Page 122 - The autoimmune hypothesis of narcolepsy and its unexplored clinical features M.S. Schinkelshoek

Our findings on the effect of sodium oxybate use on body weight are in line with other studies that suggest that NT1 patients lose weight when using sodium oxybate (Boscolo-Berto R, 2012, Husain et al., 2009). Explanations for this treatment effect are lacking. However, recent pre-clinical research suggests that energy-combusting brown adipose tissue may be causally involved in the development of obesity in NT1 (Madden et al., 2012, Sellayah et al., 2011).
Chapter 6 contains our findings on daytime sleep-state misperception in NT1 and other sleep disorders. In this prospective study, we assessed the occurrence of, and factors influencing sleep state misperception in several sleep disorders with excessive daytime sleepiness. We looked at both classical and reverse sleep state misperception and found that sleep state misperception is common in people with NT1 and -2, idiopathic hypersomnia, obstructive sleep apnea and insufficient sleep syndrome. Classical sleep state misperception is more frequent in patients with longer sleep onset latencies who only reach non-REM sleep stage 1 during a nap.
Daytime sleep state misperception is a relevant symptom for NT1 patients, since it may influence the capacity to notice daytime naps. In this way, information on the prevalence of daytime sleep state misperception is valuable for both patient and sleep physician when assessing disease severity and medication effect. Based on our findings, this is not only the case for NT1, but also for patients with other, much more prevalent, sleep disorders with excessive daytime sleepiness, such as obstructive sleep apnea and insufficient sleep syndrome. Hence, information on daytime sleep state misperception could also provide valuable information in the assessment of disease severity and treatment effect in other sleep disorders (Liu et al., 2018).
• NT1 patients lose weight upon initiating sodium oxybate treatment
• Modafinil use does not lead to a weight decrease in these patients
• The effect of sodium oxybate on weight is more pronounced in
women and patients with a high BMI
• Daytime sleep state misperception was measured during the short naps of the multiple sleep latency test
• Daytime sleep state misperception is prevalent in NT1 and -2, and other sleep disorders
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