The Z hypnotics in the management of narcolepsy: A case series

Document Type

Conference Proceeding

Publication Date

9-22-2024

Publication Title

J Sleep Res

Abstract

Introduction: The narcolepsies, types I and II and secondary, are primarily characterized by disorganization of the wake-sleep cycle architecture. This manifests by a pentade of symptoms of excessive daytime sleepiness (EDS), nocturnal sleep fragmentation, cataplexy, sleep paralysis and hypnagogic/hypnopompic hallucinations. The treatment of narcolepsy relies on sleep-related behavioral modification, stimulants for daytime sleepiness, hypnotics for nocturnal sleep fragmentation and rapid eye movement (REM) sleep suppressants drugs for the REM sleep intrusion related symptoms. The introduction of sodium oxybate (SOX) in the early 2000's used as a short acting hypnotic was a breakthrough in improving the care of narcolepsy patients by reducing both daytime sleepiness and cataplexy. We report our experience in patients with narcolepsy in whom short acting benzodiazepine receptor agonists (BzRA), zolpidem (Zol) or eszopiclone (Esz) were used at bedtime to treat both excessive daytime sleepiness and cataplexy. Method: Between 2002 and 2023, 53 patients, largely seen in a busy community based accredited sleep clinic, were diagnosed with narcolepsy. Thirteen patients (25%) had type I, 37 patients (70%) had type II and 3 patients (5%) had secondary narcolepsy (2 patients with multiple sclerosis and one viral meningitis). Twenty-three patients (8 with type I) out of 53 were treated with BzRA's (20 Zol and 3 Esz). The use of a BzRA drug was largely due to lack of insurance coverage for or side effects to the SOX. Results: Eighteen of the 23 patients (78%; 8 with type I) treated with a BzRa drug had good to excellent subjective response in their symptoms of EDS and/or cataplexy. While the remaining 5 (1 with type I) had marginal or no response (table 2). Three of the responding patients remained on zolpidem in monotherapy (ie. no stimulants). Conclusion: Short acting hypnotic BzRa drugs may be effective to manage several of the cardinal symptoms of narcolepsy, regardless of the narcolepsy type. Placebo controlled trials are needed to confirm our observations. Conflict of Interest: No.

Volume

33

First Page

2

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