REM Sleep Behavior Disorder in Children With Type 1 Narcolepsy Treated With Sodium Oxybate

Objective To study the effect of stable treatment with sodium oxybate (SO) on nocturnal REM sleep behavior disorder (RBD) and REM sleep without atonia (RSWA) that severely affected children with type 1 narcolepsy (NT1). Methods Nineteen children and adolescents with NT1 (9 female, mean age 12.5 +/- 2.7 years, mean disease duration 3.4 +/- 1.6 years) underwent neurologic investigations and video-polysomnography (v-PSG) at baseline and after 3 months of stable treatment with SO. v-PSG was independently analyzed by 2 sleep experts to rate RBD episodes. RSWA was automatically computed by means of the validated REM sleep atonia index (RAI). Results Compared to baseline, RAI significantly improved (p < 0.05) and complex movements during REM sleep were remarkably reduced after stable treatment with SO. Compared to baseline, children also reported improvement in clinical complaints and showed a different nighttime sleep-stage architecture. Conclusions RBD and RSWA improved after treatment with SO, pointing to a direct role of the drug in modulating motor control during REM sleep. Classification of Evidence This study offers Class IV evidence of the positive effect of SO on modulation of muscle atonia during REM sleep in children with NT1 because of the absence of a control group.