Clinical and Polysomnographic Characteristics of Childhood Narcolepsy in Korea
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Purpose: Diagnosis of narcolepsy in childhood is challenging because of ambiguous expression of symptoms and various clinical presentations. The purpose of this study is to delineate the clinical and polysomnographic characteristics of childhood narcolepsy. Methods: This study included 78 patients who were diagnosed with narcolepsy by clinical history and polysomnography (PSG) between February 2002 and June 2015 at Samsung Medical Center. Their medical records were reviewed retrospectively and analyzed between two groups; age of symptom onset and the presence of cataplexy. Results: The age at diagnosis and symptom onset was 15.51±2.73 years and 13.03± 2.79 years. Forty-one patients (52.6%) were diagnosed with narcolepsy with cataplexy. All exhibited excessive daytime sleepiness as the first symptom. In the multiple sleep latency test (MSLT), short sleep latency and more than 3 episodes of mean sleep onset of rapid eye movement were observed. The coexisting sleep disorders varied according to age of onset. There was no significant difference in sleep parameters between the two age groups. The patients with cataplexy had higher scores on the Epworth Sleepiness Scale and shorter mean sleep latencies in the MSLT than those without cataplexy (P<0.05). Conclusion: Pediatric narcolepsy presents with excessive daytime sleepiness and has different co-existing sleep disorders according to age of onset. The degree of sleepiness is higher in the patients with cataplexy. Narcolepsy may be suspected in children with excessive daytime sleepiness even if they do not have cataplexy. This should be confirmed using appropriate sleep questionnaires and PSG with MSLT.
Abstract
Purpose: Diagnosis of narcolepsy in childhood is challenging because of ambiguous expression of symptoms and various clinical presentations. The purpose of this study is to delineate the clinical and polysomnographic characteristics of childhood narcolepsy. Methods: This study included 78 patients who were diagnosed with narcolepsy by clinical history and polysomnography (PSG) between February 2002 and June 2015 at Samsung Medical Center. Their medical records were reviewed retrospectively and analyzed between two groups; age of symptom onset and the presence of cataplexy. Results: The age at diagnosis and symptom onset was 15.51±2.73 years and 13.03± 2.79 years. Forty-one patients (52.6%) were diagnosed with narcolepsy with cataplexy. All exhibited excessive daytime sleepiness as the first symptom. In the multiple sleep latency test (MSLT), short sleep latency and more than 3 episodes of mean sleep onset of rapid eye movement were observed. The coexisting sleep disorders varied according to age of onset. There was no significant difference in sleep parameters between the two age groups. The patients with cataplexy had higher scores on the Epworth Sleepiness Scale and shorter mean sleep latencies in the MSLT than those without cataplexy (P<0.05). Conclusion: Pediatric narcolepsy presents with excessive daytime sleepiness and has different co-existing sleep disorders according to age of onset. The degree of sleepiness is higher in the patients with cataplexy. Narcolepsy may be suspected in children with excessive daytime sleepiness even if they do not have cataplexy. This should be confirmed using appropriate sleep questionnaires and PSG with MSLT.
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