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Abstract
BackgroundPatients with narcolepsy-cataplexy (NC) mostly exhibit undetectable hypocretin levels. Hypocretin system is one of the key players in the complex interaction between sleep and the cardiovascular system. We tested the hypothesis that hypocretin deficiency affects cardiovascular risk factors by measuring nighttime and daytime ambulatory blood pressure (BP) and the night-to-day BP ratio as well as endothelial dysfunction by the digital pulse amplitude response in drug-free patients with NC compared to controls.MethodologySleep, clinical and biological cardiovascular risk factors, fingertip peripheral arterial tonometry, and 24-hour ambulatory BP monitoring were recorded in 50 drug-free patients with NC and 42 healthy control subjects, except for BP monitoring available in all controls but in 36 patients with NC.Principal FindingsMore patients than controls were smokers, obese and with dyslipidemia. One-third of patients with NC were “non-dippers” (defined as <10% drop in BP during sleep) compared to only 3% of controls. The diastolic non-dipper BP profile had up to 12-fold higher odds of being associated with NC. We noted negative correlations between mean diastolic BP fall during night, REM sleep percentage and number of sleep onset REM periods, and a positive correlation with mean sleep latency on the MSLT. The digital pulse amplitude response measured by fingertip was similar between NC and controls.ConclusionWe found a high percentage of non-dippers in patients with NC with association with REM sleep dysregulation. The blunted sleep-related BP dip in NC may be of clinical relevance, as it may indicate increased risk for cardiovascular events.
Highlights
Narcolepsy with cataplexy (NC) is characterized by excessive daytime sleepiness (EDS), cataplexy, and disturbed nocturnal sleep, including parasomnias, obstructive sleep apnea syndrome, and periodic leg movements [1]
We found a high percentage of non-dippers in patients with NC with association with rapid eye movement (REM) sleep dysregulation
The blunted sleep-related blood pressure (BP) dip in NC may be of clinical relevance, as it may indicate increased risk for cardiovascular events
Summary
Narcolepsy with cataplexy (NC) is characterized by excessive daytime sleepiness (EDS), cataplexy, and disturbed nocturnal sleep, including parasomnias, obstructive sleep apnea syndrome, and periodic leg movements [1]. Animal studies have explored the cardiovascular status of hypocretin-deficient rodent during wakefulness, showing lower arterial blood pressure (BP) compared to wild type [7,8]. Blunted NREM and REM sleep-related decreases in BP have been shown in hypocretin-deficient mice [9]. Pharmacological studies in mice or rats have revealed that the administration of hypocretin stimulates arousal and elevates arterial blood pressure, heart rate (HR), oxygen consumption, body temperature, and plasma catecholamine levels [10,11,12]. We tested the hypothesis that hypocretin deficiency affects cardiovascular risk factors by measuring nighttime and daytime ambulatory blood pressure (BP) and the night-to-day BP ratio as well as endothelial dysfunction by the digital pulse amplitude response in drug-free patients with NC compared to controls
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