SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science VI. Sleep Disorders – Hypersomnia
ficulty initiating nighttime sleep in patients meeting MSLT criteria for
narcolepsy in an academic center.
Methods: All patients who met diagnostic criteria on their MSLT for
narcolepsy from March, 2006 until November, 2010 were included. The
diagnostic criteria used were based on the ICSD-R with MSLT results
showing a mean latency of 40 minutes.
Conclusion: A significant number of patients meeting MSLT criteria
for narcolepsy have objective evidence on overnight polysomnography
for difficulty initiating nighttime sleep despite severe, objective daytime
sleepiness. Difficulty initiating sleep can be disturbing to the patient and
worsen daytime sleepiness. Further investigation is necessary to determine
the contributing factors to this difficulty initiating sleep in this
population suffering from severe, daytime sleepiness. Possible factors
include depression, medication effect, anxiety, co-morbid sleep disorders
or first night effect in the lab.
0612
CLINICAL CHARACTERISTICS OF NOCTURNAL SLEEP
AND CONCOMITANT SYMPTOMS IN HYPERSOMNIAS
OF CENTRAL ORIGIN; ANALYSIS ON SELF-COMPLETED
QUESTIONNAIRE
Honda M 1,2 , Honda Y 2
1
Sleep Disorder Research Project, Tokyo Institute of Psychiatry, Tokyo,
Japan, 2 Japan Somnology Center, Neuropsychiatric Institute, Tokyo,
Japan
Introduction: Symptoms other than excessive daytime sleepiness are
not always evaluated well in patients with hypersomnia of central origin.
In order to elucidate the clinical characteristics of hypersomnias, we performed
questionnaire based study to check the nocturnal sleep problems
and concomitant autonomic nerve system (ANS) symptoms.
Methods: Subjects are 327 hypersomnia patients (204 narcolepsy with
cataplexy:NA, 29 idiopathic hypersomnia with long sleep time:IHS, 94
essential hypersomnia:EHS) recruited in Japan Somnology Center and
286 healthy controls. Self-completed questionnaire asking the frequency
of nocturnal sleep problems and concomitant ANS symptoms were conducted
and data were analyzed with SPSS software. All the participants
provided written informed consent before the survey.
Results: Overall sleep latency was not different. Percentage of short
sleep latency (less than 5 min) was high in NA (48.5% vs 33.8% in
controls), while the percentage of sleep initiating problems (more than
30 min) were equally observed (5.8% in NA vs 5.6% in controls). Nocturnal
awakening were significantly more in NA(70.7% vs 22.3% in
controls) and less in IHS (10.3%). Times required for full awakening in
the morning extended in IHS (33.9min vs 10.5min in controls, 11.5min
in NA). Subjective difficulty of awakening was high in IHS (79.3%) and
low in NA (5.8%) compared to controls (7.9%), indicating the difference
in waking up process. Nocturnal talking was more in NA(30.6%) but
also observed in IHS(17.4%) vs controls(4.5%). ANS symptoms were
more frequent in IHS (dizziness 31.0%, orthostatic hypotention 42.9%,
headache 44.8%). IHS showed more Raynaud phenomena (24.1% vs
1.8% in controls, 6.1% in NA) while NA showed more excessive sweating
(53.7% vs 12.0% in controls, 29.3% in IHS). Majority of IHS patients
(65.5%) suffered from fatigue.
Conclusion: Hypersomina of central origin show characteristic symptoms,
especially in the process of waking up in the morning and body
temperature regulation. These data will contribute to the better understanding
of hypersomnia pathophysiology.
