Sleep‐stage sequencing of sleep‐onset REM periods in MSLT predicts treatment response in patients with narcolepsy. (6th November 2015)

• Record Type: Journal Article
• Authors: Drakatos, Panagis; Patel, Kishankumar; Thakrar, Chiraag; Williams, Adrian J.; Kent, Brian D.; Leschziner, Guy D.
• Is Part Of: Journal of sleep research. Volume 25:Number 2(2016:Jun.)
• Page Start: 203
• Page End: 210
• Publication Date: 2015-11-06
• Subjects: prognostication -- NT1 -- NT2 -- treatment outcome; Sleep -- Periodicals; Sleep disorders -- Periodicals; 612.821
• DOI: 10.1111/jsr.12363
• Languages: English
• ISSNs: 0962-1105

Abstract

Summary: Current treatment recommendations for narcolepsy suggest that modafinil should be used as a first‐line treatment ahead of conventional stimulants or sodium oxybate. In this study, performed in a tertiary sleep disorders centre, treatment responses were examined following these recommendations, and the ability of sleep‐stage sequencing of sleep‐onset rapid eye movement periods in the multiple sleep latency test to predict treatment response. Over a 3.5‐year period, 255 patients were retrospectively identified in the authors' database as patients diagnosed with narcolepsy, type 1 (with cataplexy) or type 2 (without) using clinical and polysomnographic criteria. Eligible patients were examined in detail, sleep study data were abstracted and sleep‐stage sequencing of sleep‐onset rapid eye movement periods were analysed. Response to treatment was graded utilizing an internally developed scale. Seventy‐five patients were included (39% males). Forty (53%) were diagnosed with type 1 narcolepsy with a mean follow‐up of 2.37 ± 1.35 years. Ninety‐seven percent of the patients were initially started on modafinil, and overall 59% reported complete response on the last follow‐up. Twenty‐nine patients (39%) had the sequence of sleep stage 1 or wake to rapid eye movement in all of their sleep‐onset rapid eye movement periods, with most of these diagnosed as narcolepsy type 1 (72%). The presence of this specific sleep‐stage sequence in all sleep‐onset rapid eye movement periods was associated with worse treatment response ( P = 0.0023). Sleep‐stage sequence analysis of sleep‐onset rapid eye movement periods in the multiple sleep latency test may aid the prediction of treatment response in narcoleptics and provide a useful prognostic tool in clinical practice, above and beyond their classification as narcolepsy type 1 or 2.