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Hlodak J, Geckova AM, Carnakovic S, Feketeova E. Online screening for excessive daytime sleepiness: a feasibility study. Front Psychol 2024; 15:1422555. [PMID: 39165771 PMCID: PMC11334077 DOI: 10.3389/fpsyg.2024.1422555] [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: 04/24/2024] [Accepted: 07/10/2024] [Indexed: 08/22/2024] Open
Abstract
Purpose Excessive daytime sleepiness (EDS) can have a significant impact on health and quality of life but may remain undiagnosed due to low awareness and underestimation of the clinical impact of the symptoms. An online screening tool supported by media campaigns might increase awareness and help detect undiagnosed cases of EDS and narcolepsy. The aim of this study was to develop an online screening method, along with a media campaign focusing on EDS, and evaluate its feasibility. Methods Online screening supported by a media campaign targeting young and middle-aged adults (18-45 years old) were developed and implemented over a period of 1 year starting from November 2022. The Epworth Sleepiness Scale was used to identify EDS, and the Swiss Narcolepsy Scale was used to identify narcolepsy. In addition, the data on sociodemographic characteristics, selected sleep and health indicators and lifestyle behaviors were collected to indicate the etiology of the EDS. Feasibility, e.g., implementation and practicality, was assessed by the response rate, response to the promotion strategy, time spent on the tool, sample characteristics, and the prevalence of identified EDS and narcolepsy cases. Results A total of 2,390 people opened the screening link; 568 of them completed the online screening (23.8%), and most of them (n = 437, 76.9%) left their contact data to receive feedback. We identified 171 (30.1%) respondents at risk of EDS and 61 (10.7%) at risk of narcolepsy. The mean time of the screening was 15 min. Conclusion An online screening tool supported with a campaign seems to be a feasible way to increase awareness about EDS and prevent delayed detection of EDS cases.
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Affiliation(s)
- Jan Hlodak
- Faculty of Social and Economic Sciences, Institute of Applied Psychology, Comenius University, Bratislava, Slovakia
| | - Andrea Madarasova Geckova
- Faculty of Social and Economic Sciences, Institute of Applied Psychology, Comenius University, Bratislava, Slovakia
- Institute of Health Psychology and Research Methodology, Medical Faculty, University of Pavol Jozef Safarik, Kosice, Slovakia
| | - Simona Carnakovic
- First Department of Psychiatry, Medical Faculty, University of Pavol Jozef Safarik, Kosice, Slovakia
- University Hospital of L. Pasteur, Kosice, Slovakia
| | - Eva Feketeova
- University Hospital of L. Pasteur, Kosice, Slovakia
- Medical Faculty, Department of Neurology, University of Pavol Jozef Safarik, Kosice, Slovakia
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Yaria J, Olusakin T. Challenges in the Management of Narcolepsy in a Resource Limited Setting: A Case Report. Cureus 2024; 16:e58143. [PMID: 38738054 PMCID: PMC11088952 DOI: 10.7759/cureus.58143] [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] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
The management of Narcolepsy, from the initial presentation to the long-term management and follow-up, remains a challenging endeavor, especially in developing climes. Worldwide, it has been recognized as a medical condition that is frequently associated with initial misdiagnoses, and delays in definitive management, further highlighted, in resource-limited settings like Nigeria where issues are further compounded by social, cultural, and political factors. In this report, we aim to shed some light on the peculiar challenges encountered by clinicians in Nigeria, and in other similar settings, in the process of diagnosis and management of narcolepsy. We present a case of a 17-year-old male teenager with Narcolepsy Type 1 (NT1) who had been previously managed as a case of Juvenile Absence Epilepsy in various centers prior to presentation at our facility. The symptoms began two years prior to presentation at our outpatient clinic, and they were excessive daytime sleepiness, cataplexy, and sleep paralysis. The symptoms were corroborated by laboratory parameters - reduced mean sleep latency (conducted in an improvised sleep laboratory), and a low cerebrospinal fluid (CSF) hypocretin level. The patient was initially placed on Modafinil for excessive daytime sleepiness and a trial of Fluoxetine for the Cataplexy. However, due to the scarcity of Modafinil, behavioral modifications - scheduled sleep naps and sleep hygiene - were eventually employed. Narcolepsy is a debilitating illness, and consequently, the far-reaching effects of these challenges must be understood. It is important that concerted efforts be made towards improving the overall quality of care received by patients from the early identification to the treatment of narcolepsy in the Nigerian healthcare system.
