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Capittini C, De Silvestri A, Terzaghi M, Scotti V, Rebuffi C, Pasi A, Manni R, Martinetti M, Tinelli C. Correlation between HLA-DQB1*06:02 and narcolepsy with and without cataplexy: approving a safe and sensitive genetic test in four major ethnic groups. A systematic meta-analysis. Sleep Med 2018; 52:150-157. [DOI: 10.1016/j.sleep.2018.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/24/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
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Ohayon MM, Black J, Krystal AD, Shapiro CM, Swick TJ, Bogan R, Wells CC. Longitudinal study of narcolepsy symptoms in first, second, and third-degree relatives of simplex and multiplex narcolepsy families. Sleep Med 2018; 53:88-93. [PMID: 30496948 DOI: 10.1016/j.sleep.2018.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the evolution of narcolepsy symptoms in first-, second, and third-degree relatives and to compare multiplex and simplex families. METHODS A total of 4045 family members and 362 narcoleptic individuals were entered in the study; with 3255 family members interviewed twice, five to seven years apart. A control group (n = 178) composed of spouses or housemates was also interviewed twice. Family members were divided according to their blood relationship with the probands and further divided into multiplex (ie, more than one narcolepsy cases) and simplex (only one narcolepsy case) families. Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy probands were evaluated and diagnosed by a Sleep Specialist in a Sleep Clinic Center. RESULTS A total of 1123 family members from 72 families were identified as members of multiplex families while the rest of the sample were a part of simplex families (n = 2132). Multiplex families had higher incidence and chronicity of hypersomnolence than the simplex family members and the control group. For cataplexy-like symptoms, only prevalence at the time of the first assessment distinguished multiplex (5.5%) and simplex (2.9%) families. Prevalence of sleep paralysis was higher among the first- and second-degree relatives coming from multiplex families, while incidence was the highest among second- and third-degree relatives. Hypnagogic hallucinations had similar prevalence between multiplex and simplex families but the incidence and chronicity were significantly higher among multiplex families. For each symptom, predictive factors were also determined in simplex and multiplex families. CONCLUSIONS Our results show that individuals coming from multiplex families are at greater risks of a broad range of narcolepsy symptoms compared to simplex families.
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Affiliation(s)
- Maurice M Ohayon
- Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, USA.
| | - Jed Black
- Stanford Sleep Medicine Center, Redwood City, CA, USA; Jazz Pharmaceuticals, Inc, Palo Alto, CA, USA
| | | | | | - Todd J Swick
- Neurology and Sleep Medicine Consultants, Houston, TX, USA
| | - Richard Bogan
- University of South Carolina School of Medicine, Columbia, SC, USA; SleepMed, Incorporated, Columbia, SC, USA
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Liu Y, Zhang J, Lam V, Ho CKW, Zhou J, Li SX, Lam SP, Yu MWM, Tang X, Wing YK. Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy. J Clin Sleep Med 2015; 11:885-94. [PMID: 25979093 DOI: 10.5664/jcsm.4940] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the diagnostic values, longitudinal stability, and HLA association of the sleep stage transitions in narcolepsy. METHODS To compare the baseline differences in the sleep stage transition to REM sleep among 35 patients with type 1 narcolepsy, 39 patients with type 2 narcolepsy, 26 unaffected relatives, and 159 non-narcoleptic sleep patient controls, followed by a reassessment at a mean duration of 37.4 months. RESULTS The highest prevalence of altered transition from stage non-N2/N3 to stage R in multiple sleep latency test (MSLT) and nocturnal polysomnography (NPSG) was found in patients with type 1 narcolepsy (92.0% and 57.1%), followed by patients with type 2 narcolepsy (69.4% and 12.8%), unaffected relatives (46.2% and 0%), and controls (39.3% and 1.3%). Individual sleep variables had varied sensitivity and specificity in diagnosing narcolepsy. By incorporating a combination of sleep variables, the decision tree analysis improved the sensitivity to 94.3% and 82.1% and enhanced specificity to 82.4% and 83% for the diagnosis of type 1 and type 2 narcolepsy, respectively. There was a significant association of DBQ1*0602 with the altered sleep stage transition (OR = 16.0, 95% CI: 1.7-149.8, p = 0.015). The persistence of the altered sleep stage transition in both MSLT and NPSG was high for both type 1 (90.5% and 64.7%) and type 2 narcolepsy (92.3% and 100%), respectively. CONCLUSION Altered sleep stage transition is a significant and stable marker of narcolepsy, which suggests a vulnerable wake-sleep dysregulation trait in narcolepsy. Altered sleep stage transition has a significant diagnostic value in the differential diagnosis of hypersomnias, especially when combined with other diagnostic sleep variables in decision tree analysis.
