Dysautonomia in Narcolepsy: Evidence by Questionnaire Assessment
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Background and Purpose Excessive daytime sleepiness and sudden sleep attacks are themain features of narcolepsy, but rapid-eye-movement sleep behavior disorder (RBD), hyposmia,and depression can also occur. The latter symptoms are nonmotor features in idiopathic Parkinson’s disease (IPD). In the present study, IPD-proven diagnostic tools were tested to determine whether they are also applicable in the assessment of narcolepsy. Methods This was a case-control study comparing 15 patients with narcolepsy (PN) and 15control subjects (CS) using the Scales for Outcomes in Parkinson’s Autonomic Test (SCOPA-AUT), Parkinson’s Disease Nonmotor Symptoms (PDNMS), University of Pennsylvania SmellTest, Farnsworth-Munsell 100 Hue test, Beck Depression Inventory, and the RBD screeningquestionnaire. Results Both the PN and CS exhibited mild hyposmia and no deficits in visual tests. Frequentdysautonomia in all domains except sexuality was found for the PN. The total SCOPA-AUTscore was higher for the PN (18.47±10.08, mean±SD) than for the CS (4.40±3.09), as was thePDNMS score (10.53±4.78 and 1.80±2.31, respectively). RBD was present in 87% of the PNand 0% of the CS. The PN were more depressed than the CS. The differences between the PNand CS for all of these variables were statistically significant (all p<0.05). Conclusions The results of this study provide evidence for the presence of dysautonomia andconfirm the comorbidities of depression and RBD in narcolepsy patients. The spectrum, whichis comparable to the nonmotor complex in IPD, suggests wide-ranging, clinically detectabledysfunction beyond the narcoleptic core syndrome.
Abstract
Background and Purpose Excessive daytime sleepiness and sudden sleep attacks are themain features of narcolepsy, but rapid-eye-movement sleep behavior disorder (RBD), hyposmia,and depression can also occur. The latter symptoms are nonmotor features in idiopathic Parkinson’s disease (IPD). In the present study, IPD-proven diagnostic tools were tested to determine whether they are also applicable in the assessment of narcolepsy. Methods This was a case-control study comparing 15 patients with narcolepsy (PN) and 15control subjects (CS) using the Scales for Outcomes in Parkinson’s Autonomic Test (SCOPA-AUT), Parkinson’s Disease Nonmotor Symptoms (PDNMS), University of Pennsylvania SmellTest, Farnsworth-Munsell 100 Hue test, Beck Depression Inventory, and the RBD screeningquestionnaire. Results Both the PN and CS exhibited mild hyposmia and no deficits in visual tests. Frequentdysautonomia in all domains except sexuality was found for the PN. The total SCOPA-AUTscore was higher for the PN (18.47±10.08, mean±SD) than for the CS (4.40±3.09), as was thePDNMS score (10.53±4.78 and 1.80±2.31, respectively). RBD was present in 87% of the PNand 0% of the CS. The PN were more depressed than the CS. The differences between the PNand CS for all of these variables were statistically significant (all p<0.05). Conclusions The results of this study provide evidence for the presence of dysautonomia andconfirm the comorbidities of depression and RBD in narcolepsy patients. The spectrum, whichis comparable to the nonmotor complex in IPD, suggests wide-ranging, clinically detectabledysfunction beyond the narcoleptic core syndrome.
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