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Affiliation(s)
- Joseph Yaria
- Medicine, University College Hospital Ibadan, Ibadan, NGA
| | - Tobi Olusakin
- General Practice, Vine Branch Medical Center, Ibadan, NGA
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Tanioka K, Hirasawa T, Yanagihara M, Takeuchi N, Nakayama H, Usui A, Inoue Y. Reliability and validity of the Japanese version of the Ullanlinna Narcolepsy Scale and Swiss Narcolepsy Scale for screening Japanese individuals with narcolepsy type 1. Sleep Med 2023; 109:245-251. [PMID: 37487277 DOI: 10.1016/j.sleep.2023.07.015] [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: 04/25/2023] [Revised: 05/30/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To validate the Japanese versions of the Ullanlinna Narcolepsy Scale (J-UNS) and Swiss Narcolepsy Scale (J-SNS) for screening narcolepsy in the Japanese population and to discuss strategies for their use in hypersomniac individuals. METHODS We selected 451 outpatients with excessive daytime sleepiness (EDS) already diagnosed according to the International Classification of Sleep Disorders third edition. They responded to both scales twice at 1-month intervals. After eliminating individuals who met the exclusion criteria, validity and reliability analyses were performed on 408 and 381 participants, respectively. RESULTS Patients with narcolepsy type 1 (NT1) displayed higher J-UNS and lower J-SNS scores than those with NT2 and other sleep disorders. The intraclass correlation coefficients and weighted κ coefficient for scale scores in the total participants and patients with NT1 were ≥0.70 and ≥ 0.40, respectively, indicating high reliability. Furthermore, both the sensitivity and specificity of these scales upon using the original cut-off scores (14 for UNS and 0 for SNS) for detecting NT1 were 0.70 or ≥0.70, suggesting high validity. Additionally, the receiver operating characteristic curve analysis revealed that the best cut-off score did not change for the J-SNS but that for the J-UNS, it increased to 18. In our study, the scale's sensitivity and specificity changed from 96% to 82% and 58%-78%, respectively. CONCLUSIONS Both scales revealed satisfactory screening abilities for NT1 in the Japanese population. However, it may be better to use J-UNS cut-off scores of 18 for a population with EDS.
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Affiliation(s)
- Kosuke Tanioka
- Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Toshiyuki Hirasawa
- Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Mariko Yanagihara
- Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Noboru Takeuchi
- Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Hideaki Nakayama
- Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Akira Usui
- Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, SY building 5-10-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
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Kuts A, Poluektov M, Zakharov A, Govzman V, Ponomareva I, Yakupov E, Zavalko I, Tikhomirova O, Sviryaev Y, Yakovlev A, Polyakov A, Melnikov A, Bassetti CL. Clinical and neurophysiological characteristics of 89 patients with narcolepsy and cataplexy from the Russian Narcolepsy Network. J Clin Sleep Med 2023; 19:355-359. [PMID: 36305577 PMCID: PMC9892735 DOI: 10.5664/jcsm.10340] [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: 05/27/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES The first reports of narcolepsy with cataplexy in Russia were made by Mankovsky (The pathogenesis of narcolepsy (the case of epidemic encephalitis with cataplexy) published in the Sovremennaya psihonevrologia) in 1925. The largest series of patients (n = 110) was reported by A. Vein (doctoral thesis: Hypersomnia Syndrome) in 1964. However, until today, narcolepsy remained relatively unknown in Russia. The aim of this study is to report clinical and polysomnography (PSG)/multiple sleep latency test (MSLT) results in the Russian population and compare them with the European Narcolepsy Network (EU-NN) data (n = 1099) reported. METHODS Eleven sleep centers from Russia agreed to participate and completed a questionnaire including 58 questions concerning demographic, clinical, PSG, and MSLT data. RESULTS There were 89 patients with a mean age of 35.6 ± 16.9 years (± here and further indicates standard deviation), 58% males, and 42% females. Narcolepsy started at a mean age of 25.6 ± 14.6 years (range 5-74 years). The mean Epworth Sleepiness Scale score was 18.4 ± 3.5 points (range: 11-24). Sleep paralysis was reported by 59.1%, and hallucinations by 82% of patients. In MSLT, ≥ 2 sleep-onset REM (rapid eye movement) periods (SOREMPs) were found in 81.6%. No center provided human leukocyte antigen (HLA) or cerebral spinal fluid hypocretin data. CONCLUSIONS Clinical and neurophysiological data from this first study of the Russian Narcolepsy Network suggest a similar profile to the recently reported EU-NN data. The more severe and higher percentage of patients with cataplexy and presenting with both excessive daytime sleepiness and cataplexy may reflect low awareness of narcolepsy in Russia. