Narcolepsy is a chronic, neurologic sleep disorder that typically begins in childhood or adolescence. People with narcolepsy live with complex symptoms that include excessive daytime sleepiness, disrupted nighttime sleep, cataplexy (sudden loss of voluntary muscle tone), sleep paralysis, and hallucinations upon awakening or falling asleep, and often require lifelong treatment. Ongoing research suggests that they may also have an increased likelihood of developing hypertension and cardiovascular (CV) or cardiometabolic (CM) disease.
To increase awareness of comorbid conditions and provide a uniform set of recommendations on how to address and mitigate them, a consensus panel of experts, including sleep medicine specialists with interest in cardiology and cardiologists with experience in sleep medicine, convened to discuss the dangers of these conditions for people living with narcolepsy and reinforced the importance of improving and maintaining CV health and healthy sleep. Following the discussion, the panelists reached an agreement on strategies to mitigate these risks, which were summarized in three detailed recommendations.1
1. Identifying the Risk of Cardiovascular Comorbidities
Based on observational and retrospective analyses of claims and administrative data – one example was the CardioVascular Burden Of Narcolepsy Disease (CV-BOND) study championed by Jazz, which measured the risk of new-onset CV events in adults with narcolepsy – people living with this sleep disorder are at an increased risk of developing CV comorbidities than those without the condition. While the reasons for this connection are not fully understood, a deficiency in the neuropeptide, orexin, which plays a role in sleep and wakefulness regulation, may be a contributing factor, and even lifestyle choices of people living with narcolepsy can indirectly impact their risk.1,2
People with sleep disorders like narcolepsy may experience other sleep-related conditions, such as restless leg syndrome and obstructive sleep apnea, both of which increase the risk of stroke, heart failure, coronary artery disease, atrial fibrillation and other arrhythmias. With these considerations in mind, it’s important that people living with narcolepsy, especially those with genetic predispositions and/or a family history of certain CV conditions, receive annual health checks to monitor their vitals, including blood pressure, weight and more, regardless of the current status of their CV health.
Read more about the CV-BOND study to learn more about the real-world evidence, here.
2. Modifying Lifestyle Changes to Reduce the Risk of Cardiovascular and Cardiometabolic Disease
It’s important that patients and physicians continue to raise awareness and increase education around the connection between narcolepsy and CV/CM disease. In addition to annual check-ups, it’s important that physicians counsel patients to make positive lifestyle choices and consider the surrounding aspects of their lives and history.
Patients can actively reduce their risk of developing these comorbidities by adopting a healthier lifestyle. This includes mindful eating habits and a balanced diet, regular exercise, reduced sodium intake and not smoking (or quitting smoking). It’s also important for patients and physicians to note that modifiable risk factors like sodium intake may be related to diet but can also be linked to prescription medications. If possible, treatment plans should be tailored to these individuals based on the potential risk for hypertension and CV disease.
3. Reducing Sodium Intake to Lower Risk Factors Associated With Narcolepsy
Generally, sodium intake has been associated with CV risk. As mentioned, this is a modifiable risk factor, and the panel recommends that treatment plans for people living with narcolepsy be tailored based on the risk for hypertension and CV disease.
Because narcolepsy typically develops during adolescence, concerning oneself about sodium intake and CV risks may seem unnecessary. In fact, these risks are not routinely evaluated in this patient population, but researchers have noted that being aware of risk factors, especially sodium levels in prescribed medications, is important for long-term CV outcomes because “people with narcolepsy have potentially more years of exposure to adverse risk factors.”
Read this Q&A between Dr. Kelvin Tan and Dr. Logan Schnieder, who discuss the importance of holistic approaches to the management of sleep conditions.
These consensus recommendations are designed to increase awareness of CV/CM risks in people with narcolepsy. They also serve as a guide for future research, as well as to reaffirm the importance of providing the medical community with actionable guidelines that aim to foster the best outcomes for their patients.
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