Prevalence of narcolepsy symptomatology and diagnosis in the European general population.
ABSTRACT To determine the prevalence of narcolepsy in the general population of five European countries (target population 205,890,882 inhabitants).
Overall, 18,980 randomly selected subjects were interviewed (participation rate 80.4%). These subjects were representative of the general population of the UK, Germany, Italy, Portugal, and Spain. They were interviewed by telephone using the Sleep-EVAL expert system, which provided narcolepsy diagnosis according to the International Classification of Sleep Disorders (ICSD).
Excessive daytime sleepiness was reported by 15% of the sample, with a higher prevalence in the UK and Germany. Napping two times or more in the same day was reported by 1.6% of the sample, with a significantly higher rate in Germany. Cataplexy (episodes of loss of muscle function related to a strong emotion), a cardinal symptom of narcolepsy, was found in 1.6% of the sample. An ICSD narcolepsy diagnosis was found in 0.047% of the sample: The narcolepsy was severe for 0.026% of the sample and moderate in 0.021%.
This is the first epidemiologic study that estimates the prevalence of narcolepsy in the general population of these five European countries. The disorder affects 47 individuals/100,000 inhabitants.
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ABSTRACT: Les symptômes du trouble déficit d’attention avec ou sans hyperactivité (TDA/H) sont fréquemment observés chez les sujets souffrant d’hypersomnie centrale. 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 ? Notre travail a pour objectif, d’une part, d’étudier la fréquence du TDA/H chez des sujets souffrant de narcolepsie-cataplexie, narcolepsie sans cataplexie et hypersomnie idiopathique et, d’autre part, d’étudier les déterminants cliniques, biologiques et polysomnographiques de cette association. Ce travail pourrait améliorer nos connaissances sur la physiopathologie de ces troubles.Médecine du Sommeil 11/2014; DOI:10.1016/j.msom.2014.09.001
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ABSTRACT: Sleep paralysis (SP) is a common condition occurring either at sleep onset or sleep offset. During SP the sleeper experiences gross motor paralysis while the sensory system is clear. Hypnogogic and hypnopompic hallucinations are common during SP and may involve seeing, hearing, and sensing the presence of menacing intruders in one’s bedroom. This “intruder” is often perceived as a shadowy humanoid figure. Supernatural accounts of this hallucinated intruder are common across cultures. In this paper, we postulate that a functional disturbance of the right parietal cortex explains the shadowy nocturnal bedroom intruder hallucination during SP. This hallucination may arise due to a disturbance in the multisensory processing of body and self at the temporoparietal junction. We specifically propose that this perceived intruder is the result of a hallucinated projection of the genetically “hard-wired” body image (homunculus), in the right parietal region; namely, the same circuits that dictate aesthetic and sexual preference of body morphology. One way to test this hypothesis would be to study clinical populations who may have genetically acquired “irregularities” in their internal hard-wired body image in the right superior parietal lobule (SPL); for example, individuals with apotemnophilia or anorexia nervosa. If such individuals experience SP (e.g., induced in a sleep lab), and they hallucinate this shadowy figure, one would predict that they would see humanoid shadows and shapes with body irregularities, mirroring their own internal body image morphology. If correct, our hypothesis will offer a neurological explanation for this nocturnal bedroom intruder that has been a source of controversy, and striking and implausible cultural interpretations throughout history. Indeed, if our proposed hypothesis is tested and corroborated, dissemination of such findings would provide great relief to SP experiencers worldwide and could potentially be used in a therapeutic context.Medical Hypotheses 10/2014; 83(6). DOI:10.1016/j.mehy.2014.10.002 · 1.15 Impact Factor
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ABSTRACT: Evidence suggests that autoimmune diseases tend to co-occur so that patients with an autoimmune disorder are at higher risk of a second autoimmune disease. The association between allergic and autoimmune diseases is also of considerable interest. There are no reports on the association between sporadic or familial narcolepsy with cataplexy and other non-neurological immune-mediated diseases. This study reported on the comorbid immunopathological diseases associated with narcolepsy. One-hundred and fifty six narcoleptic patients with a mean age at diagnosis of 39.1 ± 17.8 years (range, 6–70 years) were assessed using the clinical history, physical and neurological examinations, sleep questionnaires, neuroimaging and human leucocyte antigen typing. Diagnosis was confirmed by polysomnography followed by a multiple sleep latency test or by measuring hypocretin-1 levels. Patients with immunopathological diseases were matched for gender and age at the onset of narcoleptic symptoms with narcoleptic patients without immunopathological diseases. Twenty-six patients (16.6%; 50% women; one familial, 25 sporadic) had one or more immunopathological diseases associated: autoimmune diseases, such as idiopathic thrombocytopenic purpura, multiple sclerosis, systemic lupus erythematosus, psoriasis, Crohn's disease, ulcerative colitis, autoimmune thyroid disease, Peyronie's disease and idiopathic recurrent facial palsy; other immunopathological diseases, like atopic dermatitis, allergic asthma and allergic rhinitis. Although not significant, the age at diagnosis of narcolepsy was 9.3 years earlier in patients with narcolepsy + immunopathological diseases. The results demonstrate that the prevalence of comorbid immunopathological diseases is high in narcolepsy, and cataplexy is significantly more severe in patients with narcolepsy + immunopathological diseases.Journal of Sleep Research 03/2014; DOI:10.1111/jsr.12143 · 2.95 Impact Factor