title: Examining the Frequency of Stimulant Misuse among Patients with Primary Disorders of Hypersomnolence: A Retrospective Cohort Study.
abstract: Narcolepsy and idiopathic hypersomnia are commonly treated by sleep specialists and encountered by other medical providers. Although pharmacotherapy with modafinil and traditional stimulants is considered the mainstay of treatment, physicians are often uncomfortable with their prescription because of concerns regarding misuse. The goal of this study was to assess the frequency of stimulant misuse in this population.
  
  
  
  A retrospective cohort study was performed evaluating patients 18 years and older diagnosed with narcolepsy with and without cataplexy and idiopathic hypersomnia with and without long sleep between 2003-2008. Patients were included if they obtained stimulant prescriptions from and had at least one follow-up visit subsequent to initial diagnosis at our center. Stimulant misuse was defined by multiple prescription sources or early refill requests, which are systematically entered into the record by nursing staff.
  
  
  
  A total of 105 patients met inclusion criteria for the study; 45 (42%) were male. Mean age at multiple sleep latency test was 42 (± 16). Twelve (11%) patients had a history of illicit substance misuse, and one (1%) patient demonstrated previous stimulant misuse. Fifty-seven (54%) patients carried psychiatric diagnoses, 88% of whom reported depression. Median duration of monitored stimulant therapy was 26 months (range 1-250). None of the 105 patients was found to have evidence of stimulant misuse.
  
  
  
  This study suggests that the frequency of stimulant misuse in patients with narcolepsy and idiopathic hypersomnia is extremely low. Concerns regarding drug misuse should not leverage decisions to provide long-term therapy.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: William G
authors.initials: WG
authors.lastname: Mantyh
authors.affiliation: Center for Sleep Medicine, Mayo Clinic, Rochester, MN.|Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN.
authors.forename: R Robert
authors.initials: RR
authors.lastname: Auger
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN.|Center for Sleep Medicine, Mayo Clinic, Rochester, MN.|Division of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Timothy I
authors.initials: TI
authors.lastname: Morgenthaler
authors.affiliation: Center for Sleep Medicine, Mayo Clinic, Rochester, MN.|Department of Neurology, Mayo Clinic, Rochester, MN.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Silber
authors.affiliation: Center for Sleep Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Moore
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D000662:Amphetamines / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy* / Q000453:epidemiology*; D000076064:Drug Misuse / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D000662:Amphetamines
keywords: narcolepsy; primary hypersomnolence; stimulant misuse