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; URL: https://clinicaltrials.gov/ct2/show/NCT05375890; Name: Clinical and Neurophysiological Characteristics of Narcolepsy; Identifier: NCT05375890. CITATION Kuts A, Poluektov M, Zakharov A, et al. Clinical and neurophysiological characteristics of 89 patients with narcolepsy and cataplexy from the Russian Narcolepsy Network. J Clin Sleep Med. 2023;19(2):355-359.
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Affiliation(s)
| | | | - Alexander Zakharov
- Department of Neurology and Neurosurgery, Samara State Medical University, Samara, Russia
- Samara State Medical University, Research Institute of Neurosciences, Samara, Russia
| | - Vlada Govzman
- Clinical Hospital “RZD-Medicine”, Khabarovsk, Russia
| | | | | | | | - Olga Tikhomirova
- Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia, Saint-Petersburg, Russia
| | - Yurii Sviryaev
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | | | - Alexander Polyakov
- V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, Saint-Petersburg, Russia
| | | | - Claudio L.A. Bassetti
- Sechenov University, Moscow, Russia
- University Hospital (Inselspital), Bern, Switzerland
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Maski K, Worhach J, Steinhart E, Boduch M, Morse AM, Strunc M, Scammell T, Owens J, Jesteadt L, Crisp C, Williams D, Sideridis G. Development and Validation of the Pediatric Hypersomnolence Survey. Neurology 2022; 98:e1964-e1975. [PMID: 35314496 PMCID: PMC9141629 DOI: 10.1212/wnl.0000000000200187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Narcolepsy and idiopathic hypersomnia usually begin in early adolescence, but diagnostic delays ranging from 5 to 10 years are common, affecting disease burden. To improve early identification of these treatable conditions, we developed and validated the Pediatric Hypersomnolence Survey (PHS). METHODS Content was developed through literature review, patient focus groups, interviews with experts in the field, and field testing. We then validated the 14-item self-reported survey across 3 hospitals and web recruitment from patient groups. In the validation phase, we recruited a total of 331 participants (patients with narcolepsy type 1 [n = 64], narcolepsy type 2 [n = 34], idiopathic hypersomnia [n = 36], and other sleep disorders [n = 97] and healthy controls [n = 100], ages 8-18 years) to complete the survey. We assessed a range of psychometric properties, including discriminant diagnostic validity for CNS disorders of hypersomnolence using receiver operating characteristic curve analysis and reliability across a 1-week period. RESULTS Confirmatory factor analysis indicated a 4-domain solution with good reliability expressed by satisfactory omega values. Across groups, the PHS total score showed appropriate positive correlations with other validated surveys of sleepiness (r = 0.65-0.78, p < 0.001) and negative correlations with multiple sleep latency test measures (mean sleep latency: r = -0.27, p = 0.006; number of sleep-onset REM periods: r = 0.26, p = 0.007). Compared to controls and patients with other sleep disorders, the area under the curve for participants with narcolepsy or idiopathic hypersomnia was 0.87 (standard error 0.02, 95% CI 0.83-0.91) with high sensitivity (81.3, 95% CI 73.7%-87.5%) and specificity (81.2%, 95 CI 75.1%-86.4%). Test-retest reliability was r = 0.87. DISCUSSION The PHS is a valid and reliable tool for clinicians to identify pediatric patients with narcolepsy and idiopathic hypersomnia. Implemented in clinical practice, the PHS will potentially decrease diagnostic delays and time to treatment, ultimately reducing disease burden for these debilitating conditions. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that the PHS accurately identifies patients with central disorders of hypersomnolence.
