Obstructive sleep apnea in narcolepsy.
OBJECTIVE
Narcolepsy and obstructive sleep apnea syndrome (OSAS) are two conditions associated with excessive daytime sleepiness (EDS). They may coexist in the same patient but the frequency of this association and its clinical significance is unknown. The presence of obstructive sleep apnea (OSA) in a narcoleptic patient may interfere with the diagnosis of narcolepsy. The aim of the study was to determine the prevalence of OSA in narcolepsy.


METHODS
University hospital sleep clinic series of narcoleptic patients diagnosed with nocturnal polysomnography and multiple sleep latency test. Patients were systematically interviewed evaluating narcoleptic and OSAS features and their response to continuous positive airway pressure (CPAP) treatment when applied.


METHODS
One hundred and thirty-three patients with narcolepsy.


RESULTS
Thirty-three patients (24.8%) had an apnea-hypopnea index greater than 10 with a mean index of 28.5+/-15.7. Ten of them were initially diagnosed only with OSAS and the diagnosis of narcolepsy was delayed 6.1+/-7.8years until being evaluated in our center for residual EDS after CPAP therapy. In the remaining 23 patients, narcolepsy and OSA were diagnosed simultaneously. Cataplexy occurred with similar frequency in both groups. EDS did not improve in 11 of the 14 patients who were treated with CPAP. The presence of OSA was associated with male gender, older age and higher body mass index.


CONCLUSIONS
OSA occurs frequently in narcolepsy and may delay the diagnosis of narcolepsy by several years and interfere with its proper management. In patients with OSA, cataplexy should be actively looked for to exclude the presence of narcolepsy. Treatment with CPAP does not usually improve EDS in narcoleptics with OSA.
Sansa
Gemma
G
Neurology Service, Hospital Clínic, Institut d'Investigació Biomèdiques August Pi i Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain.
Iranzo
Alex
A
Santamaria
Joan
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002385:Cataplexy / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000175:diagnosis / Q000453:epidemiology*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult