tetano
Editor, Senior Moderator
J Clin Sleep Med
. 2020 Dec 8.
doi: 10.5664/jcsm.9052. Online ahead of print.
Single center analysis of patients with H1N1 vaccine-related narcolepsy and sporadic narcolepsy presenting over the same time period
Damien Ferguson[SUP] 1 [/SUP], Sarah Wrigley[SUP] 1 [/SUP], Elaine Purcell[SUP] 2 [/SUP], Sarah Keane[SUP] 2 [/SUP], Ben McGinn[SUP] 2 [/SUP], Siobhan O Malley[SUP] 3 [/SUP], Bryan Lynch[SUP] 3 [/SUP], Catherine Crowe[SUP] 2 [/SUP]
Affiliations
Abstract
Study objectives: We aimed to describe the clinical features of narcolepsy in patients referred to our sleep center between 2009 and 2016, and to compare these features across age groups and between sporadic versus AS03-adjuvanted H1N1 influenza vaccine-related cases.
Methods: This is a retrospective, consecutive study of adult and pediatric narcolepsy cases in the Republic of Ireland. All participants underwent structured assessments, including polysomnography and multiple sleep latency testing. Brain MRI, hypocretin levels and HLA typing were also carried out on the majority of patients. Patients were compared across age groups as well as aetiology.
Results: Forty (74%) patients were vaccine-related. The median age was 13.5 years and time from symptom onset to diagnosis was 112 weeks. Median time from vaccination to symptom onset was 26 weeks. In children, hypnogogic hallucinations and sleep paralysis were less frequent than in adults (17% vs. 67%, p = 0.018 and 0% vs. 75%, p < 0.0005). MSLT sleep latency was shorter in children than adults (median 1.75 vs. 4 mins, p = 0.011). Vaccine-related and sporadic cases had typical clinical presentations. Vaccine-related cases had longer PSG latency (median 10.5 vs 5 mins, p = 0.043), longer stage 2 sleep (209.6 ? 44.6 vs. 182.3 ? 34.2 mins, p = 0.042), and a trend towards longer total sleep times (p = 0.09). No differences were noted in relation to MSLT, hypocretin, HLA typing and MRI.
Conclusions: Results show that vaccine-related cases greatly outnumbered sporadic cases during the study period and suggest that sporadic and vaccine-related narcolepsy are clinically similar entities.
Keywords: AS03-adjuvant; HLA-DQB1*0602; Pandemrix; hypocretin-1; influenza A; influenza vaccine; narcolepsy; subtype H1N1.
. 2020 Dec 8.
doi: 10.5664/jcsm.9052. Online ahead of print.
Single center analysis of patients with H1N1 vaccine-related narcolepsy and sporadic narcolepsy presenting over the same time period
Damien Ferguson[SUP] 1 [/SUP], Sarah Wrigley[SUP] 1 [/SUP], Elaine Purcell[SUP] 2 [/SUP], Sarah Keane[SUP] 2 [/SUP], Ben McGinn[SUP] 2 [/SUP], Siobhan O Malley[SUP] 3 [/SUP], Bryan Lynch[SUP] 3 [/SUP], Catherine Crowe[SUP] 2 [/SUP]
Affiliations
- PMID: 33289477
- DOI: 10.5664/jcsm.9052
Abstract
Study objectives: We aimed to describe the clinical features of narcolepsy in patients referred to our sleep center between 2009 and 2016, and to compare these features across age groups and between sporadic versus AS03-adjuvanted H1N1 influenza vaccine-related cases.
Methods: This is a retrospective, consecutive study of adult and pediatric narcolepsy cases in the Republic of Ireland. All participants underwent structured assessments, including polysomnography and multiple sleep latency testing. Brain MRI, hypocretin levels and HLA typing were also carried out on the majority of patients. Patients were compared across age groups as well as aetiology.
Results: Forty (74%) patients were vaccine-related. The median age was 13.5 years and time from symptom onset to diagnosis was 112 weeks. Median time from vaccination to symptom onset was 26 weeks. In children, hypnogogic hallucinations and sleep paralysis were less frequent than in adults (17% vs. 67%, p = 0.018 and 0% vs. 75%, p < 0.0005). MSLT sleep latency was shorter in children than adults (median 1.75 vs. 4 mins, p = 0.011). Vaccine-related and sporadic cases had typical clinical presentations. Vaccine-related cases had longer PSG latency (median 10.5 vs 5 mins, p = 0.043), longer stage 2 sleep (209.6 ? 44.6 vs. 182.3 ? 34.2 mins, p = 0.042), and a trend towards longer total sleep times (p = 0.09). No differences were noted in relation to MSLT, hypocretin, HLA typing and MRI.
Conclusions: Results show that vaccine-related cases greatly outnumbered sporadic cases during the study period and suggest that sporadic and vaccine-related narcolepsy are clinically similar entities.
Keywords: AS03-adjuvant; HLA-DQB1*0602; Pandemrix; hypocretin-1; influenza A; influenza vaccine; narcolepsy; subtype H1N1.