High Rates of Psychiatric Comorbidity in Narcolepsy: Findings From the Burden of Narcolepsy Disease (BOND) Study of 9,312 Patients in the United States.
OBJECTIVE
To evaluate psychiatric comorbidity patterns in patients with a narcolepsy diagnosis in the United States.


METHODS
Truven Health Analytics MarketScan Research Databases were accessed to identify individuals ≥ 18 years of age with ≥ 1 ICD-9 diagnosis code(s) for narcolepsy continuously insured between 2006 and 2010 and non-narcolepsy controls matched 5:1 (age, gender, region, payer). Extensive subanalyses were conducted to confirm the validity of narcolepsy definitions. Narcolepsy subjects and controls were compared for frequency of psychiatric comorbid conditions (based on ICD-9 codes/Clinical Classification Software [CCS] level 2 categories) and psychiatric medication use.


RESULTS
The final population included 9,312 narcolepsy subjects and 46,559 controls (each group, mean age = 46.1 years; 59% female). All categories of mental illness were significantly more prevalent in patients with narcolepsy versus controls, with the highest excess prevalence noted for CCS 5.8 Mood disorders (37.9% vs 13.8%; odds ratio [OR] = 4.0; 95% CI, 3.8-4.2), CCS 5.8.2 Depressive disorders (35.8% vs 13.0%; OR = 3.9; 95% CI, 3.7-4.1), and CCS 5.2 Anxiety disorders (25.1% vs 11.9%; OR = 2.5; 95% CI, 2.4-2.7). Excess prevalence of anxiety and mood disorders (narcolepsy vs controls) was higher in younger age groups versus older age groups. Psychiatric medication usage was higher in the narcolepsy group versus controls in the following categories: selective serotonin reuptake inhibitors (36% vs 17%), anxiolytic benzodiazepines (34% vs 19%), hypnotics (29% vs 13%), serotonin-norepinephrine reuptake inhibitors (21% vs 6%), and tricyclic antidepressants (13% vs 4%) (all P values < .0001).


CONCLUSIONS
Narcolepsy is associated with significant comorbid psychiatric illness burden and higher psychiatric medication usage compared with the non-narcolepsy population.
Stanford Center for Sleep Sciences and Medicine, Palo Alto, California, USA.
Chad M
CM
Ruoff
Strategic Health Resources, La Canada, California, USA.
Nancy L
NL
Reaven
Strategic Health Resources, La Canada, California, USA.
Susan E
SE
Funk
Statistics Department, California Polytechnic State University, San Luis Obispo, California, USA.
Karen J
KJ
McGaughey
Stanford Sleep Epidemiology Research Center, Stanford University School of Medicine, Palo Alto, California, USA.
Maurice M
MM
Ohayon
Sleep Disorders Program, Stanford University, Redwood City, California, USA.
Christian
C
Guilleminault
450 Broadway St, Pavilion B, 2nd Floor, Redwood City, CA 94063. jedblack@stanford.edu.|Sleep Disorders Clinic, Stanford University School of Medicine, Palo Alto, California, USA.|Jazz Pharmaceuticals, Palo Alto, California, USA.
Jed
J
Black
D000293:Adolescent; D000328:Adult; D000368:Aged; D002385:Cataplexy / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D009290:Narcolepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D014481:United States; D055815:Young Adult