title: Listening to the Patient Voice in Narcolepsy: Diagnostic Delay, Disease Burden, and Treatment Efficacy.
abstract: OBJECTIVE
  Describe common symptoms, comorbidities, functional limitations, and treatment responsiveness among patients with narcolepsy. Investigate the effect of pediatric onset of narcolepsy symptoms on time to diagnosis of narcolepsy and presence of comorbid depression.
  
  
  METHODS
  Cross-sectional survey of 1,699 people in the United States with self-reported diagnosis of narcolepsy. We utilized mixed-methods data analyses to report study findings.
  
  
  RESULTS
  Most participants reported receiving a diagnosis of narcolepsy more than 1 y after symptom onset. We found that the strongest predictor of this delayed diagnosis was pediatric onset of symptoms (odds ratio = 2.4, p < 0.0005). Depression was the most common comorbidity but we detected no association with pediatric onset of narcolepsy symptoms. Overall, participants reported that fatigue and cognitive difficulties were their most burdensome symptoms in addition to sleepiness and cataplexy. The majority of participants reported residual daytime fatigue and/or sleepiness despite treatment. Most participants reported they could not perform at work or school as well as they would like because of narcolepsy symptoms.
  
  
  CONCLUSIONS
  This study provides unique insight into the narcolepsy disease experience. The study quantifies the problem of diagnostic delay for narcolepsy patients in the United States and highlights that symptoms are more likely to be missed if they develop before 18 y of age. These results suggest that narcolepsy awareness efforts should be aimed at parents, pediatric health care providers, school professionals, and children/adolescents themselves. Disease burden is high because of problems with fatigue, cognition, and persistence of residual symptoms despite treatment.
authors.affiliation: Harvard Medical School, Boston, MA.|Boston Children's Hospital, Boston, MA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Maski
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Erin
authors.initials: E
authors.lastname: Steinhart
authors.affiliation: Harvard Medical School, Boston, MA.|Boston Children's Hospital, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Harvard Medical School, Boston, MA.|Beth Israel Deaconess Hospital, Boston, MA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Scammell
authors.affiliation: Project Sleep, Los Angeles, CA.
authors.forename: Julie
authors.initials: J
authors.lastname: Flygare
authors.affiliation: FasterCures, A Center of the Milken Institute, Washington, DC.
authors.forename: Kimberly
authors.initials: K
authors.lastname: McCleary
authors.affiliation: Wake Up Narcolepsy, Inc, Worcester, MA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gow
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: cataplexy; children; delayed diagnosis; narcolepsy; symptoms; treatment