SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science VI. Sleep Disorders – Hypersomnia
0605
EXAMINING THE FREQUENCY OF STIMULANT MISUSE
AMONG PATIENTS WITH PRIMARY DISORDERS OF
HYPERSOMNOLENCE: A RETROSPECTIVE COHORT
STUDY
Spoon KC 1 , Morgenthaler TI 1,3 , Silber MH 1,4 , Slocumb NL 1 , Auger R 1,2
1
Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA,
2
Department of Psychiatry & Psychology, Mayo Clinic, Rochester,
MN, USA, 3 Department of Pulmonary & Critical Care Medicine, Mayo
Clinic, Rochester, MN, USA, 4 Department of Neurology, Mayo Clinic,
Rochester, MN, USA
Introduction: Narcolepsy and idiopathic hypersomnia are commonly
treated by sleep specialists and encountered by other medical providers.
Although pharmacotherapy with modafinil and the traditional stimulants
is considered the mainstay of treatment, physicians are often uncomfortable
with their long-term prescription because of concerns regarding
patient misuse. The goal of this study was to assess the frequency of
stimulant misuse in this population while under treatment at the Mayo
Center for Sleep Medicine.
Methods: A retrospective cohort study was performed evaluating patients
18 years and older diagnosed with narcolepsy with and without
cataplexy and idiopathic hypersomnia with and without long sleep between
1997 and 2007. Patients were included if they obtained stimulant
prescriptions from and had at least one follow-up visit subsequent to
initial diagnosis at our center. Stimulant misuse was defined by “drugseeking
behavior” (e.g., multiple drug sources or alleged lost prescriptions)
which is systematically entered into the record by nursing staff,
who, under the guidance of sleep specialists, determine eligibility of all
patients for prescription refills.
Results: A total of 105 patients met inclusion criteria for the study, 45
(42%) were male. Mean age at multiple sleep latency test was 42 (+/-
16). Twelve (11%) patients had a past history of illicit substance misuse
and one (1%) patient had previous stimulant misuse. 57 (54%) patients
had a psychiatric diagnosis, including 50 (88%) with depression. Median
duration of monitored stimulant therapy was 26 months (range
1-250). During this time, none of the 105 patients were found to have
evidence of stimulant misuse.
Conclusion: This study suggests that the frequency of stimulant misuse
in patients with narcolepsy and idiopathic hypersomnia is extremely
low. The risk of drug misuse should not influence decisions to provide
long term therapy.
0606
IS BIRTH ORDER ASSOCIATED WITH NARCOLEPSY RISK
AMONG GENETICALLY SUSCEPTIBLE INDIVIDUALS?
Watson NF 1,2 , Ton TG 1 , Koepsell TD 3 , Longstreth WT 1,3
1
Neurology, University of Washington, Seattle, WA, USA, 2 Sleep
Center, University of Washington, Seattle, WA, USA, 3 Epidemiology,
University of Washington, Seattle, WA, USA
Introduction: Birth order may play a role in autoimmune diseases and
in early childhood infections, both factors implicated in the etiology of
narcolepsy. Narcolepsy is considered an autoimmune disease that has
associations with HLA haplotypes, season of birth, anti-trib2 antibodies,
and T-cell receptor alpha locus polymorphisms. Streptococcal infections
are reported to be associated with narcolepsy. We sought to
investigate the association between birth order and narcolepsy risk in
a population-based case-control study, in which all study subjects were
HLA-DQB1*0602 positive.
Methods: Between 2001-2005, 67 prevalent narcolepsy cases were enrolled,
and 95 controls were recruited through random-digit dialing with
frequency matching on age and sex. All subjects were between ages 18-
50 years old, residents of King County, Washington, and positive for
HLA-DQB1*0602. Genotyping was performed on DNA from buccal
scrapings. Birth order was ascertained by asking, “What was your or-
der among your siblings?” We used logistic regression to generate odds
ratios adjusted for income and African American race because these factors
differed between cases and controls.
Results: Analyses included 67 cases (mean age 34.3 [SD=9.1], 70.2%
female) and 95 controls (mean age 35.1 [SD=8.8], 75.8% female). Associations
for birth order were as follows: First born (cases 44.1% vs.
controls 50.2%, OR=1.0; Reference), second born (Cases 32.3% vs.
Controls 32.9%, OR=1.6; 95% CI 0.7, 3.7), third born or higher (Cases
23.6% vs. Controls 16.8%, OR=2.5; 95% CI 1.0, 6.0). A linear trend was
significant (p=0.039). Sibling gender did not differ between narcolepsy
cases and controls (Brothers: Cases 55.2% vs. Controls 52.8%, OR=1.0;
95% CI 0.5, 2.0; Sisters: Cases 59.7% vs. Controls 59.2%, OR=1.5; 95%
CI 0.7, 3.2).
Conclusion: Narcolepsy risk was significantly associated with higher
birth order in a population-based study of genetically susceptible individuals.
This finding supports an environmental influence on narcolepsy
risk through an autoimmune mechanism, early childhood infections, or
both.
0607
SEX DIFFERENCES IN NARCOLEPSY
Won C, Purvis T, Qin L, Mohsenin V
Yale University, New Haven, CT, USA
Introduction: Notable sex differences in disease prevalence, manifestation,
and health consequencesare are well described in many common
sleep disorders such as sleep disordered breathing, insomnia, and restless
leg syndrome. However, sex differences in narcolepsy remain understudied,
and there is little scientific information regarding the clinical
significance and consequences of narcolepsy in women.
Methods: We performed a cross-sectional analysis on 109 consecutive
patients with narcolepsy from a single academic adult sleep center
from 2005-2010. Patients were administered a questionnaire evaluating
symptoms, sleep habits, lifestyle parameters, and medical history at the
time of their narcolepsy diagnosis. Responses were compared in men
and women with narcolepsy with and without cataplexy. Polysomnographic
data from the time of their diagnosis were also compared.
Results: Of the 109 narcoleptic subjects, 41 (38%) were men and 68
(62%) were women. Mean age at diagnosis and age of onset of symptoms
did not differ between sexes(29 and 15 yrs respectively in men, vs
31 and 17 yrs respectively in women). Men and women were equally
overweight (BMI 26 ±4 vs 27 ±6, respectively). Cataplexy was more
common in women (56% vs 37%, p=0.05), but there were no sex differences
in other narcolepsy-related symptoms (e.g. Epworth Sleepiness
Score, sleep paralysis and hallucinations), and no sex differences
in polysomnographic data. Occurrence of obstructive sleep apnea was
high in this relatively young population, and expected sex differences
were not observed (24.4% vs 17.6%, men and women, respectively,
p=0.40). ADHD was more commonly diagnosed in men (19.5% vs
2.9%, p=0.006). Women and men were equally likely to complain of
headaches, insomnia, depressed mood, anxiety, or chronic pain. Women
were more likely to consume daily caffeine (82.4% vs 63.4%, p=0.03),
but there were no differences in use of homeopathic wake-promoting
therapies, tobacco, or illicit drugs. Finally, women more commonly
reported that their sleep problems negatively impacted their sex life
(55% vs 29%, p=0.01). Women and men reported similarly high occurrences
of poor work/school performance (>90%), social dissatisfaction
(>35%), and driving problems (>40%) related to sleepiness.
Conclusion: Women and men with narcolepsy were remarkably similar
in narcolepsy related symptoms, demographics, and sleep study data.
Despite this, important sex differences in medical and lifestyle consequences
were appreciated.
A209
SLEEP, Volume 34, Abstract Supplement, 2011