Sleep, mood, pain disorders most common comorbidities in those with narcolepsy

Key takeaways:

• Patients with narcolepsy were more than twice as likely as matched controls to have chronic pain.
• Additional comorbidities associated with narcolepsy were irritable bowel syndrome, asthma and hypothyroidism.

Individuals with narcolepsy were significantly more likely to have sleep, mood and pain disorders compared with matched controls, indicating where treatment may best target common comorbidities, according to new research from Sleep Advances.

“Increased rates of psychiatric and sleep disorders have been reported in patients with narcolepsy,” Melissa C. Lipford, MD, a neurologist at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Further complicating the care of this patient population is the chronic nature of narcolepsy; pharmacotherapy is generally lifelong and may need to be adjusted in line with potentially changing disease severity and comorbidities.”

Lipford and colleagues analyzed electronic health record data and utilized natural language processing (NLP) algorithms to characterize the demographics and determine related comorbidities of a large cohort of individuals with narcolepsy who were seen at the Mayo Clinic.

They examined EHR data of first-time Mayo Clinic patients between 2000 and 2020 who registered at least one narcolepsy-specific ICD-9/10 code and at least one disease-supportive statement, then created a propensity-matched control cohort for multiple sociodemographic factors (birth year, age at first institutional encounter, sex, race, ethnicity, number of diagnosis codes, mortality).

The NLP model was trained on nearly 14,000 sentences from the EHR with an 85% to 15% train-test ratio. When tested specifically for narcolepsy with a 200-record sample, the model had 95% recall for positive cases, as well as 96% accuracy and 97% precision.

Data were subsequently extracted and analyzed for the 20 most common comorbidities, which were compared and ranked between the treated and matched groups.

From an initial pool of more than 6 million records, 2,057 individuals with narcolepsy were identified (median age 32 years; 59.6% women; 92.6% white), with a similar number of matched controls (median age 35 years; 58.9% women; 94.6% white).

According to the results, the most common comorbidities in the narcolepsy group compared with matched controls were sleep disorders (restless legs syndrome, obstructive sleep apnea and insomnia), mood disorders (depression, dysthymia and anxiety) and pain disorders (chronic pain syndrome, migraine, fibromyalgia, carpal tunnel syndrome and myalgia).

The researchers found chronic pain was more than twice as likely to occur in the narcolepsy cohort than in matched controls.

Data also showed that irritable bowel syndrome, asthma, cervical spondylosis, syncope and hypothyroidism carried significant associations with narcolepsy.

“Contrary to previous claims-based studies, data from this comprehensive analysis found that cardiovascular disease is not among the top 20 comorbidities,” Jennifer Gudeman, senior vice president of medical and clinical affairs at Avadel Pharmaceuticals, which funded the study, told Healio in an email. “By taking a disease-agonistic view and simply seeking to understand what the top 20 increased comorbidities were in the narcolepsy cohort, these data reflect what is prevalent and should be prioritized in caring for people with narcolepsy.”