Abstract Details

Title Misdiagnoses and Comorbidities among Participants in the Nexus Narcolepsy Registry

Topic Sleep

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-037

Objective To describe the frequency of misdiagnoses and comorbidities in participants diagnosed with narcolepsy.

Background Narcolepsy diagnosis can be challenging. Presence of comorbidities and overlapping symptoms between narcolepsy and other conditions may contribute to diagnostic delay and misdiagnosis. Symptoms of narcolepsy may be mistaken for conditions such as depression or psychiatric illness.

Design/Methods The Nexus Narcolepsy Registry is an ongoing, longitudinal, patient-reported, web-based database of adult participants diagnosed with narcolepsy. Data was collected from June 2015-September 2017, with 1024 participants completing ≥1 assessment. Participants were categorized based on self-reported pediatric (<18 years) or adult (≥18 years) onset of narcolepsy symptoms. Descriptive analyses and Chi-square tests were conducted to assess patients’ misdiagnoses and comorbidities. There was no multiple comparisons adjustment.

Results Nearly 60% (59.3%; 95% confidence interval [CI]: 56.2%-62.5%) of participants reported receiving ≥1 misdiagnosis to explain their narcolepsy symptoms before receiving a narcolepsy diagnosis. The most common misdiagnoses, regardless of age of onset, included: depression (31.3%), anxiety disorder (16.3%), attention deficit/hyperactivity disorder (ADHD, 16.2%), insomnia (14.4%), and hypersomnia (14.3%). Of the most common misdiagnoses, ADHD was more frequent in those with pediatric onset compared to those with adult onset (19.2% vs. 12.3%, p=0.005), as was bipolar disorder (14.2% vs. 9.1%, p=0.019). Epilepsy was also more frequent in pediatric versus adult onset of narcolepsy symptoms (7.8% vs. 3.7%, p=0.013), as was schizophrenia (5.4% vs. 2.1%, p=0.015). The most frequently reported comorbidities, regardless of age of onset, were: depression (34.0%), anxiety disorder (27.1%), obstructive sleep apnea (OSA, 11.6%), hypersomnia (9.9%), and ADHD (9.6%). Of the most common comorbidities, OSA occurred more frequently among those with adult symptom onset (14.2%) versus pediatric symptom onset (9.6%; p=0.033).

Conclusions Patients with narcolepsy may be misdiagnosed and/or have various comorbidities, including psychiatric conditions. These findings are consistent with what has previously been reported in the literature.

Authors/Disclosures
Maurice M. Ohayon, MD, PhD, DSc (Stanford) PRESENTER	The institution of Dr. Ohayon has received research support from Jazz pharmaceuticals. The institution of Dr. Ohayon has received research support from Takeda Pharmaceuticals.
Michael J. Thorpy, MD (Montefiore Medical Center)	Dr. Thorpy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz. Dr. Thorpy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avadel. Dr. Thorpy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for alkermes. Dr. Thorpy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Harmony. Dr. Thorpy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for centessa. Dr. Thorpy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axsome. Dr. Thorpy has received publishing royalties from a publication relating to health care.
Jed Black, MD (Jazz Pharmaceuticals)	Jed Black, MD has received personal compensation for serving as an employee of Jazz Pharmaceuticals. Jed Black, MD has stock in Jazz Pharmaceuticals. Jed Black, MD has stock in .
	No disclosure on file
	No disclosure on file
	No disclosure on file
Kathleen Villa	No disclosure on file

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