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Early- and late-onset narcolepsy: possibly two distinct clinical phenotypes

  • Neurology • Original Article
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Abstract

Purpose

To investigate the clinical characteristics and the risk factors associated with excessive daytime sleepiness (EDS) in patients with early- and late-onset narcolepsy.

Methods

Patients with narcolepsy were consecutively recruited. All patients were separated into early- and late-onset groups according to the onset age of disease ≤ 15 and > 15 years, respectively. Demographic, clinical, and sleep parameters were compared between the two groups. Linear regressions were performed to examine the risk factors of subjective and objective EDS in patients with early- and late-onset narcolepsy.

Results

A total of 101 patients with narcolepsy (median age at recruitment = 18.0 years) were classified into an early-onset group (67 patients with median age at onset = 12.0 years) and a late-onset group (34 patients with median age at onset = 28.5 years). Compared with early-onset group, late-onset group scored significantly higher on Epworth Sleepiness Scale (ESS), Ullanlinna Narcolepsy Scale (UNS), sleep paralysis, rapid eye movement (REM) sleep behavior disorder (RBD) questionnaire-Hong Kong (all P < 0.050). UNS-cataplexy and sleep paralysis had significantly positive associations with subjective EDS, and N1%, arousal index, and periodic limb movements index were positively associated with objective EDS in the early-onset group (all P < 0.050). However, these associations were not observed in late-onset narcolepsy.

Conclusion

Late onset narcolepsy had more severe self-reported narcolepsy symptoms. REM sleep related symptoms and disrupted nighttime sleep were associated with EDS in early-onset narcolepsy. These findings suggest that early- and late-onset narcolepsy may represent two distinct phenotypes.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (grant no. 82171480) and the National Key R&D Program of China (grant no. 2021 YFC2501403).

Author information

Authors and Affiliations

  1. Sleep Medicine Center, West China Hospital, Sichuan University, 28 Dian Xin Nan Jie, Chengdu, 610041, Sichuan Province, China

    Min Wu, Lu Tan, Junying Zhou & Xiangdong Tang

  2. Shihezi University School of Medicine, Shihezi University, Shihezi, China

    Min Wu

  3. Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China

    Xiao Li & Shirley Xin Li

  4. The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China

    Shirley Xin Li

  5. West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China

    Jinbo Fang

  6. Department of Neurology, West China Hospital, Sichuan University, Chengdu, China

    Junying Zhou

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  1. Min Wu
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  4. Lu Tan
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Contributions

All authors contributed to the study design and data collection. MW analyzed and interpreted the data, and drafted the manuscript. XL and LT contributed to analysis of data. SXL and JBF revised the manuscript. JYZ and XDT designed and conceptualized the study, and revised the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Junying Zhou or Xiangdong Tang.

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Ethics approval

This study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the ethics committees of West China Hospital of Sichuan University. Informed consent was obtained from all participants or their legal guardians.

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The authors declare that they have no conflict of interest.

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Wu, M., Li, X., Li, S.X. et al. Early- and late-onset narcolepsy: possibly two distinct clinical phenotypes. Sleep Breath 27, 2443–2452 (2023). https://doi.org/10.1007/s11325-023-02820-5

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  • DOI: https://doi.org/10.1007/s11325-023-02820-5

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