Narcolepsy

Last reviewed: 6 Nov 2022
Last updated: 18 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • excessive daytime sleepiness
  • cataplexy
  • hypnagogic/hypnopompic hallucinations
  • sleep paralysis
More key diagnostic factors

Other diagnostic factors

  • chronic fatigue or tiredness
  • poor performance at work
  • poor memory and concentration
  • car accidents
  • slurred speech
  • blurred vision
  • irregular breathing pattern
  • sleep attacks
  • fragmented nocturnal sleep
  • symptoms of other sleep disorders
  • obesity
  • status cataplecticus
  • hepatomegaly
  • paresis
Other diagnostic factors

Risk factors

  • human leukocyte antigen (HLA)-II DQA1*0102-DQB1*0602
  • Prader-Willi syndrome
  • Niemann-Pick disease type C
  • low cerebrospinal fluid hypocretin
  • linkage to 4p13-q21
  • genes on chromosome 6 or chromosome 21
  • hypothalamic tumors
  • hypothalamic infarct/hemorrhage
  • head trauma
  • central nervous system infection
  • central nervous system arteriovenous malformations
  • multiple sclerosis
More risk factors

Diagnostic investigations

1st investigations to order

  • actigraphy and sleep diary
  • overnight polysomnography
  • multiple sleep latency test (MSLT)
More 1st investigations to order

Investigations to consider

  • HLA typing
  • cerebrospinal fluid hypocretin-1 level
  • maintenance of wakefulness test
More investigations to consider

Treatment algorithm

ONGOING

adults with excessive daytime sleepiness (EDS)

adults with cataplexy

children with excessive daytime sleepiness (EDS)

children with cataplexy

Contributors

Authors

Octavian C. Ioachimescu, MD, PhD
Octavian C. Ioachimescu

Associate Professor

Emory University

Atlanta VA Medical Center

Atlanta

GA

Disclosures

OCI is an editor of a book cited in this topic.

Peer reviewers

Kumaraswamy Budur, MD

Medical Doctor

Sleep Disorders Center

Department of Psychiatry

Cleveland Clinic

Cleveland

OH

Disclosures

KB declares that he has no competing interests.

Seiji Nishino, MD, PhD

Associate Professor

Psychiatry and Behavioral Science

Stanford University School of Medicine

Stanford

CA

Disclosures

SN declares that he has no competing interests.

Kingman P. Strohl, MD, FCCP

Professor of Medicine

Director

Center for Sleep Disorders Research

Professor of Anatomy

Department of Medicine

Case Western Reserve University

Cleveland

OH

Disclosures

KPS declares that he has no competing interests.

Paul Reading, MBBS

Consultant Neurologist

James Cook University Hospital

Middlesbrough

UK

Disclosures

PR declares that he has no competing interests.

  • Differentials

    • Untreated sleep apnea
    • Periodic limb movements of sleep
    • Restless legs syndrome (RLS)
    More Differentials
  • Guidelines

    • Treatment of central disorders of hypersomnolence
    • European guideline and expert statements on the management of narcolepsy in adults and children
    More Guidelines
  • Patient leaflets

    Sleep apnea in adults (obstructive)

    Insomnia

    More Patient leaflets
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