the patient-care strategy is recommended, and clearly define the comparator against which the patient-care strategy was evaluated. In some recommendations, the comparator will be an alternative patient-care strategy (e.g., a "gold standard" or previously available alternative), while in other recommendations the comparator will be a placebo or no treatment; this is determined by the availability of evidence, and analyses decisions made by the AASM task force. Implementation of the complete GRADE criteria by the AASM allows us the best path forward towards continuing to provide high quality clinical practice guidelines.
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25
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Cremaschi RC, Hirotsu C, Tufik S, Coelho FM. Narcolepsy type 1 and type 2 - a 10-year follow-up: body mass index and comorbidities. Sleep Med 2017; 32:285-286. [PMID: 28065686 DOI: 10.1016/j.sleep.2016.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Renata Carvalho Cremaschi
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernando Morgadinho Coelho
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.
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Abstract
Narcolepsy is a life-long, underrecognized sleep disorder that affects 0.02%-0.18% of the US and Western European populations. Genetic predisposition is suspected because of narcolepsy's strong association with HLA DQB1*06-02, and genome-wide association studies have identified polymorphisms in T-cell receptor loci. Narcolepsy pathophysiology is linked to loss of signaling by hypocretin-producing neurons; an autoimmune etiology possibly triggered by some environmental agent may precipitate hypocretin neuronal loss. Current treatment modalities alleviate the main symptoms of excessive daytime somnolence (EDS) and cataplexy and, to a lesser extent, reduce nocturnal sleep disruption, hypnagogic hallucinations, and sleep paralysis. Sodium oxybate (SXB), a sodium salt of γ hydroxybutyric acid, is a first-line agent for cataplexy and EDS and may help sleep disruption, hypnagogic hallucinations, and sleep paralysis. Various antidepressant medications including norepinephrine serotonin reuptake inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants are second-line agents for treating cataplexy. In addition to SXB, modafinil and armodafinil are first-line agents to treat EDS. Second-line agents for EDS are stimulants such as methylphenidate and extended-release amphetamines. Emerging therapies include non-hypocretin-based therapy, hypocretin-based treatments, and immunotherapy to prevent hypocretin neuronal death. Non-hypocretin-based novel treatments for narcolepsy include pitolisant (BF2.649, tiprolisant); JZP-110 (ADX-N05) for EDS in adults; JZP 13-005 for children; JZP-386, a deuterated sodium oxybate oral suspension; FT 218 an extended-release formulation of SXB; and JNJ-17216498, a new formulation of modafinil. Clinical trials are investigating efficacy and safety of SXB, modafinil, and armodafinil in children. γ-amino butyric acid (GABA) modulation with GABAA receptor agonists clarithromycin and flumazenil may help daytime somnolence. Other drugs investigated include GABAB agonists (baclofen), melanin-concentrating hormone antagonist, and thyrotropin-releasing hormone agonists. Hypocretin-based therapies include hypocretin peptide replacement administered either through an intracerebroventricular route or intranasal route. Hypocretin neuronal transplant and transforming stem cells into hypothalamic neurons are also discussed in this article. Immunotherapy to prevent hypocretin neuronal death is reviewed.
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Affiliation(s)
- Vivien C Abad
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University Outpatient Center, Redwood City, CA, USA
| | - Christian Guilleminault
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University Outpatient Center, Redwood City, CA, USA
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Lapid MI, Kuntz KM, Mason SS, Aakre JA, Lundt ES, Kremers W, Allen LA, Drubach DA, Boeve BF. Efficacy, Safety, and Tolerability of Armodafinil Therapy for Hypersomnia Associated with Dementia with Lewy Bodies: A Pilot Study. Dement Geriatr Cogn Disord 2017; 43:269-280. [PMID: 28448998 PMCID: PMC5503747 DOI: 10.1159/000471507] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS Hypersomnia is common in dementia with Lewy bodies (DLB). We assessed the efficacy, safety, and tolerability of armodafinil for hypersomnia associated with DLB. METHODS We performed a 12-week pilot trial of armodafinil therapy (125-250 mg orally daily) in DLB outpatients with hypersomnia. The patients underwent neurologic examinations, a neuropsychological battery, laboratory testing, electrocardiography, and polysomnography. Efficacy was assessed at 2, 4, 8, and 12 weeks. Safety assessment included laboratory examinations, QTc interval, and heart rate. Tolerability was assessed by analysis of adverse events. Data were analyzed using the last-observation-carried-forward method. RESULTS Of 20 participants, 17 completed the protocol. The median age was 72 years, most of the participants were men (80%), and most had spouses as caregivers. The Epworth Sleepiness Scale (p < 0.001), Maintenance of Wakefulness Test (p = 0.003), and Clinical Global Impression of Change (p < 0.001) scores improved at week 12. The Neuropsychiatric Inventory total score (p = 0.003), visual hallucinations (p = 0.003), and agitation (p = 0.02) improved at week 4. Caregiver overall quality of life improved at week 12 (p = 0.004). No adverse events occurred. CONCLUSION These pilot data suggest improvements in hypersomnia and wakefulness and reasonable safety and tolerability of armodafinil therapy in hypersomnolent patients with DLB. Our findings inform the use of pharmacologic strategies for managing hypersomnolence in these patients.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Current and future treatment options for narcolepsy: A review. Sleep Sci 2017. [DOI: 10.1016/j.slsci.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Narcolepsy is a chronic neurological sleep disorder with potentially disabling
symptoms ranging from occupational concerns to mental health difficulties.
