Clinical Characteristics And Independent Risk Factors Of Narcolepsy With Obstructive Sleep Apnea

Objective: To summarize the clinical features of 52 cases of narcolepsy,to investigate the clinical features and risk factors of narcolepsy with Obstructive sleep apnea(OSA),and to seek clinical indicators with diagnostic value,so as to provide evidence for the clinical assessment of narcolepsy with OSA.Methods: A total of 52 patients with narcoleptic sleep treated in the outpatient Department of Neurology,Affiliated Hospital of Jining Medical College from January 2017 to August 2022 were selected.Data of gender,age of onset,clinical symptoms,Polysomnography(PSG)and Multiple Sleeping Latency Test(MSLT)were collected for analysis,and clinical characteristics of narcoleptic patients were summarized.Narcolepsy was divided into the group with OSA(n=16)and the group without OSA(n=36)according to whether or not it was accompanied by OSA.Firstly,univariate analysis was conducted to find out the statistically significant factors with OSA,and then binary Logistic analysis was used to explore the independent risk factors of OSA co-morbidity with narcolepsy.Furthermore,receiver operating characteristic(ROC)was applied to determine the diagnostic efficiency of meaningful indicators obtained by regression analysis.Results:1.Among 52 cases of narcoleptic narcoleptic patients,the male:female 1.6:1,the age distribution of onset of the patients showed a double peak,the age of 10～19 years and 30～39 years accounted for 36.54% and21.15%,respectively.The course of the patients ranged from 3 months to21 years,among which the number of patients with a course of 1～5 years was the most,accounting for 57.69%.2.Among the 52 narcoleptic patients,the four major symptoms included daytime narcolepsy in 52 cases(100%),cataplexy in 30 cases(57.0%),sleep paralysis in 23 cases(44.2%),and sleep hallucinations in17 cases(33.0%).Other nighttime symptoms included dreaminess and babbling in 10 cases(19.2%),Shouting and hitting in 4 cases(7.7%),difficulty falling asleep in 4 cases(more than 30 minutes)in 7.7%,poor emotional control in 20 cases(38.5%),memory loss in 12 cases(23.1%),tinnitus in 9 cases(17.3%),and sleep loss in 4 cases.Anxiety and depression in 11 cases(21.2%).3.Analysis of PSG and MSLT results showed that the patient had sleep disorder at night.4.Among the 52 patients with narcoleptic sleep,16(30.8%)were not accompanied by OSA,while 32(69.2%)were accompanied by OSA.5.Through univariate analysis,it was found that age of onset,Body Mass Index(BMI),cataplexy,percentage of NREM-N1,percentage of NREM-N3,and awakening times of patients had statistical significance for OSA co-morbidity of narcolepsy(P < 0.05).6.By binary Logistic regression analysis,it was found that awakening frequency(OR=1.022,P=0.026)was an independent risk factor for narcolepsy with OSA.7.The area under the ROC curve of awakening times was 0.779,and the cut-off value was 40.5 times.At this time,the sensitivity was 87.5%and the specificity was 58.3%.Conclusion:1.52 cases of narcoleptic narcoleptic patients were mostly male,and the onset age was double peak,mainly 10～19 years old and 30～39 years old.The course of the disease was 1～5 years,and the clinical symptoms were varied and the sleep was disturbed at night.2.OSA is a common comorbidities.Compared with narcolepsy without OSA,narcolepsy with OSA has an older onset age,higher BMI value,more prone to cataplexy,a larger percentage of NREM-N1 stage,a smaller percentage of NREM-N3 stage,and more awakenations.3.Awakening frequency was an independent risk factor for narcolepsy with OSA.4.The number of awakenings has a higher diagnostic accuracy for OSA associated with narcolepsy.