Prevalence and neurophysiological correlates of sleep disordered breathing in pediatric type 1 Narcolepsy

Study Objectives: To investigate the prevalence and neurophysiological correlates of obstructive sleep disordered breathing (OSA) in type 1 narcolepsy (NT1) children and adolescents. Methods: Thirty-eight drug-naïve consecutive NT1 children/adolescents and 21 age- and sex-balanced controls underwent clinical assessment, nocturnal PSG and MSLT, and CSF hcrt-1 determination. According to the rules for pediatric population, an obstructive apneahypopnea index (Obstructive AHI) ≥ 1 (obstructive and mixed events), defined comorbid OSA. Results: NT1 children showed higher prevalence of overweight/obesity and severe nocturnal sleep disruption (lower sleep efficiency, and increased N1 sleep stage percentage) coupled with higher motor activity (periodic limb movement index [PLMi] and REM atonia index) compared to controls. Sleep-related respiratory variables did not differ between NT1 and control children (OSA prevalence of 13.2% and 4.8%, respectively). NT1 children with OSA were younger and showed lower N2 sleep stage percentage and higher PLMI than NT1 children without comorbid OSA. Overweight/obesity was not associated with OSA in NT1. Conclusion: Despite higher BMI, OSA prevalence did not differ between with NT1 and control children. OSA in pediatric NT1 patients is a rare and mild comorbidity, further contributing to nocturnal sleep disruption without effects on daytime sleepiness.