title: The impact of gender on timeliness of narcolepsy diagnosis.
abstract: OBJECTIVE
  To examine the impact of gender in narcoleptic patients on timeliness of diagnosis, symptomology, and health and lifestyle impairment.
  
  
  METHODS
  This is a cross-sectional study of 109 consecutive patients (68 women) with newly diagnosed narcolepsy with and without cataplexy, from a University sleep disorders center. Consecutive patients were administered an 8-page questionnaire at the time of their diagnosis regarding sleep habits, medications, and medical conditions, lifestyle impairments, as well as details regarding narcolepsy-related symptoms.
  
  
  RESULTS
  Men and women presented with remarkably similar narcolepsy related symptoms, yet women were more likely to be delayed in diagnosis; 85% of men were likely to be diagnosed by 16 years after symptom onset, compared to 28 years in women. More women were likely to remain undiagnosed at any given time point after symptom onset (hazard ratio for diagnosis of men compared to women 1.53; 95% CI 1.01-2.32; p = 0.04). Men and women reported similar degree of subjective sleepiness as measured by the Epworth Sleepiness Scale (mean 16.2 ± 4.5; p = 0.18), though women demonstrated significantly more severe objective sleepiness on multiple sleep latency testing (MSLT) (mean sleep latency in women = 5.4 min (± 4.1), in men 7.4 min (± 3.5); p = 0.03). Despite being more objectively sleepy, women were less likely to report lifestyle impairments in the areas of personal relationships (71% men, 44% women, p = 0.01) and physical activity (36% men, 16% women, p = 0.02), but were also more likely to self-medicate with caffeine (63.4% men, 82.4% women; p = 0.03).
  
  
  CONCLUSIONS
  Narcolepsy impacts men and women's health and lifestyle differently, and may cause delays diagnosis for women.
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Christine
authors.initials: C
authors.lastname: Won
authors.affiliation: Yale University School of Public Health and Epidemiology.
authors.forename: Mandana
authors.initials: M
authors.lastname: Mahmoudi
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Li
authors.initials: L
authors.lastname: Qin
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Taylor
authors.initials: T
authors.lastname: Purvis
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Aditi
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Vahid
authors.initials: V
authors.lastname: Mohsenin
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D005260:Female; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008019:Life Style; D008297:Male; D009043:Motor Activity; D009290:Narcolepsy / Q000175:diagnosis* / Q000188:drug therapy; D017286:Polysomnography / Q000379:methods; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires
keywords: Narcolepsy; diagnosis; gender; hypersomnia; sex; sleep; women