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The Swiss Narcolepsy Scale (SNS) and its short form (sSNS) for the discrimination of narcolepsy in patients with hypersomnolence: a cohort study based on the Bern Sleep–Wake Database

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Abstract

Previous studies reported high sensitivity and specificity of the Swiss Narcolepsy Scale (SNS) for the diagnosis of narcolepsy type 1. We used data from the Bern Sleep–Wake Database to investigate the discriminating capacity of both the SNS and the Epworth Sleepiness Scale (ESS) to identify narcolepsy type 1 and type 2 in patients with central disorders of hypersomnolence (CDH) or sleepy patients with obstructive sleep apnea (OSA). In addition, we aimed to develop a simplified version of the SNS. We created the two-item short-form SNS (sSNS), based on the discriminative capability of the models including all possible combinations of the five questions of the SNS. Using the previously published co-efficiencies, we confirmed the high capacity of the SNS in identifying narcolepsy type 1. The updated SNS (based on new co-efficiencies and cutoff) and the sSNS showed high capacity and were both superior to ESS in identifying narcolepsy type 1. The sSNS correlated significantly with the SNS (r = − 0.897, p < 0.001). No scale showed sufficient discrimination for narcolepsy type 2. This is the largest cohort study that confirms the discriminating power of SNS for narcolepsy type 1 in patients with hypersomnolence and the first study to assess its discriminative power for narcolepsy type 2. The easy-to-use and easy-to-calculate short-form scale has a high discriminating power for narcolepsy type 1 and may be used as screening tool, especially among general practitioners, to identify patients and accelerate their referral to a center of expertise.

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Acknowledgements

We thank Corinne Roth, Sandra Röthlisberger and Tanja Gerber for their assistance with the data transfer to the Bern Sleep–Wake Database. We also thank Christian Sturzenegger for the consultation.

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Author notes

  1. Panagiotis Bargiotas and Anelia Dietmann have equally contributed to this work.

Authors and Affiliations

  1. Sleep Wake Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland

    Panagiotis Bargiotas, Anelia Dietmann, Ulf Kallweit, Marta Garcia Calle, Markus Schmidt, Johannes Mathis & Claudio L. Bassetti

  2. CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland

    Alan G. Haynes

  3. Clinical Sleep and Neuroimmunology, Institute of Immunology, University of Witten/Herdecke, Witten, Germany

    Ulf Kallweit

Authors
  1. Panagiotis Bargiotas
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  2. Anelia Dietmann
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  4. Ulf Kallweit
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  7. Johannes Mathis
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Correspondence to Panagiotis Bargiotas.

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Conflicts of interest

The authors thank Jazz Pharmaceuticals for funding of this study. Jazz Pharmaceuticals also reviewed the manuscript and had the opportunity to provide suggestions to the authors for their consideration. Although Jazz Pharmaceuticals reviewed the content of this manuscript, the ultimate interpretation, and the decision to submit it for publication was made by the authors independently. “Jazz pharmaceuticals holds a royalty-bearing non-exclusive license to the SNS from the University of Bern”. Panagiotis Bargiotas has no specific conflict of interest with respect of present work. Dr. Bargiotas has received congress fees and travel reimbursements from Lundbeck Foundation. Anelia Dietmann, Marta Garcia Calle, Markus Schmidt, and Johannes Mathis have no specific conflict of interest with respect of present work and have nothing to declare. Alan G. Haynes is affiliated with CTU Bern, University of Bern, which has a staff policy of not accepting honoraria or consultancy fees. However, CTU Bern is involved in design, conduct, or analysis of clinical studies funded by not-for-profit and for-profit organizations. In particular, pharmaceutical and medical device companies provide direct funding to some of these studies. For an up-to-date list of CTU, Bern’s conflicts of interest see “https://www.ctu.unibe.ch/research/declaration_of_interest/index_eng.html”. Ulf Kallweit has received Honoraria for consultancy/advisory board and/or speaking engagements from: AOP Orphan Pharma; Bioprojet Pharma; Harmony Biosciences; Jazz Pharma; UCB Pharma. Claudio Bassetti has no specific conflict of interest with respect of present work. Prof. Bassetti has received honoraria for consultancy, lectures, and board memberships from the following institutions/companies: Jazz, Servier, UCB, Zambon, Cephalon Lundbeck, Pfizer Bohringer Ingelheim. His research is currently supported by grants of the following institutions/companies: Swiss National Science Foundation (SNF), ResMed, Respironics, Vifor Pharma, UCB Pharma, Schweizerische Herzstiftung, Tropos Stiftung, Parkinson Schweiz.

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Bargiotas, P., Dietmann, A., Haynes, A.G. et al. The Swiss Narcolepsy Scale (SNS) and its short form (sSNS) for the discrimination of narcolepsy in patients with hypersomnolence: a cohort study based on the Bern Sleep–Wake Database. J Neurol 266, 2137–2143 (2019). https://doi.org/10.1007/s00415-019-09365-2

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  • DOI: https://doi.org/10.1007/s00415-019-09365-2

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