Abstract
BackgroundNarcolepsy is a chronic sleep disorder with a broad variety of symptoms. Although narcolepsy is primarily characterized by excessive daytime sleepiness and cataplexy (loss of muscle control triggered by emotions), patients may suffer from hypnagogic hallucinations, sleep paralysis, and fragmented night sleep. However, the spectrum of narcolepsy also includes symptoms not related to sleep, such as cognitive or psychiatric problems. Symptoms vary greatly among patients and day-to-day variance can be considerable. Available narcolepsy questionnaires do not cover the whole symptom spectrum and may not capture symptom variability. Therefore, there is a clinical need for tools to monitor narcolepsy symptoms over time to evaluate their burden and the effect of treatment.ObjectiveThis study aimed to describe the design, development, implementation, and evaluation of the Narcolepsy Monitor, a companion app for long-term symptom monitoring in narcolepsy patients.MethodsAfter several iterations during which content, interaction design, data management, and security were critically evaluated, a complete version of the app was built. The Narcolepsy Monitor allows patients to report a broad spectrum of experienced symptoms and rate their severity based on the level of burden that each symptom imposes. The app emphasizes the reporting of changes in relative severity of the symptoms. A total of 7 patients with narcolepsy were recruited and asked to use the app for 30 days. Evaluation was done by using in-depth interviews and user experience questionnaire.ResultsWe designed and developed a final version of the Narcolepsy Monitor after which user evaluation took place. Patients used the app on an average of 45.3 (SD 19.2) days. The app was opened on 35% of those days. Daytime sleepiness was the most dynamic symptom, with a mean number of changes of 5.5 (SD 3.7) per month, in contrast to feelings of anxiety or panic, which was only moved 0.3 (SD 0.7) times per month. Mean symptom scores were highest for daytime sleepiness (1.8 [SD 1.0]), followed by lack of energy (1.6 [SD 1.4]) and often awake at night (1.5 [SD 1.0]). The personal in-depth interviews revealed 3 major themes: (1) reasons to use, (2) usability, and (3) features. Overall, patients appreciated the concept of ranking symptoms on subjective burden and found the app easy to use.ConclusionsThe Narcolepsy Monitor appears to be a helpful tool to gain more insight into the individual burden of narcolepsy symptoms over time and may serve as a patient-reported outcome measure for this debilitating disorder.
Highlights
BackgroundNarcolepsy is a chronic neurological sleep disorder caused by a deficiency of the hypothalamic neurotransmitter, hypocretin [1,2]
The Narcolepsy Monitor allows patients to report a broad spectrum of experienced symptoms and rate their severity based on the level of burden that each symptom imposes
Under the supervision of the authors, a group of 5 students involved in the User System Interaction Program of the Eindhoven University of Technology (TU/e), started in 2016 with an exploration on the design statement, “Design a mobile app for narcolepsy patients that runs on their personal device, to self-monitor the subjective severity of narcolepsy symptoms.”
Summary
BackgroundNarcolepsy is a chronic neurological sleep disorder caused by a deficiency of the hypothalamic neurotransmitter, hypocretin [1,2]. Patients often experience attacks of muscle weakness triggered by emotions, called cataplexy [6] These symptoms, together with hypnagogic hallucinations, sleep paralysis, and disturbed nocturnal sleep, are referred to as the classic pentad of narcolepsy [7]. Differences in experienced severity are influenced by medication effect and medication tolerance as well as circumstances of daily living and individual variation in coping strategies. Both the broad symptom spectrum and symptom variability stress the need for individually tailored care in narcolepsy. Narcolepsy is primarily characterized by excessive daytime sleepiness and cataplexy (loss of muscle control triggered by emotions), patients may suffer from hypnagogic hallucinations, sleep paralysis, and fragmented night sleep. There is a clinical need for tools to monitor narcolepsy symptoms over time to evaluate their burden and the effect of treatment
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