The aim of the present study was to examine gender and age-specific effects on subjective daytime sleepiness (as measured by the Epworth Sleepiness Scale), body weight and eating behaviour in patients with central disorders of hypersomnolence. Based on the European Narcolepsy Network database, we compared 1035 patients with narcolepsy type I and 505 patients with other central disorders of hypersomnolence ("narcoleptic borderland"), including narcolepsy type II (N = 308) and idiopathic hypersomnia (N = 174), using logistic regression and general linear models. In the entire study population, the Epworth Sleepiness Scale was higher in women (N = 735, mean age = 30 years, mean Epworth Sleepiness Scale = 16.6 ± SD 3.9) than in men (N = 805, mean age = 32 years, mean Epworth Sleepiness Scale = 15.8 ± SD 4.4). In women with narcolepsy type I (N = 475), both Epworth Sleepiness Scale and body mass index increased in parallel with age. In women of the narcoleptic borderland (N = 260), the Epworth Sleepiness Scale markedly peaked in their early 30s, while body mass index only started to rise at that age. This rise in body mass index following the Epworth Sleepiness Scale peak cannot be explained by sleepiness-induced uncontrolled eating, as self-reported uncontrolled eating was negatively associated with the Epworth Sleepiness Scale in this group. We propose that the narcoleptic borderland harbours a unique cluster of women in their fertile years with an unexplored aetiology requiring further investigation towards tailored interventions.

Anatomy and Neurosciences Amsterdam UMC location Vrije Universiteit Amsterdam Amsterdam the Netherlands

Center for Investigation and Research in Sleep Lausanne University Hospital Lausanne Switzerland

Center for Narcolepsy and Hypersomnias Professorship for Narcolepsy and Hypersomnolence Research Department of Medicine University Witten Herdecke Witten Germany

Center for Sleep Medicine Sleep Research and Epileptology Klinik Barmelweid AG Barmelweid Switzerland

Charité Medical University Berlin Interdisciplinary Center for Sleep Medicine Berlin Germany

Compulsivity Impulsivity and Attention Amsterdam Neuroscience Amsterdam the Netherlands

Department of Biomedical and Neuromotor Sciences Alma Mater Studiorum University of Blogna Bologna Italy

Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy

Department of Clinical Neurophysiology Institute of Psychiatry and Neurology Warsaw Poland

Department of Clinical Neurosciences Clinicum University of Helsinki and Helsinki Sleep Clinic Terveystalo Healthcare Helsinki Finland

Department of Neurology Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Sleep Medicine and Neuromuscular Disorders University of Münster Münster Germany

Department of Sleep Medicine National Institute of Mental Health Klecany and 3rd Faculty of Medicine Charles University Prague Czech Republic

Institute of Neurosciences of Montpellier University of Montpellier INSERM Montpellier France

Leiden University Medical Center Department of Neurology Leiden the Netherlands

National Reference Centre for Narcolepsy and Rare Hypersomnias Montpellier France

Neurocenter of Southern Switzerland Faculty of Biomedical Sciences Università della Svizzera Italiana Sleep Medicine Unit EOC Lugano Switzerland

Neurology Department and Centre of Clinical Neurosciences 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Neurology Department Hephata Klinik Schwalmstadt Germany

Neurology Department Medical Faculty of P J Safarik University University Hospital of L Pasteur Kosice Kosice Slovak Republic

Neurology Department Sleep Disorders Clinic Innsbruck Medical University Innsbruck Austria

Neurology Service Institut de Neurociències Hospital Clínic University of Barcelona Barcelona Spain

Neurophysiology and Sleep Disorders Unit Hospital Universitario Vithas Madrid Arturo Soria Universidad CEU San Pablo CEU Universities Madrid Spain

Ohio Sleep Medicine Institute Dublin Ohio USA

Pediatric Sleep Center Hospital Robert Debré Paris France

Psychiatry Department University Hospital Son Espases Health Research Institute of the Balearic Islands Mallorca Spain

RCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy

Serviço de Neurofisiologia Centro Hospitalar Universitário de Santo António Porto and UMIB Instituto Ciências Biomédicas Abel Salazar and ITR Universidade do Porto Porto Portugal

Sleep and Epilepsy Unit Clinical Neurophysiology Service University General Hospital Gregorio Marañón Research Institute Gregorio Marañón University Complutense of Madrid Madrid Spain

Sleep Medicine Center Kempenhaeghe Heeze the Netherlands

Sleep Wake Disorders Unit Department of Neurology Gui de Chauliac University Hospital Montpellier France

Stichting Epilepsie Instellingen Nederlands Sleep wake Center Heemstede the Netherlands

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