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Hsu CW, Tseng PT, Tu YK, Lin PY, Wang LJ, Hung CF, Yang YH, Kao HY, Yeh CB, Lai HC, Chen TY. Month of birth and the risk of narcolepsy: a systematic review and meta-analysis. J Clin Sleep Med 2021; 18:1113-1120. [PMID: 34893148 DOI: 10.5664/jcsm.9816] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study is to evaluate the relationship between the month of birth (MOB) and the risk of narcolepsy. METHODS We conducted a systematic review of electronic databases, namely PubMed, Embase, and Cochrane CENTRAL, from their inception to September 30, 2021. We also added data on narcolepsy from the National Database in Taiwan. Then we extracted the relative risk ratios (RR) of narcolepsy in each month of birth to that of the general population and transformed them from month of birth to season. A random-effects model was used to calculate pooled RRs from the meta-analysis and 95% confidence interval (CI). RESULTS The current meta-analysis analyzed seven studies and included 3776 patients from eight areas. The RR was highest in March (RR 1.11 [95% CI 0.99-1.26]) or August (1.11 [0.98-1.26]) and lowest in April (0.90 [0.78-1.03]). However, none of the MOBs reached statistical significance. Moreover, the patterns of the three continents were different. In North America, the highest and lowest significant risks were found in March (1.47 [1.20-1.79]) and September (0.75 [95% CI 0.56-0.99]). In Asia, the notable lowest risk was in April (0.80 [0.66-0.97]). In Europe, the risk of narcolepsy is not significantly related to any MOB. In terms of seasons, only spring births in North America had a significantly higher risk (1.21 [1.06-1.38]). CONCLUSIONS The findings indicated that the risk of narcolepsy and MOB differed across the three continents. This study indicates the important role of environmental factors in narcolepsy. SYSTEMATIC REVIEW REGISTRATION Registry: PROSPERO; Identifier: CRD42020186660.
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Affiliation(s)
- Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan.,Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Yu Kao
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hsiao-Ching Lai
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
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