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Affiliation(s)
- Kiran Maski
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Jennifer Worhach
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Erin Steinhart
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Madeline Boduch
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Anne Marie Morse
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Michael Strunc
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Thomas Scammell
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Judith Owens
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Lindsay Jesteadt
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Claire Crisp
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - David Williams
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
| | - Georgios Sideridis
- From the Department of Neurology (K.M., J.W., M.B., T.S., J.O.), Boston Children's Hospital; Massachusetts General Hospital (E.S.), Boston; Department of Neurology (A.M.), Geisinger Medical Center, Danville, PA; Department of Neurology (M.S.), Children's Hospital of the King's Daughter, Norfolk, VA; Department of Neurology (T.S.), Beth Israel Deaconess Medical Center, Boston; 6. Wake Up Narcolepsy, Inc (L.J., C.C.), Worcester; and ICCTR Biostatistics and Research Design Center (D.W., G.S.), Boston Children's Hospital, MA
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6
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Dietmann A, Wenz E, van der Meer J, Ringli M, Warncke JD, Edwards E, Schmidt MH, Bernasconi CA, Nirkko A, Strub M, Miano S, Manconi M, Acker J, von Manitius S, Baumann CR, Valko PO, Yilmaz B, Brunner AD, Tzovara A, Zhang Z, Largiadèr CR, Tafti M, Latorre D, Sallusto F, Khatami R, Bassetti CLA. The Swiss Primary Hypersomnolence and Narcolepsy Cohort study (SPHYNCS): Study protocol for a prospective, multicentre cohort observational study. J Sleep Res 2021; 30:e13296. [PMID: 33813771 PMCID: PMC8519114 DOI: 10.1111/jsr.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022]
Abstract
Narcolepsy type 1 (NT1) is a disorder with well‐established markers and a suspected autoimmune aetiology. Conversely, the narcoleptic borderland (NBL) disorders, including narcolepsy type 2, idiopathic hypersomnia, insufficient sleep syndrome and hypersomnia associated with a psychiatric disorder, lack well‐defined markers and remain controversial in terms of aetiology, diagnosis and management. The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a comprehensive multicentre cohort study, which will investigate the clinical picture, pathophysiology and long‐term course of NT1 and the NBL. The primary aim is to validate new and reappraise well‐known markers for the characterization of the NBL, facilitating the diagnostic process. Seven Swiss sleep centres, belonging to the Swiss Narcolepsy Network (SNaNe), joined the study and will prospectively enrol over 500 patients with recent onset of excessive daytime sleepiness (EDS), hypersomnia or a suspected central disorder of hypersomnolence (CDH) during a 3‐year recruitment phase. Healthy controls and patients with EDS due to severe sleep‐disordered breathing, improving after therapy, will represent two control groups of over 50 patients each. Clinical and electrophysiological (polysomnography, multiple sleep latency test, maintenance of wakefulness test) information, and information on psychomotor vigilance and a sustained attention to response task, actigraphy and wearable devices (long‐term monitoring), and responses to questionnaires will be collected at baseline and after 6, 12, 24 and 36 months. Potential disease markers will be searched for in blood, cerebrospinal fluid and stool. Analyses will include quantitative hypocretin measurements, proteomics/peptidomics, and immunological, genetic and microbiota studies. SPHYNCS will increase our understanding of CDH and the relationship between NT1 and the NBL. The identification of new disease markers is expected to lead to better and earlier diagnosis, better prognosis and personalized management of CDH.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Elena Wenz
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Julia van der Meer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maya Ringli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan D Warncke
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ellen Edwards
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Corrado A Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | | | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Jens Acker
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
| | | | | | - Philip O Valko
