Table 3.
Rates of narcolepsy diagnosis and care types 1 year postdiagnosis—overall and by insurance provider (n = 700).
| Percentage of Patients Receiving Care Type | Odds Ratio for Likelihood of Care Receipt in Medicaid Patients (Ref: Commercial)d | ||||||
|---|---|---|---|---|---|---|---|
| All | Commercial (n = 368) | Medicaid (n = 332) | P c | OR | (95% CI) | P | |
| n (%) | n (%) | n (%) | |||||
| Evaluation (postdiagnosis)a | |||||||
| PSG + MSLT | 165 (23.6%) | 92 (25.0%) | 73 (22.0%) | .34 | 0.83 | (0.57, 1.19) | .30 |
| PSG only | 47 (6.7%) | 23 (6.3%) | 24 (7.2%) | .60 | 1.12 | (0.60, 2.07) | .72 |
| MSLT only | 52 (7.4%) | 31 (8.4%) | 21 (6.3%) | .29 | 0.76 | (0.41, 1.42) | .39 |
| Any history of evaluationb | |||||||
| PSG + MSLT | 326 (46.6%) | 186 (50.5%) | 140 (42.2%) | .02 | 0.67 | (0.47, 0.95) | .02 |
| PSG only | 81 (11.6%) | 35 (9.5%) | 46 (13.9%) | .07 | 1.43 | (0.88, 2.34) | .15 |
| MSLT only | 11 (1.6%) | 4 (1.1%) | 7 (2.1%) | .27 | 2.35 | (0.64, 8.56) | .19 |
| Pharmacological carec | |||||||
| Sodium oxybate | 24 (3.4%) | 19 (5.2%) | 5 (1.5%) | .007 | — | — | — |
| Monoamine oxidase inhibitor | 0 | 0 | 0 | — | — | — | — |
| Selective histamine H3-receptor inverse agonists | 0 | 0 | 0 | — | — | — | — |
| SNRIs | 23 (3.3%) | 13 (3.5%) | 10 (3.0%) | .69 | — | — | — |
| SSNRIs | 29 (4.1%) | 22 (6.0%) | 7 (2.1%) | .01 | — | — | — |
| SSRIs | 42 (6.0%) | 32 (8.7%) | 10 (3.0%) | .001 | — | — | — |
| Stimulants | 357 (51.0%) | 184 (50.0%) | 173 (52.1%) | .57 | 1.04 | (0.76, 1.42) | .81 |
| Any pharmacological care | 395 (56.4%) | 212 (57.6%) | 183 (55.1%) | .50 | 0.86 | (0.63, 1.18) | .35 |
| Other care | |||||||
| Pulmonary specialty care | 132 (18.9%) | 85 (23.1%) | 47 (14.2%) | .002 | 0.54 | (0.36, 0.82) | .003 |
| Neurology specialty care | 188 (26.9%) | 107 (29.1%) | 81 (24.4%) | .16 | 0.77 | (0.54, 1.09) | .14 |
| Primary care/family medicine | 487 (69.6%) | 317 (86.1%) | 170 (51.2%) | <.001 | 0.15 | (0.10, 0.22) | <.001 |
| Behavioral health | 241 (34.4%) | 143 (38.9%) | 98 (29.5%) | .009 | 0.62 | (0.42, 0.90) | .01 |
| Any pharmacological or other care | 640 (91.4%) | 358 (97.3%) | 282 (84.9%) | <.001 | 0.14 | (0.07, 0.28) | <.001 |
aOf the 264 patients who had PSG only, MSLT only, or PSG + MSLT in the 1 year following diagnosis, 74 patients (28.0%) also had 1 of these evaluation procedures at the time of their narcolepsy diagnosis. bWe defined any history of evaluation as PSG + MSLT, PSG only, or MSLT only at any time, meaning this could be 1 year prior to their 2017 diagnosis, at the time of diagnosis, or in the 1 year after diagnosis. cSample sizes were too small for most pharmacological care types to conduct logistic regression. Chi-squared tests and binomial logistic regression models after adjusting for child’s sex, age, prior sleep disorder diagnoses, and any complex chronic conditions, behavioral health, or neurodevelopmental diagnoses during 1 year prior to and at time of narcolepsy and any other prior sleep disorder diagnosis. Bold indicates significant associations for chi-squared analyses or odds ratios (P < .05). MSLT = Multiple Sleep Latency Test, PSG = polysomnography, Ref = reference, SNRIs = selective norepinephrine reuptake inhibitors, SSNRIs = selective serotonin and norepinephrine reuptake inhibitors, SSRIs = selective serotonin reuptake inhibitors.