STUDY OBJECTIVES: In some patients, it is difficult to correctly nosologically classify daytime sleepiness. Clinical manifestations may be nonspecific; on the basis of objective measures it is possible to determine the current severity of sleepiness, but they do not always allow accurate diagnosis. It is especially difficult to distinguish between idiopathic hypersomnia (IH) and hypersomnia associated with a psychiatric disorder (PSY). METHODS: To find significant differences between the IH and PSY groups, we included 67 patients (IH, n = 15; PSY, n = 52) in the study, focusing on differences in self-reported symptoms, evaluating current depressive symptoms using the Beck Depression Inventory-II score and personality traits measured by the Temperament and Character Inventory. All of the patients underwent polysomnography, the Multiple Sleep Latency Test, and ad libitum sleep monitoring. RESULTS: The patients with IH showed greater difficulty than those in the PSY group with waking up in the morning (P < .001) and complained of memory (P = .04) and attention deficit (P = .006). They also showed higher total sleep time (P < .001) and sleep efficiency (P = .007) and a shorter mean sleep latency on the Multiple Sleep Latency Test (P < .001). Nevertheless, the IH and PSY groups did not differ in Beck Depression Inventory scores or personality characteristics. CONCLUSIONS: IH is a syndrome in which depression/external life stressors and personality characteristics also play a role. Patients with IH may benefit from the cooperation of sleep specialists with psychotherapists/psychiatrists. CITATION: Bušková J, Novák T, Miletínová E, et al. Self-reported symptoms and objective measures in idiopathic hypersomnia and hypersomnia associated with psychiatric disorders: a prospective cross-sectional study. J Clin Sleep Med. 2022;18(3):713-720.
- MeSH
- duševní poruchy * komplikace MeSH
- idiopatická hypersomnie * komplikace diagnóza psychologie MeSH
- lidé MeSH
- narkolepsie * komplikace MeSH
- poruchy nadměrné spavosti * komplikace diagnóza MeSH
- prospektivní studie MeSH
- průřezové studie MeSH
- zpráva o sobě MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- antidepresiva škodlivé účinky MeSH
- lidé MeSH
- multisystémová atrofie komplikace patofyziologie MeSH
- narkolepsie komplikace patofyziologie MeSH
- parasomnie spojené s REM spánkem patofyziologie MeSH
- parasomnie patofyziologie MeSH
- parkinsonské poruchy komplikace patofyziologie MeSH
- porucha chování v REM spánku * diagnóza patofyziologie terapie MeSH
- spánek REM fyziologie účinky léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Childhood narcolepsy is associated with various emotional, behavioural and cognitive dysfunctions as well as with psychiatric and neurodevelopmental disorders: anxiety, depression, attention deficit hyperactivity disorder and psychosis. A relationship between these conditions is unclear - comorbidity or similar pathophysiological mechanisms can be suggested. OBJECTIVE: We reported four children with narcolepsy type 1 (NT1) and autism spectrum disorder (ASD) - Asperger syndrome (AS). RESULTS AND CONCLUSION: To the best of our knowledge co-occurrence of NT1 and AS has not been described in the literature as noted in this report.
- MeSH
- antidepresiva terapeutické užití MeSH
- Aspergerův syndrom diagnóza MeSH
- deprese diagnóza farmakoterapie MeSH
- dítě MeSH
- hyperkinetická porucha diagnóza MeSH
- komorbidita * MeSH
- lidé MeSH
- methylfenidát aplikace a dávkování MeSH
- narkolepsie komplikace MeSH
- poruchy nadměrné spavosti diagnóza farmakoterapie MeSH
- stadia spánku fyziologie MeSH
- tikové poruchy diagnóza MeSH
- úzkostné poruchy diagnóza farmakoterapie MeSH
- věk při počátku nemoci * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Cardiopulmonary fitness depends on daily energy expenditure or the amount of daily exercise. Patients with narcolepsy spent more time being sleepy or asleep than controls; thus we may speculate that they have a lower quantity and quality of physical activity. The aim of the present study was thus to test the hypothesis that exercise tolerance in narcolepsy negatively depends on sleepiness. PATIENTS AND METHODS: The cross-sectional study included 32 patients with narcolepsy with cataplexy, 10 patients with narcolepsy without cataplexy, and 36 age- and gender-matched control subjects, in whom a symptom-limited exercise stress test with expired gas analysis was performed. A linear regression analysis with multivariate models was used with stepwise variable selection. RESULTS: In narcolepsy patients, maximal oxygen uptake (VO2peak) was 30.1 ± 7.5 mL/kg/min, which was lower than 36.0 ± 7.8 mL/kg/min, p = 0.001, in controls and corresponded to 86.4% ± 20.0% of the population norm (VO2peak%) and to a standard deviation (VO2peakSD) of -1.08 ± 1.63 mL/kg/min of the population norm. VO2peakdepended primarily on gender (p = 0.007) and on sleepiness (p = 0.046). VO2peak% depended on sleepiness (p = 0.028) and on age (p = 0.039). VO2peakSD depended on the number of cataplexy episodes per month (p = 0.015) and on age (p = 0.030). CONCLUSIONS: Cardiopulmonary fitness in narcolepsy and in narcolepsy without cataplexy is inversely related to the degree of sleepiness and cataplexy episode frequency.