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Bahtiyar Yilmaz
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.,Maurice Müller Laboratories, Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Andreas-David Brunner
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Athina Tzovara
- Institute of Computer Science, University of Bern, Bern, Switzerland.,Department of Neurology, Sleep Wake Epilepsy Center, NeuroTec, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Zhongxing Zhang
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Carlo R Largiadèr
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mehdi Tafti
- Department of Biomedical Science, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Federica Sallusto
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland.,Institute for Research in Biomedicine, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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Zenklusen I, Muehlan C, Ulc I, Liška J, Dingemanse J. The dual orexin receptor antagonist daridorexant does not affect the pharmacokinetics of the BCRP substrate rosuvastatin. Clin Exp Pharmacol Physiol 2020; 47:1843-1849. [PMID: 32603512 DOI: 10.1111/1440-1681.13370] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
Abstract
Daridorexant is a dual orexin receptor antagonist in clinical development for the treatment of insomnia. Breast-cancer resistant protein (BCRP) is an efflux pump expressed in intestinal epithelium and hepatocytes, contributing to the absorption, distribution, and elimination of drugs and endogenous compounds. In vitro, daridorexant inhibits BCRP with an IC50 of 3.0 μmol/L. The BCRP substrate rosuvastatin is a cholesterol-lowering drug, recommended for clinical drug-drug interaction (DDI) studies. In order to exclude an inhibitory effect of daridorexant on BCRP, this single-centre, open-label, two-treatment Phase 1 study investigated the effect of daridorexant at steady state on the pharmacokinetics (PK) of single-dose rosuvastatin in 20 healthy male subjects. In addition, safety and tolerability were assessed. A single oral dose of 10 mg rosuvastatin on Day 1 was followed by 96 hours observation. Thereafter, 25 mg daridorexant was administered once daily (o.d.) on Days 5-8 and in combination with 10 mg rosuvastatin on Day 8. On Days 9-12, subjects received 25 mg daridorexant alone. PK sampling was performed up to 120 hours after treatment administration. The results showed that concomitant administration of 25 mg daridorexant o.d. at steady state did not affect the exposure parameters of rosuvastatin in a relevant way, as indicated by the ratios of geometric means (GMRs) ([rosuvastatin + daridorexant]/[rosuvastatin alone]) of 0.93 for both Cmax and AUC0-∞ . Administration of a single dose of 10 mg rosuvastatin, multiple doses of 25 mg daridorexant alone or in combination were well tolerated. Taken together, daridorexant and BCRP substrates can be safely co-administered.
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Affiliation(s)
- Isabelle Zenklusen
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Clemens Muehlan
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Ivan Ulc
- CEPHA s.r.o. Komenskeho 19, Pilsen, Czech Republic
| | - Jiří Liška
- CEPHA s.r.o. Komenskeho 19, Pilsen, Czech Republic
| | - Jasper Dingemanse
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
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8
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Therapy for Cataplexy. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-0619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of the review
Cataplexy, an involuntary loss of muscle activity triggered by strong emotions is the most impressive symptom in narcolepsy. This review gives an overview of the current understanding of cataplexy and its available treatment options.
Recent findings
With the discovery of hypocretin/orexin, the understanding of the pathophysiology of cataplexy advanced in the past decades. In the recent years, with the development of new anticataplectic agents (e.g., Pitolisant) symptomatic treatment of cataplexy has further improved. Abrupt cessation of anticataplectic medication especially antidepressants increase the risk of status cataplecticus, a virtually continuous series of long-lasting cataplectic attacks.
Summary
Cataplexies still remain an under-recognized phenomenon due to missing diagnostic measures. Treatment for cataplexy still remains symptomatic but new agents with better tolerability and usability are continuously developed. New therapeutic actions either targeting the autoimmune mechanisms underlying orexin cell death or substituting orexin action are promising treatments for the near future.
