Article

Subjective and polysomnographic characteristics of patients diagnosed with narcolepsy

Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan 48202.
General Hospital Psychiatry (Impact Factor: 2.9). 06/1990; 12(3):191-7. DOI: 10.1016/0163-8343(90)90078-Q
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ABSTRACT In order to better characterize the subjective and polysomnographic findings in patients with narcolepsy, a follow-up questionnaire was mailed to all patients diagnosed with the disorder at the Henry Ford Hospital Sleep Disorders and Research Center. The questionnaire inquired regarding the present, previous, and change in status for the constellation of narcolepsy symptoms. Memory problems, problems of daytime function, and nocturnal sleep disturbance were included among the questions related to the symptomatic constellation. By definition, all patients were symptomatic of daytime sleepiness and were diagnosed with narcolepsy only if there were two or more rapid eye movement (REM) onsets documented on the polysomnographic evaluation. A high percentage of patients reported nocturnal sleep disturbance, which was one of the symptoms with the latest reported onset. Retrospective comparison of questionnaire responses to the clinical polysomnography revealed significantly more sleep maintenance difficulties in the group of patients reporting this symptom on the questionnaire. Patients with disturbed nocturnal sleep reported taking more naps during the day, although the Multiple Sleep Latency Test (MSLT) failed to show differences in sleep latency. Interestingly, this group of patients was found to have a significantly higher number of sleep onset REM episodes on the MSLT. Finally, the findings are discussed as they compare to studies that required the presence of cataplexy as part of their inclusion criteria.

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    • "In this study, 77.8% of the narcolepsy patients experienced cataplexy, which is in line with previous studies reporting over 70% narcolepsy patients showed cataplexy (20, 21). As the main pathophysiology of cataplexy, the imbalance between monoaminergic and cholinergic transmissions in the pons has been proposed. "
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    ABSTRACT: Cataplexy is one of the most pathognomonic symptoms in narcolepsy. This study was designed to investigate the frequency of the HLA-DQB1 allele and cerebrospinal fluid (CSF) hypocretin levels in Korean narcoleptics with cataplexy as compared with those who do not have cataplexy. Seventy-two narcoleptics were selected based on polysomnography and multiple sleep latency test as well as their history and clinical symptoms at Sleep Disorders Clinic. The patients were divided into a narcolepsy with cataplexy group (n=56) and a narcolepsy without cataplexy group (n=16). All patients were subjected to HLA typing to determine the frequency of DQB1 allele and to spinal tapping to measure the level of CSF hypocretin. In cataplexy-positive patients, as compared with cataplexy-negative patients, the frequency of HLA-DQB1*0602 was found to be significantly high (89.3% vs. 50.0%) (p=0.003). On the other hand, the frequency of HLA-DQB1*0601 was found to be significantly low (0% vs. 43.8%) (p<0.001). In 48 of 56 cataplexy-positive patients (85.7 %), hypocretin levels were decreased (<or=110 pg/mL). However, only 6 of 16 cataplexy-negative patients (37.5%) exhibited a decreased hyopcretin level (p<0.001). The high frequency of HLA-DQB1*0602, low frequency of HLA-DQB1*0601 and low hypocretin levels in cataplexy-positive groups suggest that cataplexy-positive narcolepsy might be an etiologically different disease entity from the cataplexy-negative.
    Journal of Korean Medical Science 03/2007; 22(1):127-31. DOI:10.3346/jkms.2007.22.1.127 · 1.25 Impact Factor
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    • "logical trait . SOREMPs during the MSLT also correlated with NPSG REM latency , a parameter independently scored by different technicians ( see Table 1 , data not shown for multivariate models ) . A very short REM latency during NPSG is also predictive of narcolepsy in clinical samples ( Rechtschaffen et al . , 1963 ; van den Hoed et al . , 1981 ; Rosenthal et al . , 1990a , b ; Folkerts et al . , 1996 ; Aldrich et al . , 1997 ; Overeem et al . , 2001 ; Dauvilliers et al . , 2003a ) . As in other studies ( Bishop et al . , 1996 ; Chervin and Aldrich , 2000 ; Singh et al . , 2005 ) , we found that the occurrence of SOREMP was strongly asso - ciated with short sleep latencies during the MSLT naps ( Table 1 "
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    ABSTRACT: The diagnosis of narcolepsy without documented cataplexy is based on the observation of two or more sleep-onset REM periods (SOREMPs) during the Multiple Sleep Latency Test (MSLT). We report on the prevalence and correlates of SOREMPs in the community-based Wisconsin Sleep Cohort Study. MSLTs were conducted following nocturnal polysomnography (NPSG) and daily sleep diaries in 289 males and 267 females (age 35-70, 97% Caucasians). Multiple SOREMPs were observed in 13.1% of males and 5.6% of females. An MSLT mean sleep latency < or =8 min and > or =2 SOREMPs (diagnostic of narcolepsy) was observed in 5.9% (males) and 1.1% (females), all without cataplexy. Because of significant sex interactions, analyses were stratified by sex. Increased prevalence of HLA-DQB1*0602, a marker of narcolepsy, was observed in males but not in females with > or =2 SOREMPs. Males with multiple SOREMPs compared with those with no SOREMPs had shorter rapid eye movement (REM) latency during NPSG, were sleepier on the MSLT and reported increased sleepiness, hypnagogic hallucinations and cataplexy-like symptoms, suggesting a narcolepsy-like phenotype. In males only, the occurrence of SOREMPs increased with shift work and some indirect markers of sleep restriction, such as shorter sleep a day before NPSG. SOREMPs were unrelated to age, body mass index, depression (Zung Scale), anxiety (State-Trait Anxiety Scale) and the number of apnea and hypopnea events per hour of sleep (AHI), but were associated with decreased mean lowest oxygen saturation in males. Finally, we found that both males and females with SOREMPs reported taking more antidepressants, but those were of the types known not to suppress REM sleep. These results suggest a high prevalence of narcolepsy without cataplexy, as defined by the International Classification of Sleep Disorders, and/or a large number of false-positives for the MSLT.
    Brain 06/2006; 129(Pt 6):1609-23. DOI:10.1093/brain/awl079 · 10.23 Impact Factor
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    ABSTRACT: There are methodological difficulties in assessing cognitive function in narcolepsy, but despite these it appears that there is a defect in maintenance of attention, which is more significant than the problems with memory. The subject’s perception of memory loss is however greater than what can be demonstrated objectively. There may also be a generalised executive dysfunction unrelated to attention and memory deficits. Anxiety and depression are common, particularly in younger subjects. Psychosis is usually drug-induced, particularly by amphetamines. The realistic dreams and hypnagogic hallucinations should be distinguished from schizophrenia and REM sleep behaviour disorder. There is considerable functional impairment due to the symptoms of narcolepsy with reduced quality of life, particularly in the domains of vitality and physical roles. Changes with age are probably important, but there are only few differences between the genders. Education, performance at work, social and recreational activities are all impaired by narcolepsy, but attention to lifestyle aspects and treatment with modern drugs, particularly modafinil and sodium oxybate, can improve functional capacity.
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