- MeSH
- akcelerometrie MeSH
- bdění fyziologie MeSH
- cvičení fyziologie MeSH
- dospělí MeSH
- kataplexie komplikace farmakoterapie patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lineární modely MeSH
- mladiství MeSH
- mladý dospělý MeSH
- multivariační analýza MeSH
- narkolepsie komplikace farmakoterapie patofyziologie MeSH
- průřezové studie MeSH
- senioři MeSH
- spotřeba kyslíku * fyziologie MeSH
- stupeň závažnosti nemoci MeSH
- věkové faktory MeSH
- zátěžový test MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Histaminergic neurons are crucial to maintain wakefulness, but their role in cataplexy is unknown. We assessed the safety and efficacy of pitolisant, a histamine H3 receptor inverse agonist, for treatment of cataplexy in patients with narcolepsy. METHODS: For this randomised, double-blind, placebo-controlled trial we recruited patients with narcolepsy from 16 sleep centres in nine countries (Bulgaria, Czech Republic, Hungary, Macedonia, Poland, Russia, Serbia, Turkey, and Ukraine). Patients were eligible if they were aged 18 years or older, diagnosed with narcolepsy with cataplexy according to version two of the International Classification of Sleep Disorders criteria, experienced at least three cataplexies per week, and had excessive daytime sleepiness (defined as an Epworth Sleepiness Scale score ≥12). We used a computer-generated sequence via an interactive web response system to randomly assign patients to receive either pitolisant or placebo once per day (1:1 ratio). Randomisation was done in blocks of four. Participants and investigators were masked to treatment allocation. Treatment lasted for 7 weeks: 3 weeks of flexible dosing decided by investigators according to efficacy and tolerance (5 mg, 10 mg, or 20 mg oral pitolisant), followed by 4 weeks of stable dosing (5 mg, 10 mg, 20 mg, or 40 mg). The primary endpoint was the change in the average number of cataplexy attacks per week as recorded in patient diaries (weekly cataplexy rate [WCR]) between the 2 weeks of baseline and the 4 weeks of stable dosing period. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01800045. FINDINGS: The trial was done between April 19, 2013, and Jan 28, 2015. We screened 117 patients, 106 of whom were randomly assigned to treatment (54 to pitolisant and 52 to placebo) and, after dropout, 54 patients from the pitolisant group and 51 from the placebo group were included in the intention-to-treat analysis. The WCR during the stable dosing period compared with baseline was decreased by 75% (WCRfinal=2·27; WCRbaseline=9·15; WCRfinal/baseline=0·25) in patients who received pitolisant and 38% (WCRfinal=4·52; WCRbaseline=7·31; WCRfinal/baseline=0·62) in patients who received placebo (rate ratio 0·512; 95% CI 0·43-0·60, p<0·0001). Treatment-related adverse events were significantly more common in the pitolisant group than in the placebo group (15 [28%] of 54 vs 6 [12%] of 51; p=0·048). There were no serious adverse events, but one case of severe nausea in the pitolisant group. The most frequent adverse events in the pitolisant group (headache, irritability, anxiety, and nausea) were mild or moderate except one case of severe nausea. No withdrawal syndrome was detected following pitolisant treatment; one case was detected in the placebo group. INTERPRETATION: Pitolisant was well tolerated and efficacious in reducing cataplexy. If confirmed in long-term studies, pitolisant might constitute a useful first-line therapy for cataplexy in patients with narcolepsy, for whom there are currently few therapeutic options. FUNDING: Bioprojet, France.
