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NASHVILLE, Tenn. -- People with narcolepsy frequently had mood and pain comorbidities that complicated diagnosis and treatment plans, observational data showed.

In a propensity-matched cohort analysis of more than 4,000 individuals, people with narcolepsy were more than twice as likely to be diagnosed with depression (OR 2.11, 95% CI 1.86-2.40, P<0.001) or chronic pain syndrome (OR 2.20, 95% CI 1.76-2.76, P<0.001), reported Amy Everitt, PharmD, RPh, of Avadel Pharmaceuticals in Chesterfield, Missouri, at Psych Congress 2023.

Individuals with narcolepsy were more likely to have:

• Anxiety: OR 1.67 (95% CI 1.46-1.89, P<0.001)
• Dysthymia: OR 1.86 (95% CI 1.54-2.25, P<0.001)
• Myalgia: OR 1.69 (95% CI 1.45-1.97, P<0.001)
• Migraine: OR 1.96 (95% CI 1.66-2.31, P<0.001)
• Fibromyalgia: OR 1.90 (95% CI 1.61-2.25, P<0.001)

They also had sleep disorders, including insomnia (OR 1.84, 95% CI 1.57-2.17, P<0.001), obstructive sleep apnea (OR 3.27, 95% CI 2.83-3.79, P<0.001), or restless leg syndrome (OR 3.94, 95% CI 3.09-5.02, P<0.001).

"A lot of times when someone has narcolepsy and they go see an HCP [healthcare provider], they're misdiagnosed," Everitt told MedPage Today. "If they come in complaining of having fragmented sleep, they may end up with an insomnia diagnosis first, or if they're confused during the day because they're not sleeping, they lack motivation, [they have] irritability, they may get a mood disorder diagnosis."

The number one symptom of narcolepsy is excessive, recurrent daytime sleepiness, which usually means an individual will regularly fall asleep during the day, she noted.

People with narcolepsy may also suffer from a range of other conditions, but this data show those conditions may overlap more than previously thought, she added.

"Sleep disorders and mood disorders were not surprising," Everitt explained during a poster presentation. "One thing that did surprise us was the pain disorders. There are five different pain disorders that had an odds ratio between one and two in patients with narcolepsy."

This could be caused by fragmented sleep, which has been tied to pain problems, she said.

The researchers identified 2,057 individuals with narcolepsy from an aggregated Mayo Clinic electronic health records database of 6.4 million patients from 2000 to 2020, matching them with 2,057 patients who did not have a narcolepsy diagnosis. Patients with narcolepsy had a narcolepsy-specific ICD-9 or -10 code and supportive statements in their records.

Nearly 60% in each group were female. More than 90% were white. Median age at first encounter was similar (32 in the narcolepsy group and 35 in the matched cohort).

Understanding common comorbidities may help clinicians better treat narcolepsy patients, the researchers noted.

"Just knowing that the odds ratios are between one and two or higher for anxiety, dysthymia, [and] depression, be on the lookout for [narcolepsy]," Everitt said. "If they're having excessive daytime sleepiness, dig a little deeper."

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