title: Manipulation of core body and skin temperature improves vigilance and maintenance of wakefulness in narcolepsy.
abstract: BACKGROUND
  Impaired vigilance and sleepiness are two majordaily complaints of patients with narcolepsy. We previously showed their sleepiness to be correlated to an abnormally regulated skin temperature, i.e., increased distal skin temperature compared with proximal skin temperature.
  
  
  OBJECTIVE
  Our goal was to investigate a possible causal contribution of skin temperature disturbances to impairments in the ability to maintain vigilance and wakefulness in narcolepsy.
  
  
  METHODS
  In a modified constant routine protocol, the Psychomotor Vigilance Task (PVT) and the Maintenance of Wakefulness Test (MWT) were repeatedly assessed. Meanwhile, skin and core body temperatures were mildly manipulated within the thermoneutral range of the normal diurnal rhythm using a thermosuit and hot or cold food and drinks.
  
  
  METHODS
  Tertiary narcolepsy referral center in a university hospital
  
  
  METHODS
  Eight patients (5 males) diagnosed with narcolepsy with cataplexy according to the ICSD-2 criteria (mean age +/- SD: 28.6 +/- 6.4, range 18-35 years).
  
  
  METHODS
  None.
  
  
  METHODS
  MWT sleep latency and PVT response speed.
  
  
  RESULTS
  Compared to core cooling, core warming attenuated the typical decline in PVT response speed with increasing time-on-task by 25% (P = 0.02). Compared to distal skin warming, distal skin cooling increased the time that the patients were able to maintain wakefulness by 24% (distal warming: 1.88 min. vs. distal warming: 2.34 min.; P < 0.01).
  
  
  CONCLUSIONS
  Core body and skin temperatures causally affect vigilance and sleepiness in narcolepsy. This could lead to future practical applications.
authors.affiliation: Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
authors.forename: Rolf
authors.initials: R
authors.lastname: Fronczek
authors.forename: Roy J E M
authors.initials: RJ
authors.lastname: Raymann
authors.forename: Nico
authors.initials: N
authors.lastname: Romeijn
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Overeem
authors.forename: Maria
authors.initials: M
authors.lastname: Fischer
authors.forename: J Gert
authors.initials: JG
authors.lastname: van Dijk
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: Lammers
authors.forename: Eus J W
authors.initials: EJ
authors.lastname: Van Someren
mesh_terms: D000293:Adolescent; D000328:Adult; D001143:Arousal / Q000502:physiology*; D001831:Body Temperature / Q000502:physiology*; D001833:Body Temperature Regulation; D005260:Female; D006801:Humans; D008297:Male; D009290:Narcolepsy / Q000517:prevention & control*; D011597:Psychomotor Performance / Q000502:physiology; D012867:Skin; D014851:Wakefulness / Q000502:physiology*