SOREMs in Sleep Clinic Patients: A Reliable Indicator of Narcolepsy? Sharon A. Chung, PhD

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1 SOREMs in Sleep Clinic Patients: A Reliable Indicator of Narcolepsy? Sharon A. Chung, PhD Toronto Western Hospital, University Health Network and Youthdale Treatment Centres

2 Conflict of Interest Disclosures for Speakers 1. I do not have any potential conflicts of interest to disclose, OR X 2. I wish to disclose the following potential conflicts of interest Type of Potential Conflict Grant/Research Support Details of Potential Conflict Philips Respironics Consultant Speakers Bureaus Financial support Other X 3. The material presented in this lecture has no relationship with the above potential conflict, OR 4. This talk presents material that is related to one or more of these potential conflicts, and the following objective references are provided as support for this lecture:

3 Introduction/background SOREM: REM sleep occurrence within 15 minutes from the onset of nighttime sleep or daytime napping Considered one of the main features of narcolepsy SOREMs also reported with several sleep and psychiatric disorders and also in normal individuals without sleep complaints

4 Narcolepsy Triad cataplexy sleep paralysis hypnagogic hallucinations

5 Research Questions SOREM? sleep paralysis cataplexy hypnagogic hallucinations 1. Are the majority of patients with SOREMs diagnosed with narcolepsy? 2. Are patients with SOREMs sleepier than those without SOREMs? 3. Do more SOREMs = greater degree of daytime sleepiness?

6 Methods: RETROSPECTIVE CHART REVIEW Charts of patients with SOREMs on MSLT or MWT Case Controlled: sleep clinic patients without SOREMs Sleep architecture and physiological measures taken from the initial diagnostic sleep studies (pre-treatment) Inclusion Criteria: Patients who completed overnight PSG and either MSLT or MWT Diagnoses determined from the physicians consult notes NARCOLEPSY It really freaks out the dog!

7 Results: PSG VARIABLES SOREM group (N= 223): M62%/F38%, 39±14 yrs Control group (N= 179): M55%/F45%, 46±14 yrs* (p<0.001) The significance level was set at p<0.001 to reduce the occurrence of Type I errors resulting from multiple comparisons.

8 Distribution of Diagnoses (SOREM grp) 19%

9 Distribution of Diagnoses (CONTROLS)

10 Daytime Measures: SOREM vs CONTROL Study Group Mean Std. Deviation Range Sig N SSS SOREM Control ESS SOREM Control MSLT msl SOREM Control MWT msl SOREM Control ZOGIM SOREM Control THAT SOREM Control FS SOREM Control p =.169 p =.073 p <0.001 p <0.001 p =.438 p =.292 p =.261

11 Age-adjusted comparison: MSLTSOL & MWTSOL

12 Results: CORRELATION ANALYSES Do # SOREMS = EDS??

13 Summary Only 1 in 5 of patients with SOREMs were diagnosed with narcolepsy; the vast majority had other disorders (OSA, depression, anxiety, ABI). Patients with SOREMs do not report being sleepy, fatigued or having poor alertness. They also do not have shorter sleep onset latencies on MSLT or MWT. A greater number of SOREMs is not correlated with greater subjective sleepiness, but during MSLT testing, more SOREMs are associated with a shorter sleep onset latency.

14 Conclusion SOREMs are NOT an accurate or specific diagnostic marker of narcolepsy: SOREMs occur across a wide variety of sleep and psychiatric disorders Patients with SOREMs are NOT sleepier than those without SOREMs Patients with a greater number of SOREMs do not feel sleepy but fall asleep quicker. They are not aware of their degree of sleepiness.

15 Conclusion SOREMs are NOT an accurate or specific diagnostic marker of narcolepsy: SOREMs occur across a wide variety of sleep and psychiatric disorders Patients with SOREMs are NOT sleepier than those without SOREMs Patients with a greater number of SOREMs do not feel sleepy but fall asleep quicker. They are not aware of their degree of sleepiness. Based on findings from SOREMs on MSLT, not MWT Bonnet and Arand (2005) have proposed that the MSLT may be a better measure of sleepiness whereas the MWT may reflect levels of alertness Overall, difficult to interpret and warrant further investigation Bonnet MH, Arand DL. Impact of motivation on Multiple Sleep Latency Test and Maintenance of Wakefulness Test measurements. J Clin Sleep Med. 2005;1(4):

Neurological causes of excessive daytime sleepiness. Professor Adam Zeman Royal Devon and Exeter Hospital University of Exeter Medical School

Neurological causes of excessive daytime sleepiness Professor Adam Zeman Royal Devon and Exeter Hospital University of Exeter Medical School Excessive daytime sleepiness Physiological sleep deprivation,