The patient had vivid dreams almost every night, and the dreams seemed real and clear. During the course of the disease, the patient experienced 4 near falls with weakened legs before going to sleep, without actual cataplexy, with the most recent one occurring in 2017. More recently, the frequency of attacks was about 2–3 times a day. Brief rest or strong external stimuli could awaken the patient. The patient was a 22-year-old male who showed recurrent daytime sleepiness without apparent causes, which occurred more frequently at rest, such as walking, reading, watching TV, and driving, and lasted for about 10 min each time. Our center recently diagnosed a case of type 1 narcolepsy through PSG recordings, MSLT, monitoring of hypocretin level in the CSF, and detection of HLA DQB1*0602. The following case is presented in accordance with the CARE reporting checklist (available at ). Daytime sleepiness may improve spontaneously in 20–25% of patients, who may become completely asymptomatic ( 7). Some type 2 patients may progress to type 1, while the rest remain stable. Its pathogenesis is unknown, but it may be related to the partial loss of hypocretin neurons. The symptoms of type 2 narcolepsy are similar to those of type 1, but without cataplexy, and the level of hypocretin in the CSF is normal ( 6). HLA DQB1*0602 allele positivity is also often detected in type 1 patients, suggesting that the disease has a certain genetic background. Hypocretin level in the cerebrospinal fluid (CSF) <110 pg/mL can confirm the diagnosis of type 1 narcolepsy, while 20% of these patients have no cataplexy. Type 1 narcolepsy is associated with irreversible damage of the hypocretin neurons. Type 1 narcolepsy is mainly characterized by excessive sleepiness and cataplexy caused by emotional factors (i.e., laughter and anger), and may also manifest as sleep paralysis, hallucinations before falling asleep, nighttime sleep disturbance, cardiovascular–metabolic abnormalities (i.e., obesity, type 2 diabetes, OSA, and other cardiovascular diseases), neurological complications (i.e., mood disorders, anxiety, eating disorders, and attention deficit hyperactivity disorder), and other sleep disorders (restless leg syndrome, periodic leg movements, and REM sleep behavior disorder) ( 5). Recent studies have suggested that REM-related OSA is also closely related to narcolepsy ( 4).Īccording to the International Classification of Sleep Disorders III, narcolepsy is classified as Types 1 and 2.
Narcolepsy can be combined with increased appetite, obesity, and snoring, making it easily misdiagnosed as OSA-hypopnea syndrome. The average sleep latency of narcolepsy is less than 8 min, with more than 2 early-onset cycles of rapid eye movement (REM) sleep.
Diagnosis requires polysomnographic (PSG) recordings and a multiple sleep latency test (MSLT). Narcolepsy is considered to be a genetic autoimmune disease of the brain that usually onsets in childhood or adolescence ( 3). Approximately 0.026–0.05% of the US population is affected by this disease, making it a rare condition ( 1, 2) however, we cannot rule out the possibility that many potential patients have not been diagnosed. It is the most common disease that causes daytime sleepiness other than obstructive sleep apnea (OSA). Narcolepsy is a sleep disorder with the main manifestations of excessive daytime sleepiness, cataplexy, sleep paralysis, sleep hallucinations, and nighttime sleep disturbance. Keywords: Narcolepsy sleep disorder polysomnographic (PSG), case report In conclusion, further studies are needed to verify more treatments and improve the patient’s life quality. So far, there is no clear evidence to support immunotherapy. Whether the incidence of narcolepsy may increase after covid19 remains to be observed. Despite the low incidence rate, diagnosis of narcolepsy is still confusing and needs clinicians' attention. Data from China in 2014 showed a significant increase in the incidence of narcolepsy in 2011 after the H1N1 epidemic in China in 2009. We review the knowledge and researches on this disease in Mainland China in the past 10 years. Mutiple sleep latentcy test (MSLT) showed that the average sleep latency was 3.1 min, and abnormal REM sleep episodes were detected in 4 naps.
In the present study, we report the first case of narcolepsy diagnosed at the district, with a complete medical history, objective examinations, and cerebrospinal fluid and hematological tests, but no cataplexy. It is still not fully recognized by clinicians, and many patients are often misdiagnosed with epilepsy, syncope, or mental disorders. Abstract: Narcolepsy is a sleep disorder with the main manifestations of excessive daytime sleepiness, cataplexy, sleep paralysis, sleep hallucinations, and nighttime sleep disturbance.
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