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Affiliation(s)
- Yaping Liu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Venny Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Crover Kwok Wah Ho
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Junying Zhou
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shirley Xin Li
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Siu Ping Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Mandy Wai Man Yu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Trotti LM, Staab BA, Rye DB. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia. J Clin Sleep Med 2013; 9:789-95. [PMID: 23946709 DOI: 10.5664/jcsm.2922] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Differentiation of narcolepsy without cataplexy from idiopathic hypersomnia relies entirely upon the multiple sleep latency test (MSLT). However, the test-retest reliability for these central nervous system hypersomnias has never been determined. METHODS Patients with narcolepsy without cataplexy, idiopathic hypersomnia, and physiologic hypersomnia who underwent two diagnostic multiple sleep latency tests were identified retrospectively. Correlations between the mean sleep latencies on the two studies were evaluated, and we probed for demographic and clinical features associated with reproducibility versus change in diagnosis. RESULTS Thirty-six patients (58% women, mean age 34 years) were included. Inter -test interval was 4.2 ± 3.8 years (range 2.5 months to 16.9 years). Mean sleep latencies on the first and second tests were 5.5 (± 3.7 SD) and 7.3 (± 3.9) minutes, respectively, with no significant correlation (r = 0.17, p = 0.31). A change in diagnosis occurred in 53% of patients, and was accounted for by a difference in the mean sleep latency (N = 15, 42%) or the number of sleep onset REM periods (N = 11, 31%). The only feature predictive of a diagnosis change was a history of hypnagogic or hypnopompic hallucinations. CONCLUSIONS The multiple sleep latency test demonstrates poor test-retest reliability in a clinical population of patients with central nervous system hypersomnia evaluated in a tertiary referral center. Alternative diagnostic tools are needed.
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Affiliation(s)
- Lynn Marie Trotti
- Program in Sleep, Department of Neurology, Emory University School of Medicine, Atlanta, GA 30329, USA.
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Abstract
This report describes a case of narcolepsy with cataplexy masked by the chronic use of cigarettes and nicotine patches. It has been described that narcoleptic smokers report relief of symptoms by smoking tobacco cigarettes. In addition, a case describing partial treatment of sleepiness using a nicotine patch in an adolescent with narcolepsy was recently reported in this journal. Our case adds to the growing literature that nicotine may be used to manage symptoms associated with narcolepsy.
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Affiliation(s)
- Matthew R Ebben
- Center for Sleep Medicine, Weill Cornell Medical College, 425 East 61st Street, 5th Floor, New York, NY 10065, USA.
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Wing YK, Chen L, Lam SP, Li AM, Tang NL, Ng MH, Cheng SH, Ho CK, Mok V, Leung HW, Lau A, Chan MHM, Chan HS, Chan PS. Familial aggregation of narcolepsy. Sleep Med 2011; 12:947-51. [PMID: 22036600 DOI: 10.1016/j.sleep.2011.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/12/2011] [Accepted: 05/04/2011] [Indexed: 10/15/2022]
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FONG SYY, HO CKW, LI AM, WING YK. Excessive daytime sleepiness in obstructive sleep apnea patients after home CPAP treatment: A long-term outcome study. Sleep Biol Rhythms 2009. [DOI: 10.1111/j.1479-8425.2009.00403.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang J, Li AM, Kong APS, Lai KYC, Tang NLS, Wing YK. A community-based study of insomnia in Hong Kong Chinese children: Prevalence, risk factors and familial aggregation. Sleep Med 2009; 10:1040-6. [PMID: 19410511 DOI: 10.1016/j.sleep.2009.01.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 01/16/2009] [Accepted: 01/19/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVES There has been limited data on familial aggregation of insomnia. We aimed to explore the prevalence, risk factors and familial aggregation of childhood insomnia with a large community-based sample. METHODS A community-based epidemiologic study of sleep disorders was conducted among primary school children. Those children with at least one reported biological parent were recruited. A total of 5695 children (mean age 9.2; SD 1.8), 4939 of their reported biological mothers (mean age 38.9; SD 4.6) and 4289 of their reported biological fathers (mean age 43.3; SD 5.5) were studied. RESULTS The rates of insomnia 3 times/week in the past 12 months were 4.0%, 12.8% and 9.7% for children, mothers and fathers, respectively. A robust familial aggregation of insomnia was found even after adjustment of the shared environmental and socio-demographic factors. There was a significant dose-response relationship among the children across their parental status from neither, fathers, mothers to both parents with insomnia [3.0%, 7.1%, 9.5% and 11.9%; with ORs (95% CIs)=2.48 (1.82-4.37) for fathers, 3.42 (2.55-4.59) for mothers and 4.42 (2.42-8.10) for both parents, respectively]. In addition, the frequency of insomniac symptoms of the parents also had a dose-response effect on the rate of insomnia of their children. CONCLUSIONS Insomnia is a common problem in both children and their parents. A significant familial aggregation of childhood onset insomnia was seen in this study even after adjustment of the co-risk factors. There was a dose-response effect of parental insomnia on the rate of insomnia of their children with a slight predilection of maternal influences.
