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Session Schedule

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0:00:00
A vicious circle: Psychiatric and cognitive comorbidities in narcolepsy and their impact on patient-reported outcome measures
Merve Aktan Süzgün (Turkey)

0:21:20
Unmasking the overlap: Exploring the link between narcolepsy, obstructive sleep apnea, and their impact on cardiovascular and metabolic health
Jatuporn Wanchaitanawong (Thailand)

0:43:45
What precision medicine brings to narcolepsy practical clinic: The importance of genetics, biomarkers and phenotype in stratifying the subtypes
Christianne Martins Correa da Silva (Brazil)

1:05:40
The present and future of research, diagnosis, and treatment of central disorders of hypersomnolence
Emmanuel Mignot (United States)

1:25:05
Question and answer

Summary

By the recent developments in the field of sleep medicine, it has become increasingly clear that narcolepsy is not just about the classical pentad of core symptoms, namely excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis, and disturbed nocturnal sleep. Narcolepsy goes beyond this paradigm. Either the subjective complaints of the patients may be much broader than previously thought or the classical symptoms may have diverse clinical manifestations. EDS may reflect more than the involuntary naps with impaired sustained attention, automatic behaviors, brain fog, and cognitive complaints. Other symptoms beyond the pentad, which might be even more prevalent than a 'core symptom', include mental health problems such as depressive mood, suicidality, anxiety, fatigue, and altered stress response. The increased prevalence of eating disorders, inactivity and metabolic disturbances in narcolepsy contribute to the obesity, and obesity, sleep-related breathing disorders, and high risk of cardiovascular events are all associated with each other. All these domains of complaints cumulatively disturb the quality of life in this group of patients and for some of the patients even more promptly than the core symptoms of the hypersomnolence diagnosis. The complexity of the disease spectrum necessitates a personalized approach in the diagnosis and management of patients with narcolepsy. In recent years, precision medicine came into ground for stratifying the subpopulations of narcolepsy patients and understanding the differences between the subtypes regarding genetic and hypocretin deficits, which is decisive in predicting response to the new therapy based on hypocretin.

This session incorporates the new comprehension of narcolepsy in the light of the most recent discoveries that help to understand the disease and its complexity beyond the classical description. Starting with a psychiatric perspective, there will be a review of the most common psychiatric and cognitive complaints in narcolepsy, their impact on daily life activities and management in light with the results of most recent cohort studies. We will focus on challenges in treatment, since the standard therapy regimens available for narcolepsy can worsen some psychiatric symptoms, but also discuss novel insights about non-pharmacological strategies. Regarding cardiovascular risk, there will be a review of recent data from large population studies that pointed to narcolepsy as an independent risk of major cardiovascular adverse events. Narcolepsy`s association with sleep apnea may delay the diagnosis and worsen symptoms and cardiovascular outcomes. Differences in subtypes of narcolepsy will be discussed with a focus on genetics, hypocretin status, and clinical presentations beyond cataplexy. Ethnic peculiarities will also be addressed based on studies, which were conducted worldwide with different populations. The session will close with a presentation on the approach to personalized care, the utilization of the new therapies based on hypocretin, and future perspectives in research and diagnostic methods that could better stratify the patients with central disorders of hypersomnolence.

Learning Objectives:

Upon completion of this CME activity, participants will be able to:
• Extend the understanding about psychiatric and cognitive comorbidities in patients with narcolepsy and their effect on daytime functionality and quality of life from a new perspective, which proposes a vicious circle of hypersomnia that, reflects the interrelationship between EDS, fatigue, physical inactivity, social avoidance and lack of mood stabilization
• Explore the relationship between narcolepsy and obstructive sleep apnea, as well as to investigate potential mechanisms linking these conditions. Evaluate the increased risk of cardiovascular events in narcolepsy with the negative effect of metabolic changes, high rate of obesity and decreased physical activity
• Introduce concepts of precision medicine and the need for a multimodal approach for diagnosis of narcolepsy and its subtypes beyond the actual criteria (ICSD-3TR). Understand the importance of integrating precision medicine with the phenotype to better stratify the groups in central disorders of hypersomnolence
• Gain a broad insight into ongoing and future diagnostic and therapeutic approaches in narcolepsy, such as the alternatives for multiple sleep latency tests and hypocretin-based therapy, respectively