March 26, 2023 3:20 pm

In current months, the NeurologyLive® group has been covering the news on the newest updates in the clinical care of men and women with neuromuscular issues, numerous sclerosis, movement issues, sleep issues, and a lot more. For our coverage of sleep issues, our group has spoken with a number of professionals and highlighted numerous clinical findings relevant for the populations of sufferers with issues such as narcolepsy, insomnia, cataplexy, and numerous other people.

For Globe Sleep Day—celebrated on March 17, 2023—the group has culminated some of the largest pieces of news to supply updates on new developments in the literature of sleep medicine to spread awareness on the prevention and therapy of sleep issues.

Click right here for a lot more coverage of the newest news in sleep issues from NeurologyLive®.

Most current Literature

Clinical and Neuropsychological Information on Narcolepsy Shows No Distinction in Comparison of Worldwide Networks

A not too long ago published study (NCT05375890) in the Journal of Clinical Sleep Medicine showed nonsignificant variations in clinical and neuropsychological information in the Russian Narcolepsy Network (RN-NN) relative to that previously reported in the European Narcolepsy Network (EU-NN).1 The findings showed a lot more extreme and greater percentages of sufferers who practical experience cataplexy in Russia, suggesting a low awareness of narcolepsy.

Comparing information with the EU-NN,two the RN-NN had fewer sufferers with excessive daytime sleepiness (EDS) as a initial symptom (25.six% vs 43.eight% P = .0014), whereas the percentage of each EDS and cataplexy as a initial symptom was nearly twice as higher as in the EU-NN information (67.four% vs 48.eight P = .0013). Notably, the prevalence of extreme cataplexy circumstances was greater in the RN-NN than in the EU-NN information (93.eight% [n = 80] vs 62.six% [n = 829] in EU-NN P = .001).

Sleep paralysis (59.1%, n = 88) and hallucinations (82.%, n = 89 P = .0017) had been present in the RN-NN a lot more usually than in the European cohort (52.six% [n = 257] and 63.1% [n = 370], respectively). Information with polysomnography and imply sleep latency test (MSLT) in RN-NN are comparable, while observed MSLT scores (four.9 [±2.9] minutes [n = 52] vs three.9 ± three. minutes [n = 927] P = .0193) had been as greater in the Russian cohort.

Narcolepsy Causes Considerable Influence on Social Partnership Wellness in Adolescents, Study Shows

In an exploratory study not too long ago published in the Journal of Clinical Sleep Medicine, findings revealed an overarching theme that adolescents and their parents practical experience difficulty in attempting to balance narcolepsy symptom management with meaningful social engagement.three In the study, symptoms of daytime fatigue and cataplexy had been the most considerable and normally discussed amongst adolescents and their parents as getting an influence on social relationships.

Notably, adolescents reported feeling frustrated by their sleep disorder impacting their social lives such as consistently needing to program ahead with their sleep schedule. Furthermore, each adolescents and their parents expressed the will need for health-related providers to much better comprehend their altering priorities, validate social limitations, and supply a lot more facts about the social implications of situation and therapy.

Adolescents in between the ages of 12 and 17 years old with narcolepsy and their parents completed a semistructured interview individually in between July 2021 and December 2021. Participants had been incorporated if they had a confirmed diagnosis of narcolepsy variety 1 (n = 12 85.7%) or variety two (n = two 14.three%) utilizing polysomnography/MSLT or other testing and had been fluent in English. Information records had been extracted, primarily based on their narcolepsy medication program and Epworth Sleepiness Scale (ESS) score three months just before the interview date, from Boston Children’s Hospital. Of note, three sufferers had a health-related record from outdoors the hospital. Interview transcripts had been analyzed utilizing a multistage thematic evaluation.

Titration Prevalent in Solriamfetol, Leads to Improvements in Daytime Sleepiness

Solriamfetol (Sunosi Axsome Therapeutics), an FDA-authorized medication for EDS, is generally initiated at 75 mg/day, with titration typical, according to the SURWEY study assessing actual-globe doctor approaches.four Following initiation, sufferers skilled improvements in ESS scores, and most sufferers perceived improvement in their EDS status.

The most typical beginning doses all round had been 75 mg/day (69%) or 150 mg/day (20%), with most of the remaining sufferers initiated at 37.five mg. Just about half (43%) of sufferers had their therapy titrated, with 90% finishing titration as prescribed. Titration was most normally completed inside 7 days (57%). For sufferers who changed therapy, switching to solriamfetol was managed utilizing an abrupt method for 88% of sufferers, an overlapping (tapered) method for 9% of sufferers, and an unknown method for two% of sufferers.

