title: Sleep-stage sequencing of sleep-onset REM periods in MSLT predicts treatment response in patients with narcolepsy.
abstract: Current treatment recommendations for narcolepsy suggest that modafinil should be used as a first-line treatment ahead of conventional stimulants or sodium oxybate. In this study, performed in a tertiary sleep disorders centre, treatment responses were examined following these recommendations, and the ability of sleep-stage sequencing of sleep-onset rapid eye movement periods in the multiple sleep latency test to predict treatment response. Over a 3.5-year period, 255 patients were retrospectively identified in the authors' database as patients diagnosed with narcolepsy, type 1 (with cataplexy) or type 2 (without) using clinical and polysomnographic criteria. Eligible patients were examined in detail, sleep study data were abstracted and sleep-stage sequencing of sleep-onset rapid eye movement periods were analysed. Response to treatment was graded utilizing an internally developed scale. Seventy-five patients were included (39% males). Forty (53%) were diagnosed with type 1 narcolepsy with a mean follow-up of 2.37 ± 1.35 years. Ninety-seven percent of the patients were initially started on modafinil, and overall 59% reported complete response on the last follow-up. Twenty-nine patients (39%) had the sequence of sleep stage 1 or wake to rapid eye movement in all of their sleep-onset rapid eye movement periods, with most of these diagnosed as narcolepsy type 1 (72%). The presence of this specific sleep-stage sequence in all sleep-onset rapid eye movement periods was associated with worse treatment response (P = 0.0023). Sleep-stage sequence analysis of sleep-onset rapid eye movement periods in the multiple sleep latency test may aid the prediction of treatment response in narcoleptics and provide a useful prognostic tool in clinical practice, above and beyond their classification as narcolepsy type 1 or 2.
authors.affiliation: Sleep Disorders Centre, Guy's and St Thomas Hospital, London, UK.
authors.forename: Panagis
authors.initials: P
authors.lastname: Drakatos
authors.affiliation: Sleep Disorders Centre, Guy's and St Thomas Hospital, London, UK.
authors.forename: Kishankumar
authors.initials: K
authors.lastname: Patel
authors.affiliation: Sleep Disorders Centre, Guy's and St Thomas Hospital, London, UK.
authors.forename: Chiraag
authors.initials: C
authors.lastname: Thakrar
authors.affiliation: Sleep Disorders Centre, Guy's and St Thomas Hospital, London, UK.|Professor in Sleep Medicine, King's College London, London, UK.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Williams
authors.affiliation: Sleep Disorders Centre, Guy's and St Thomas Hospital, London, UK.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kent
authors.affiliation: Sleep Disorders Centre, Guy's and St Thomas Hospital, London, UK.|Department of Clinical Neuroscience, King's College London, London, UK.
authors.forename: Guy D
authors.initials: GD
authors.lastname: Leschziner
mesh_terms: D000328:Adult; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D002385:Cataplexy / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D000077408:Modafinil; D009290:Narcolepsy / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D017286:Polysomnography; D011379:Prognosis; D012189:Retrospective Studies; D012895:Sleep, REM / Q000502:physiology*; D012978:Sodium Oxybate / Q000627:therapeutic use
chemical_list: D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D012978:Sodium Oxybate; D000077408:Modafinil
keywords: NT1; NT2; prognostication; treatment outcome