- MeSH
- antagonisté histaminového receptoru H3 terapeutické užití MeSH
- databáze bibliografické statistika a číselné údaje MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- kataplexie farmakoterapie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- narkolepsie komplikace MeSH
- následné studie MeSH
- piperidiny terapeutické užití MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- MeSH
- Kleineho-Levinův syndrom MeSH
- lidé MeSH
- narkolepsie komplikace MeSH
- noční přejídání komplikace MeSH
- obezita * komplikace MeSH
- obstrukční spánková apnoe epidemiologie etiologie patofyziologie MeSH
- poruchy příjmu potravy etiologie klasifikace komplikace MeSH
- spánková deprivace komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Klíčová slova
- pandemie prasečí chřipky, vakcína Pandemrix, protein hypokretinového receptoru 2,
- MeSH
- antagonisté orexinových receptorů MeSH
- hodnotící studie jako téma MeSH
- lidé MeSH
- narkolepsie * diagnóza genetika chemicky indukované komplikace prevence a kontrola MeSH
- orexinové receptory fyziologie imunologie účinky léků MeSH
- protilátky virové biosyntéza diagnostické užití farmakologie krev škodlivé účinky MeSH
- vakcíny proti chřipce * analýza aplikace a dávkování farmakologie škodlivé účinky terapeutické užití MeSH
- virové proteiny * aplikace a dávkování diagnostické užití farmakologie chemie izolace a purifikace škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
OBJECTIVE: Besides main disease symptoms, disturbing dreams are often found in narcoleptics and may contribute to disturbed sleep. Our main goal was to study different types of oneiric activity in narcolepsy with cataplexy (NC) and narcolepsy without cataplexy (N). METHODS: We have analyzed the medical history of 118 narcoleptics (64 men, 86 with NC, 32 with N, mean age 41.6±15 years). Their most frequent dreams were divided into four groups: (A) low recall/mundane dreams, (B) vivid dreams without disturbing negative emotion, (C) nightmares, (D) reduction of nightmares, possibly by medication. Associations with other features of the disease were statistically analyzed. RESULTS: Nightmares were found in one-third of the patients, proportionally distributed in N and NC groups; not negatively charged vivid dreams appeared more frequently in NC patients (P<0.005). No/mundane dreams occurred with higher prevalence in men (48%) than in women (20%), (P<0.005), without any significant influence of age. Occurrence of nightmares was significantly higher in patients with REM sleep behavior (P<0.05), but lower in patients with obstructive sleep apnea (P<0.005). Polysomnographic correlation of N and NC nightmare groups showed more wakefulness (P<0.05) and higher percentage of NREM1 stage (P<0.05) in NC patients with nightmares. CONCLUSION: Compared with the general population, nightmares seem to be significantly more prevalent in both NC and N, and they are not sufficiently investigated and treated. The neurobiological basis of narcolepsy and patients' dreaming activities appear to be closely related.
Narcolepsy with cataplexy is caused by a deficiency in the production of hypocretin/orexin, which regulates sleep and wakefulness, and also influences appetite, neuroendocrine functions and metabolism. In this case-control study, 11 patients with narcolepsy with cataplexy and 11 healthy adults underwent an oral glucose tolerance test, and dexamethasone suppression/corticotropin-releasing hormone stimulation test. The average age of patients and controls was 35.1 ± 13.2 and 41.0 ± 2.9 years, respectively, body mass index was 28.1 ± 6.6 and 25.5 ± 4.7 kg m(-2) . We did not find evidence of a significantly increased prevalence of disturbed glucose tolerance in patients with narcolepsy. After hypothalamo-pituitary-adrenal axis suppression, the number of non-suppressors did not differ between the groups, indicating normal negative feedback sensitivity. The level of cortisol after dexamethasone suppression was significantly lower in patients with narcolepsy, suggesting a slight basal downregulation and/or a slightly increased negative feedback sensitivity of the major endocrine stress system in narcolepsy. Following corticotropin-releasing hormone stimulation, there were no significant differences in levels of adrenocorticotropic hormone or cortisol, and in adrenocortical responsivity to adrenocorticotropic hormone. Finally, patients with narcolepsy displayed significantly higher plasma levels of tumour necrosis factor alpha, soluble tumour necrosis factor receptor p55, soluble tumour necrosis factor receptor p75 and interleukin 6 after adjustment for body mass index. The present study confirms that narcolepsy by itself is not associated with disturbances of glucose metabolism, but goes along with a subtle dysregulation of inflammatory cytokine production. We also found that dynamic hypothalamo-pituitary-adrenal system response is not altered, whereas negative feedback to dexamethasone might be slightly enhanced.
- MeSH
- adrenokortikotropní hormon krev MeSH
- dexamethason farmakologie MeSH
- dospělí MeSH
- glukózový toleranční test MeSH
- hormon uvolňující kortikotropin farmakologie MeSH
- hydrokortison krev MeSH
- index tělesné hmotnosti MeSH
- interleukin-6 metabolismus MeSH
- kataplexie krev komplikace metabolismus MeSH
- krevní glukóza metabolismus MeSH
- lidé MeSH
- narkolepsie krev komplikace metabolismus MeSH
- studie případů a kontrol MeSH
- systém hypofýza - nadledviny účinky léků metabolismus MeSH
- systém hypotalamus-hypofýza účinky léků metabolismus MeSH
- TNF-alfa krev MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Nadměrná denní spavost (EDS) je významný klinický symptom s mnoha důsledky pro jednotlivce a celou společnost. Většina případů EDS u zdravých lidí souvisí se zkrácením nočního spánku. U nemocných a starších lidí je EDS způsobena většinou fragmentací nočního spánku a malou skupinu nemocných tvoří centrální hypersomnie. Článek popisuje měření tendence usnout, epidemiologii EDS a její následky včetně zkušeností ve zdravotnictví. Letmo je zmíněna léčba.
Excessive daytime sleepiness (EDS) is an important clinical symptom with many obnoxious consequences both on individual and society levels. EDS in healthy people in most of cases results from night sleep shortage while in ill and elderly people is EDS caused by fragmentation of nocturnal sleep and just a small group is formed by patients suffering from central hypersomnias. This paper describes measurement of a tendency to fall asleep, EDS epidemiology and its after-effects including common clinical practice. Brief overview of treatment procedures is also included.