Retrospective chart evaluations from 70 German adults with EDS and narcolepsy had been collected by investigators, with sufferers classified as either changeover (n = 43 61%), add-on (n = 19 27%), or new-to-therapy (n = eight 11%) subgroups, primarily based on current EDS therapy. The imply age of the cohort was 36.9 (±13.9) years and imply physique mass index was 26.7 (SD, five.two) kg/m. Extra than half (57%) had cataplexy, and most (84%) had been treated in sleep centers.

Alterations in Sleep Architecture, Comorbidities Observed in Extended-Term Remedy With Sodium Oxybate

Findings from a tiny-scale, longitudinal study assessing sufferers with narcolepsy with cataplexy (NT1) showed that soon after three years of therapy with low to medium doses of sodium oxybate, there had been considerable variations in sleep structure and an boost in comorbidities that led to drug withdrawal.five

To the study authors expertise, this was the longest recorded trial evaluating the impact of sodium oxybate on sleep architecture and comorbidity with video-polysomnography. The trial featured 23 adults with NT1 who had been treated with an initial nocturnal dose of four.five g of sodium oxybate, with sleep parameters compared soon after six months (FU-1), 1 year (FU-two), and three years (FU-three) of uninterrupted therapy.

Findings on video polysomnography showed an boost in stage N3 in the initial sleep cycle and a REM-onset in 90% of sufferers soon after the administration of the initial dose. When comparing the time spent in the distinctive sleep stages in between FU-1 and FU-two, sufferers improved the time spent in stage N2 (z = –2.17 P = .03). At FU-three, there was a considerable improved observed in the time spent in stage N1 (z = –2.09 P = .03). Additionally the time spent in stages N1 and N2 had been substantially longer in the newest stick to-up than at FU-1 (z = –2.36 P = .001).

Even though Often Made use of, Complementary and Option Medicine Ineffective to Treat Narcolepsy

Findings from a current survey of 254 German sufferers with narcolepsy showed that biologically primarily based therapies had been the most regularly applied in complementary and option medicine (CAM) subgroups (76%) nevertheless, their influence is restricted. Although on these drugs, sufferers nonetheless felt the will need to increase their symptoms, sleepiness, and psychological effectively becoming.six

Amongst 33% of CAM customers (n = 84), vitamins/trace components (54%), homoeopathy (48%) and meditation (39%) had been applied most regularly. Fifty-4 customers (64%) described CAM as beneficial. CAM customers a lot more regularly reported side effects from preceding medication (P = .001). Notably, CAM customers reported a lot more regularly not complying with pharmacological therapy than nonCAM customers (21% vs. eight% P = .024).

After a week or a lot more, 75% of CAM customers utilized CAM and whereas only 23% of customers did only after a month or a lot more. Twenty-3 % of sufferers who did not take any standard pharmacological therapy prior (n = 38) reported existing CAM use. Twenty-seven % of sufferers applied each standard medicine and CAM at the very same time (n =69). Amongst these who reported previous or present CAM use, 73% reported getting automatic behavior (n = 61 vs. n = 97 nonCAM customers), 68% reported hypnagogic/hypnopompic hallucinations (n = 57 vs. n = 91 nonCAM customers), and 70% reported nightmares (n = 59 vs. n = 97 nonCAM customers).

1. Kuts A, Poluektov M, Zakharov A, et al. Clinical and neurophysiological traits of 89 sufferers with narcolepsy and cataplexy from the Russian Narcolepsy Network. J Clin Sleep Med. 202319(two):355-359. doi:ten.5664/jcsm.10340
two. Luca G, Haba-Rubio J, Dauvilliers Y, et al. Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study. J Sleep Res. 201322(five):482-495. doi:ten.1111/jsr.12044
three. Zhou ES, Revette A, Heckler GK, Worhach J, Maski K, Owens JA. Constructing a deeper understanding of social connection overall health in adolescents with narcolepsy disorder. J Clin Sleep Med. 202319(three):491-498. doi:ten.5664/jcsm.10372
four. Winter Y, Mayer G, Kotterba S. Solriamfetol actual globe practical experience study (SURWEY): initiation, titration, security, effectiveness, and practical experience throughout stick to-up for sufferers with narcolepsy from Germany. Sleep Med. 2023103:138-143. doi:ten.1016/j.sleep.2023.01.022.
five. Adrados MRP, Bellon JM, Triguero LL, Lopez-Esteban P, Medrano-Martinez P. Extended-term stick to-up on the effects of sodium oxybae on daytime sleepiness and sleep architecture in sufferers with narcolepsy variety 1. Rev Neurol. Published January 16, 2023. doi:ten.33588/rn.7602.2022315
six. Finger BM, Triller A, Bourke AM, et al. Complementary and option medicine use in narcolepsy. Sleep Med. 2023103:one hundred-105. doi:ten.1016/j.sleep.2023.01.013

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