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9
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Dauvilliers Y, Barateau L, Lopez R, Rassu AL, Chenini S, Beziat S, Jaussent I. Narcolepsy Severity Scale: a reliable tool assessing symptom severity and consequences. Sleep 2020; 43:5717181. [DOI: 10.1093/sleep/zsaa009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/05/2020] [Indexed: 01/11/2023] Open
Abstract
Abstract
Study Objectives
To define clinically relevant Narcolepsy Severity Scale (NSS) score ranges, confirm its main performances and sensitivity to medications, and determine whether items need to be weighted.
Methods
One hundred and forty-three consecutive untreated and 238 treated adults with narcolepsy type 1 (NT1) completed the NSS, a 15-item self-administered questionnaire (score: 0–57) that assesses the severity and consequences of the five major narcolepsy symptoms such as daytime sleepiness, cataplexy, hallucinations, sleep paralysis, and disturbed nighttime sleep (DNS). They also completed the Epworth Sleepiness scale (ESS; daytime sleepiness), Beck Depression Inventory (BDI; depressive symptoms), and EQ5D (quality of life).
Results
The mean symptom number (4.3 vs 3.5), NSS total score (33.3 ± 9.4 vs 24.3 ± 10.2), and number of narcolepsy symptoms (five symptoms: 53.1% vs 24.8%; four symptoms: 26.6% vs 22.7%; three symptoms: 15.4% vs 32.4%; two symptoms: 4.9% vs 20.2%) were significantly different between untreated and treated patients (p < 0.0001). DNS was often the third symptom (95.5 per cent). The symptom number was associated with diagnosis delay, age at onset, and ESS and BDI scores. Comparisons with ESS, BDI and EQ5D showed that NSS item weighting was not necessary to highlight between-group differences. Four NSS severity levels were defined (mild, moderate, severe, and very severe) with between-group differences related to treatment. The probability of having ESS ≥ 16, BDI ≥ 20, and EQ-5D < 60 increased with the severity level.
Conclusion
NSS is valid, reliable, and responsive to treatment in patients with NT1, with four clinically relevant severity score ranges provided. NSS has adequate clinimetric properties for broadening its use for both clinic and research.
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Affiliation(s)
- Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Lucie Barateau
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Regis Lopez
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Anna Laura Rassu
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Sofiene Chenini
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Severine Beziat
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Isabelle Jaussent
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
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Morse AM. Narcolepsy in Children and Adults: A Guide to Improved Recognition, Diagnosis and Management. Med Sci (Basel) 2019; 7:E106. [PMID: 31783668 PMCID: PMC6950577 DOI: 10.3390/medsci7120106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/21/2019] [Indexed: 01/26/2023] Open
Abstract
Narcolepsy is a rare condition that affects children and adults, and commonly has an onset in childhood. Time to appropriate diagnosis frequently is at least a decade. Unrecognized or misdiagnosed symptoms of narcolepsy contribute to increased morbidity, disability and socioeconomic liability in these patients. Delays in diagnosis may be related to variability in presentation in childhood, lack of familiarity with symptoms or appropriate diagnostic testing or misdiagnosis with accidental introduction of treatment that may modify or mask narcolepsy features. Improved awareness about the diagnosis and tailored therapies improve clinical and socioeconomic outcomes by reducing time to effective treatment. Application of effective treatment results in long-term benefits by improving clinical outcomes, potentially enabling improved education, increased employment opportunity, and improved work productivity and quality of life. This review provides a comprehensive stepwise approach to improve knowledge and comfort for recognition of symptoms, diagnostic strategies and management considerations of narcolepsy in children and adults.
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Affiliation(s)
- Anne Marie Morse
- Division of Pediatric Neurology, Janet Weis Children's Hospital, Geisinger, Danville, PA 17820, USA
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11
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Narcolepsy — clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol 2019; 15:519-539. [DOI: 10.1038/s41582-019-0226-9] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
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12
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Bargiotas P, Dietmann A, Haynes AG, Kallweit U, Calle MG, Schmidt M, Mathis J, Bassetti CL. The Swiss Narcolepsy Scale (SNS) and its short form (sSNS) for the discrimination of narcolepsy in patients with hypersomnolence: a cohort study based on the Bern Sleep–Wake Database. J Neurol 2019; 266:2137-2143. [DOI: 10.1007/s00415-019-09365-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
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