Table 1.
Demographic and diagnosis information at referral for 41 patients referred with a ‘diagnosis of narcolepsy’
| Case | Age | Prior diagnosis | Medication | PSG results | MSLT results | Drug screena | HLA type | Features of cataplexy | Final diagnosis |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 28 | Probable Nx | None | SE: 87.6 % SOLmin: 3.4 REML: 0 min AHI: 52.9 events/h |
MSL: 2.0 min MREML: 0.3 No. naps with REM: 4 |
Negative | Blood could not be obtained or patient refused | Present | True Nx |
| 2 | 26 | Probable Nx | None | SE: 84.6 % SOLmin: 2.5 REML: 0.5 min AHI: 10.1 events/h |
MSL: 1.9 min MREML: 2.6 No. naps with REM: 4 |
Negative | DQB1*06:02 | Present | True Nx |
| 3 | 56 | Nx | Dipyridamole, ezetimibe, aspirin, perindopril erbumine, bendroflumet-hiazide, co-codamol | SE: 67.3 % SOLmin: 26.0 REML: 52.0 min AHI: 34.6 events/h |
MSL: 8.2 min MREML: 11.0 No. naps with REM: 1 |
Negative | Negative | Absent | OSAHS |
| 4 | 55 | Nx | Aspirin, bisoprolol, clenil modulite, co-dydramol, furosemide, nitroglycerin, nicorandil, ramipril, salbutamol, simvastatin | SE: 51.5 % SOLmin: 161.0 REML: 95.0 min AHI: 17.8 events/h |
MSL: 18.0 min MREML: 0 No. naps with REM: 0 |
Negative | Negative | Absent | Depression/ anxiety |
| 5 | 65 | Probable Nx | None | SE: 73.4 % SOLmin: 38.0 REML: 45.5 min AHI: 13.6 events/h | MSL: 15.5 min MREML: 0 No. naps with REM: 0 | Negative | Negative | Absent | OSAHS |
| 6 | 37 | Nx | None | SE: 88.2 % SOLmin: 9.0 REML: 59.0 min AHI: 8.7 events/h |
MSL: 11.6 min MREML: 0 No. naps with REM: 0 |
Urine could not be obtained or patient refused | DQB1*0603/ 08/14, HLA-DQA1*0103 | Present | Depression/ anxiety |
| 7 | 31 | Nx | None | SE: 85.1 % SOLmin: 6.0 REML: 1.0 min AHI: 10.7 events/h |
MSL: 4.4 min MREML: 1.0 No. naps with REM: 3 |
Negative | DQB1*06:02 | Absent | True Nx |
| 8 | 31 | Probable Nx | Lansoprazole, thyroxine | SE: 83.0 % SOLmin: 26.5 REML: 95.5 min AHI: 23.4 events/h | MSL: 3.9 min MREML: 13.3 No. naps with REM: 2 |
Negative | DQB1*0602 | Present | Sleep deprivation |
| 9 | 23 | Probable Nx | Salbutamol, oral contraceptive, betamethasone cream, beclomethasonedipropionate inhaler, | SE: 93.0 % SOLmin: 6.0 REML: 57.0 min AHI: 8.2 events/h |
MSL: 11.3 min MREML: 0 No. naps with REM: 0 |
Negative | Blood could not be obtained or patient refused | Absent | True Nx |
| 10 | 65 | Nx | Nitroglycerin, co-codamol, frusemide, telmisartan, rosuvastatin, cordarone, warfarin | SE: 52.1 % SOLmin: 1.5 REML: 223.5 min AHI: 25.6 events/h |
MSL: 8.0 min MREML: 0 No. naps with REM: 0 |
Negative | Positive but type not recorded | Absent | OSAHS |
| 11 | 50 | Probable Nx | Clonidine | SE: 68.2 % SOLmin: 70.0 REML: 322.0 min AHI: 10.3 events/h |
MSL: 14.0 min MREML: 0 No. naps with REM: 0 |
Positive | Blood could not be obtained or patient refused | Present | Irregular sleep |
| 12 | 51 | Nx | None | SE: 85.3 % SOLmin: 6.5 REML: 75.0 min AHI: 10.9 events/h |
MSL: 1.8 min MREML: 6.3 No. naps with REM: 3 |
Negative | DQB1*06, DRB1*15, DQA1*01 | Present | True Nx |
| 13 | 30 | Probable Nx | None | SE: 81.3 % SOLmin: 16.5 REML: 134.0 min AHI: 19.2 events/h |
MSL: 3.4 min MREML: 3.4 No. naps with REM: 4 |
Negative | DQB1*06, DRB1*15, DQA1*01 | Present | True Nx |
