Hypersomnolence in Patients With Celiac Disease

Abstract

SESSION TITLE: Sleep 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Celiac disease is one of the most prevalent auto-immune disorders. It is induced by gluten exposure in genetically susceptible individuals. It is associated with DQ2 (DQA1*05; DQB1*02) and DQ8 (DQA1*03; DQB1*0302) human leukocyte antigen (HLA) genotypes. As narcolepsy also has associations with certain HLA loci (DQB1*0602), we aimed to investigate prevalence of sleep disorders associated with hypersomnolence in a cohort of patients with celiac disease. METHODS: Using Advanced Cohort Explorer software, we retrospectively searched the electronic medical records of patients evaluated at Mayo Clinic in Rochester, MN, between 2000 and mid-2014. We identified 750 cases of biopsy confirmed celiac disease and/or dermatitis herpetiformis. We completed manual search of these medical charts, looking for subjective complaints of hypersomnolence, diagnoses of sleep apnea, restless legs syndrome (RLS), and periodic limb movements of sleep, as well as sleep testing. We defined obstructive sleep apnea (OSA) as confirmed diagnosis, nocturnal positive pressure therapy, or clinical suspicion plus oxygen desaturation index > 8. RESULTS: Out of 750 patients we identified 73 (~10%) had known sleep disorder, sleep consultation, polysomnography, and/or overnight pulse oximetry. The most prevalent disorder was OSA (30 cases). The patients with OSA had median age of 55 years (interquartile range (IQR) 46-65), 53% were male, median body mass index was 35 (IQR 28-41), median ODI was 9.3 (IQR 4-17) and median apnea-hypopnea index was 9 (IQR 6-15). In addition, there were 6 patients with periodic limb movements of sleep, 4 patients with RLS, 2 patients with central sleep apnea, and one patient with diagnosis of narcolepsy with cataplexy (proposed prevalence of 0.13%). Compared to the reported OSA prevalence our cohort of celiac disease patients had somewhat lower prevalence with 4% patients affected. Clinically significant RLS prevalence in literature is about 2-3%, while 0.5% patients in our cohort carried the diagnosis of RLS. The previously reported prevalence of narcolepsy with cataplexy in the literature ranges from 25 to 50 per 100,000 people (0.025%-0.05%). Celiac patient cohort evaluated at Mayo Clinic in Rochester therefore had higher prevalence of narcolepsy, though it was only one patient. CONCLUSIONS: While prevalence of sleep apnea and RLS was somewhat lower in our cohort of celiac patients, narcolepsy was more frequent. However, this needs to be confirmed in the future epidemiological and case-control studies. CLINICAL IMPLICATIONS: Our findings suggest that narcolepsy might be more prevalent in patients with celiac disease than general population. Physicians managing patients with celiac disease therefore should pay attention to complaints of hypersomnolence. DISCLOSURE: The following authors have nothing to disclose: Gaja Shaughnessy, Ali Alsaad, Carl Ruthman, Norlalak Jiramethee, Jose Yataco, Emir Festic No Product/Research Disclosure Information