0613
IMPACT OF SODIUM OXYBATE ON HEALTH STATUS
MEASURES IN NARCOLEPSY USING THE CLEVELAND
CLINIC KNOWLEDGE PROJECT
Brooker C, Foldvary-Schaefer N, Moul DE
Cleveland Clinic, Cleveland, OH, USA
Introduction: Narcolepsy is often resistant to pharmacological interventions,
many lacking head-to-head testing for superiority against
sleepiness and other health measures. We investigated the self-reported
impact of sodium oxybate on the Epworth Sleepiness Scale (ESS), Fatigue
Severity Scale (FSS), Functional Outcomes of Sleep Questionnaire
(FOSQ), and Patient Health Questionnaire-9 (PHQ-9), and self-reported
total sleep time (TST).
Methods: Retrospective Cleveland Clinic Knowledge Project (KP)
chart review compared patients pre- and post-sodium oxybate therapy
at 3 and 6 months on ESS, FSS, FOSQ, and PHQ-9, to look for changes
in sleepiness, fatigue, functional status, and depression respectively. No
previous studies assessed FSS and PHQ-9 in relation to sodium oxybate;
only one included FOSQ.
Results: Twenty patients (19 Females, age 42±13yrs, 8 with cataplexy,
85% on stimulants) had mean sodium oxybate dose of 5.7±1.4
g/day at 3 months and 6.6±1.1g/day at 6 months. ESS ratings at baseline
(16.0±4.5) improved significantly at 3 (12.3±4.7; p=0.004) and
6 months (11.13±4.7; p=0.0008). FSS ratings at baseline (49.0±12.6)
showed trend improvement at 3 (43.3±15.5; p=0.22) and 6 months
(41.1±15.2; p=0.10). FOSQ ratings at baseline (20.1±18.9) did not improve
at 3 months (19.2±13.1) but did at 6 months (25.8±20.9; p=0.01).
PHQ-9 ratings (9.9±5.6 at baseline) improved significantly at 3 months
(5.5±4.8; p=0.007) but not at 6 months (4.4±4.4; p=0.2). TST (baseline
(8.2±1.7 hrs) decreased (7.4±1.0; p=0.015) at 3 months, but not significantly
at 6 months (7.8±1.2; p=0.86).
Conclusion: In addition to improving sleepiness, sodium oxybate
therapy for narcolepsy appears therapeutic across several self-reported
measures. The relative benefit of this against other interventions for
narcolepsy with cataplexy will require assessments across a variety of
functional health domains.
0614
METABOLIC ALTERATIONS IN NARCOLEPSY WITH
CATAPLEXY AND OBSTRUCTIVE SLEEP APNEA
SYNDROME
Poli F 1 , Pagotto U 2 , Pizza F 1 , Franceschini C 1 , Palaia V 1 , Kaveh
Moghadam K 1 , Mignot E 3 , Plazzi G 1
1
Department of Neurological Sciences, University of Bologna,
Bologna, Italy, 2 Endocrinology Unit, Ospedale Sant’Orsola-Malpighi,
Bologna, Italy, 3 Center for Narcolepsy, Stanford University, Palo Alto,
CA, USA
Introduction: Several studies have shown an elevated body weight and
altered metabolic parameters in patients with narcolepsy with cataplexy
(NC). Moreover, there is an increased co-morbidity between NC and
Obstructive Sleep Apnea (OSA). We explored metabolic alterations in
hypocretin-1 deficient NC adult subjects, with and without OSA, compared
with subjects complaining excessive daytime sleepiness (EDS),
and with patients with Obstructive Sleep Apnea Syndrome (OSAS). A
second aim was to confirm an increased prevalence of metabolic syndrome
(MS) in NC.
Methods: According to the International Classification of Sleep Disorders
(ICSD2), 30 NC patients, 11 patients with NC and co-morbid
OSA, 21 with EDS, and 11 with OSAS, were consecutively enrolled.
In all patients BMI, waist circumference, plasmatic glucose and lipid
profiles were measured. Family history for metabolic/endocrine diseases
was collected. Hypocretin-1 and HLA DQB1*0602 haplotype were investigated
when possible.
A211
SLEEP, Volume 34, Abstract Supplement, 2011