Recent advances related to the neurobiological basis of narcolepsy have led to
newer pharmacological treatment options and adjunctive behavioral techniques
that support symptom management. This article outlines evidence-based
pharmacologic therapies, behavioral techniques, and psychosocial costs related
to narcolepsy. Psychosocial factors, although frequently acknowledged, deserve
further attention and awareness from researchers and providers. The American
Academy of Sleep Medicine's (AASM) Quality Measure Drivers and potential future
treatment options are also discussed.
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Affiliation(s)
| | - Scott Sumerall
- Dwight D. Eisenhower V.A. Medical Center.,University of Missouri-Kansas City
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Singh J, Sharma RK, Gupta AK. A method of REM-NREM sleep distinction using ECG signal for unobtrusive personal monitoring. Comput Biol Med 2016; 78:138-143. [PMID: 27741420 DOI: 10.1016/j.compbiomed.2016.09.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 11/26/2022]
Abstract
Computers are used extensively in sleep labs for polysomnography and for assistance in sleep staging. However, the test is highly inconvenient to the patient and requires availability of specially equipped sleep labs. Alternative approaches that enable unobtrusive in-home sleep staging with ECG or other signals are highly desirable. In this paper we describe a method that can be used for distinction of REM and NREM sleep stages using spectral and non-linear features of ECG derived RR interval series. To test the accuracy of the system, we extracted the RR interval series from sleep studies of 20 young healthy individuals. Time domain, spectral and non-linear features were computed and tested for discriminability. Features showing high degree of discrimination were selected. A polynomial support vector machine was trained with selected features - percent power in HF band, LF/HF, Poincare plot parameters, exponents from Detrended fluctuation analysis, and sampEn of the half of the signals. The hyperplane was used to classify the other half of the data. The results show an accuracy of 76.25% with Cohen's kappa as 0.52 for a two-class model of five minute signal. The results dropped to 72.8% accuracy and k=0.48 for the two class model of one minute signal. The minimal set offers a reasonable trade-off for possible in-home monitoring, at least for some conditions that require only REM-NREM distinction. The method after extensive trials and standardisation, can alleviate the load of special purpose PSG labs and enable the tests to be done on general purpose computers.
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Affiliation(s)
- Jaspal Singh
- Principal Engineer, DECD, CDAC, A-34, Industrial Area, Phase-8, Mohali, India.
| | - R K Sharma
- Department of ECE, National Institute of Technology, Kurukshetra, Haryana, India
| | - A K Gupta
- Department of ECE, National Institute of Technology, Kurukshetra, Haryana, India
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Morgenthaler TI, Aronsky AJ, Carden KA, Chervin RD, Thomas SM, Watson NF. Measurement of quality to improve care in sleep medicine. J Clin Sleep Med 2015; 11:279-91. [PMID: 25700883 DOI: 10.5664/jcsm.4548] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/13/2022]
Abstract
ABSTRACT The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: restless legs syndrome, insomnia, narcolepsy, obstructive sleep apnea in adults, and obstructive sleep apnea in children. This paper describes the rationale, background, general methods development, and considerations in implementation for these sleep disorder quality measures. The Workgroup papers are published in this issue under the following titles: Quality Measures for the Care of Adult Patients with Restless Legs Syndrome, Quality Measures for the Care of Patients with Insomnia, Quality Measures for the Care of Patients with Narcolepsy, Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea, and Quality Measures for the Care of Pediatric Patients with Obstructive Sleep Apnea.
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