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Affiliation(s)
- Jihui Zhang
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
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Wing Y, Chen L. Cross-cultural epidemiology of daytime sleepiness: Universality, diversity and definition issues. Sleep Med 2009; 10:164-6. [DOI: 10.1016/j.sleep.2008.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 06/20/2008] [Indexed: 11/23/2022]
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Alaez C, Lin L, Flores-A H, Vazquez M, Munguia A, Mignot E, Haro R, Baker H, Gorodezky C. Association of narcolepsy-cataplexy with HLA-DRB1 and DQB1 in Mexican patients: a relationship between HLA and gender is suggested. BMC Med Genet 2008; 9:79. [PMID: 18706091 PMCID: PMC2533302 DOI: 10.1186/1471-2350-9-79] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 08/15/2008] [Indexed: 12/20/2022]
Abstract
Background Narcolepsy-cataplexy is characterized by excessive daytime sleepiness with recurrent episodes of irresistible sleep, cataplexy, hallucinations and sleep paralysis. Its aetiology is unknown, but it is positively associated with the human leukocyte antigens (HLA) in all studied populations. The purpose of the present study was to investigate the association of HLA class II DRB1/DQB1 alleles with narcolepsy-cataplexy in Mexican Mestizo patients. Methods This is a case-control study of consecutive patients and ethnically matched controls. We included 32 patients diagnosed with typical narcolepsy-cataplexy, of the National Institute of Neurology, of the Institute of Psychiatry and at the Center of Narcolepsy at Stanford University. As healthy controls, 203 Mexican Mestizos were included. DRB1 alleles were identified using sequence based typing. A PCR-SSOP reverse dot blot was used for DQB1 typing. Allele frequency was calculated by direct counting and the significance of the differences was assessed using the Yates Chi square. Odds ratio and confidence intervals were evaluated. Results HLA-DRB1*1501 (OR = 8.2; pc < 0.0001) and DQB1*0602 (OR = 8.4; pc < 0.0001) were found positively associated with narcolepsy. When deleting DQB1*0602+ patients from the analysis, DQB1*0301 was also found increased (OR = 2.7; p = 0.035; pc = NS). DQB1*0602/DQB1*0301 genotype was present in 15.6% of the cases (OR = 11.5; p = 0.00035), conferring a high risk. DRB1*0407 (OR = 0.2; p = 0.016 pc = NS) and DQB1*0302(OR = 0.4; p = 0.017, pc = NS) were found decreased in the patients. The gender stratification analysis showed a higher risk in females carrying DRB1*1501 (OR = 15.8, pc < 0.0001) and DQB1*0602 (OR = 19.8, pc < 0.0001) than in males (OR = 5.0 for both alleles; p = 0.012, pc = NS for DRB1 & p = 0.0012, pc = 0.017 for DQB1). The susceptibility alleles found in Mexicans with narcolepsy are also present in Japanese and Caucasians; DRB1*04 linked protection has also been shown in Koreans. A stronger HLA association is suggested in females, in accordance with the sexual dimorphism claimed previously. Conclusion This knowledge may contribute to a better understanding of the disease pathogenesis in different populations. The evaluation of the risk to develop narcolepsy-cataplexy in carriers of the described alleles/genotypes may also be possible. A larger sample should be analysed in Mexican and in other Hispanic patients to confirm these results.
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Affiliation(s)
- Carmen Alaez
- Department of Immunology and Immunogenetics, InDRE, Mexico City, Mexico.
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Chen L, Ho CKW, Lam VKH, Fong SYY, Li AM, Lam SP, Wing YK. Interrater and Intrarater Reliability in Multiple Sleep Latency Test. J Clin Neurophysiol 2008; 25:218-21. [PMID: 18677186 DOI: 10.1097/wnp.0b013e31817f36a6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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