| 14 | 29 | Nx | Pemoline, clomipramine, fluoxetine, cetirizine, selegiline, homeopathic opium, oral contraceptive | SE: 91.5 % SOLmin: 2.5 REML: 61.5 min AHI: 1.0 events/h |
MSL: 0.8 min MREML: 0.3 No. naps with REM: 4 |
Negative | Blood could not be obtained or patient refused | Present | True Nx |
| 15 | 48 | Probable Nx | Thyroxine, cetirizine | SE: 73.6 % SOLmin: 7.5 REML: 0 min AHI: 34.3 events/h |
MSL: 2.1 min MREML: 1.0 No. naps with REM: 4 |
Negative | Blood could not be obtained or patient refused | Present | True Nx |
| 16 | 30 | Probable Nx | Oral contraceptive | SE: 88.4 % SOLmin: 30.0 REML: 76.5 min AHI: 4.3 events/h |
MSL: 7.5 min MREML: 3.0 No. naps with REM: 1 |
Urine could not be obtained or patient refused | Blood could not be obtained or patient refused | Present | True Nx |
| 17 | 34 | Nx | None | SE: 0 SOLmin: 0 REML: 0 min AHI: 0 events/h |
MSL: 6.5 min MREML: 15.3 No. naps with REM: 2 |
Negative | Blood could not be obtained or patient refused | Present | True Nx |
| 18 | 44 | Nx | Dipyridamole, esomeprazole, aspirin, simvastatin, quinine | SE: 78.6 % SOLmin: 14.0 REML: 115.0 min AHI: 35.3 events/h |
MSL: 17.3 min MREML: 0 No. naps with REM: 0 |
Negative | Negative | Absent | OSAHS |
| 19 | 33 | Nx | Orlistat | SE: 86.4 % SOLmin: 1.0 REML: 2.5 min AHI: 8.8 events/h |
MSL: 0.8 min MREML: 1.0 No. naps with REM: 4 |
Negative | DQB1*0602 | Present | True Nx |
| 20 | 30 | Nx | Melatonin | SE: 71.6 % SOLmin: 27.0 REML: 61.0 min AHI: 10.3 events/h |
MSL: 3.8 min MREML: 2.7 No. naps with REM: 3 |
Negative | DQB1*0602 | Absent | Poor sleep hygiene |
| 21 | 32 | Probable Nx | Pramipexole, pregabalin | SE: 81.8 % SOLmin: 21.0 REML: 104.0 min AHI: 9.5 events/h |
MSL: 6.1 min MREML: 10.5 No. naps with REM: 1 |
Positive | Negative | Present | Parasomnia |
| 22 | 28 | Nx | None | SE: 78.5 % SOLmin: 51.0 REML: 32.5 min AHI: 18.7 events/h |
MSL: 13.6 min MREML: 0 No. naps with REM: 0 |
Negative | Blood could not be obtained or patient refused | Absent | OSAHS |
| 23 | 69 | Nx | Zopiclone, trazadone, thyroxine, tramadol, omeprazole | SE: 68.5 % SOLmin: 23.0 REML: 68.0 min AHI: 19.2 events/h |
MSL: 1.1 min MREML: 2.5 No. naps with REM: 2 |
Negative | Positive but type not recorded | Present | True Nx |
| 24 | 42 | Nx | None | SE: 55.5 % SOLmin: 7.5 REML: 89.0 min AHI: 30.5 events/h |
MSL: 4.1 min MREML: 1.3 No. naps with REM: 2 |
Positive | DQB1*0602/14/15/16/19/20/23/24/33 | Present | Depression/ anxiety |
| 25 | 27 | Probable Nx | None | SE: 84.0 % SOLmin: 11.5 REML: 0.5 min AHI: 3.7 events/h |
MSL: 2.5 min MREML: 3.6 No. naps with REM: 4 |
Negative | DQB1*0602 | Present | True Nx |
| 26 | 31 | Probable Nx | None | SE: 84.6 % SOLmin: 12.5 REML: 192.5 min AHI: 6.2 events/h |
MSL: 7.0 min MREML: 0 No. naps with REM: 0 |
Positive | DQB1*0602 | Absent | Sleep deprivation |
| 27 | 32 | Nx | Mazindol | SE: 84.8 % SOLmin: 7.0 REML: 55.5 min AHI: 14.4 events/h |
MSL: 2.4 min MREML: 1.3 No. naps with REM: 4 |
Positive | Blood could not be obtained or patient refused | Present | True Nx |
| 28 | 42 | Probable Nx | Omeprazole | SE: 94.2 % SOLmin: 4.5 REML: 59.0 min AHI: 26.1 events/h | MSL: 5.1 min MREML: 5.5 No. naps with REM: 1 | Positive | Negative | Absent | OSAHS |
| 29 | 30 | Nx | Amitriptyline, modafinil | SE: 86.3 % SOLmin: 34.5 REML: 54.0 min AHI: 6.9 events/h |
