The impact of gender on timeliness of narcolepsy diagnosis

Abstract

Study objectives: To examine the impact of gender in narcoleptic patients on timeliness of diagnosis, symptomology, and health and lifestyle impairment.

Methods: This is a cross-sectional study of 109 consecutive patients (68 women) with newly diagnosed narcolepsy with and without cataplexy, from a University sleep disorders center. Consecutive patients were administered an 8-page questionnaire at the time of their diagnosis regarding sleep habits, medications, and medical conditions, lifestyle impairments, as well as details regarding narcolepsy-related symptoms.

Results: Men and women presented with remarkably similar narcolepsy related symptoms, yet women were more likely to be delayed in diagnosis; 85% of men were likely to be diagnosed by 16 years after symptom onset, compared to 28 years in women. More women were likely to remain undiagnosed at any given time point after symptom onset (hazard ratio for diagnosis of men compared to women 1.53; 95% CI 1.01-2.32; p = 0.04). Men and women reported similar degree of subjective sleepiness as measured by the Epworth Sleepiness Scale (mean 16.2 ± 4.5; p = 0.18), though women demonstrated significantly more severe objective sleepiness on multiple sleep latency testing (MSLT) (mean sleep latency in women = 5.4 min (± 4.1), in men 7.4 min (± 3.5); p = 0.03). Despite being more objectively sleepy, women were less likely to report lifestyle impairments in the areas of personal relationships (71% men, 44% women, p = 0.01) and physical activity (36% men, 16% women, p = 0.02), but were also more likely to self-medicate with caffeine (63.4% men, 82.4% women; p = 0.03).

Conclusions: Narcolepsy impacts men and women's health and lifestyle differently, and may cause delays diagnosis for women.

Keywords: Narcolepsy; diagnosis; gender; hypersomnia; sex; sleep; women.

Figures

Figure 1. Age of symptom onset

(A) Age of symptom onset of narcolepsy for all subjects. (B) Age of symptom onset by gender. In both genders, there was a peak of onset between the ages of 10-15 years, with decreasing frequency with age and a slight increase in onset during the ages of 35-40 years.

Figure 2. Lifestyle impairments attributed to narcolepsy

Values represent percentages of men or women who attribute the listed impairments directly to symptoms of narcolepsy. *p-value