MSL: 7.9 min MREML: 0 No. naps with REM: 0 |
Urine could not be obtained or patient refused | Negative | Absent | Irregular sleep |
| 30 | 22 | Nx | None | SE: 94.3 % SOLmin: 10.5 REML: 64.0 min AHI: 5.0 events/h |
MSL: 7.5 min MREML: 0 No. naps with REM: 0 |
Negative | Negative | Absent | Sleep deprivation |
| 31 | 36 | Probable Nx | None | SE: 62.3 % SOLmin: 22.0 REML: 46.0 min AHI: 10.0 events/h |
MSL: 9.0 min MREML: 0 No. naps with REM: 0 |
Urine could not be obtained or patient refused | Blood could not be obtained or patient refused | Present | Poor sleep hygiene |
| 32 | 60 | Nx | Lansoprazole, co-codamol, domperidone, modafinil | SE: 64.8 % SOLmin: 17.5 REML: 58.0 min AHI: 24.2 events/h |
MSL: 10.4 min MREML: 0 No. naps with REM: 0 |
Positive | Negative | Absent | OSAHS |
| 33 | 20 | Nx | None | SE: 89.6 % SOLmin: 15.0 REML: 147.0 min AHI: 7.3 events/h |
MSL: 5.3 min MREML: 1.0 No. naps with REM: 3 |
Negative | Negative | Absent | True Nx |
| 34 | 48 | Probable Nx | None | SE: 56.9 % SOLmin: 7.0 REML: 66.0 min AHI: 4.5 events/h |
MSL: 4.5 min MREML: 3.0 No. naps with REM: 2 |
Negative | Blood could not be obtained or patient refused | Present | True Nx |
| 35 | 36 | Nx | None | SE: 57.4 % SOLmin: 3.0 REML: 93.5 min AHI: 38.5 events/h |
MSL: 11.1 min MREML: 0 No. naps with REM: 0 |
Negative | Blood could not be obtained or patient refused | Absent | OSAHS |
| 36 | 43 | Nx | Salbutamol, beclometasone, iron tablets | SE: 68.9 % SOLmin: 7.5 REML: 101.0 min AHI: 108.7 events/h |
MSL: 1.8 min MREML: 2.5 No. naps with REM: 1 |
Negative | DQB1*0602 | Present | True Nx |
| 37 | 57 | Probable Nx | None | SE: 70.5 % SOLmin: 0.0 REML: 0 min AHI: 18.5 events/h |
MSL: 0.8 min MREML: 0.1 No. naps with REM: 4 |
Negative | DQB1*0602 | Present | True Nx |
| 38 | 34 | Nx | Diclofenac | SE: 77.4 % SOLmin: 11.5 REML: 114.0 min AHI: 2.0 events/h |
MSL: 6.9 min MREML: 10.0 No. naps with REM: 1 |
Negative | DRB1*15, DRB5*01/02, DQB1*06, DQA | Absent | Poor sleep hygiene |
| 39 | 49 | Nx | Olanzapine, aspirin, metformin, atorvastatin, furosemide, diclofenac, co-codamol, levothyroxine, hydrocortisone, | SE: 78.8 % SOLmin: 40.5 REML: 107.0 min AHI: 16.5 events/h |
MSL: 15.5 min MREML: 0 No. naps with REM: 0 |
Negative | Negative | Absent | OSAHS |
| 40 | 62 | Nx | Fentanyl patch, levothyroxine, bendroflumethia-zide, aspirin, amitriptyline, acetaminophen, diazepam, perindopril | SE: 29.8 % SOLmin: 62.0 REML: 0 min AHI: 7.2 events/h |
MSL: 20.0 min MREML: 0 No. naps with REM: 0 |
Negative | Negative | Absent | OSAHS |
| 41 | 63 | Nx | Amitryptiline, gliclazide, metformin, simvastatin | SE: 37.9 % SOLmin: 6.5 REML: 97.0 min AHI: 71.1 events/h |
MSL: 8.4 min MREML: 0.8 No. naps with REM: 2 | Negative | Negative | Present | True Nx |
Abbreviations: PSG polysomnography, MSLT multiple sleep latency test, HLA human leukocyte antigen, Nx narcolepsy, SE sleep efficiency, REML rapid eye movement latency, AHI apnea hypogea index, MSL mean sleep latency, REM rapid eye movement, OSAHS obstructive sleep apnea hypoventilation syndrome, SOL sleep onset latency, MREML mean rapid eye movement latency
aWe routinely screen for drugs of abuse consisting of opiates, amphetamines, cocaine, methadone and benzodiazepines. Cannabinoids are also included