The MSLT quantitates sleep propensity as an objective measure of daytime sleepiness and involves a series of 5 naps separated by 2-hour intervals throughout the day. Nocturnal polysomnography and the multiple sleep latency test (MSLT) can be used to confirm narcolepsy and evaluate for other causes of EDS. Unfortunately, delay in diagnosing narcolepsy can contribute to the patient’s already significant disease burden, leading to decreased quality of life (QOL).Ī diagnosis of narcolepsy depends on clinical history and diagnostic testing. In part, the delay in diagnosis may stem from a general lack of physician awareness of narcolepsy the broad array of symptoms that may be difficult to differentiate from symptoms of other disorders and the wide range of both medical and psychiatric comorbidities associated with narcolepsy, including obesity, other sleep disorders, and psychiatric illnesses. Although symptoms usually appear in late adolescence or early adulthood, on average there is a delay of 10 years before an accurate diagnosis is established. Once they emerge, the symptoms of narcolepsy are usually lifelong, especially when the illness is associated with cataplexy. In addition, disrupted nighttime sleep is common. Other characteristic symptoms include sleep paralysis and hallucinations, which classically occur at the transition from wake to sleep, and vice versa (ie, hypnagogic and hypnopompic). Cataplexy can commonly manifest as jaw sagging and/or knees buckling, but it can present more subtly or can result in temporary total-body paralysis, leading to the affected patient falling to the ground. Cataplexy, the sudden, involuntary loss of skeletal muscle tone that lasts from seconds to 1 or 2 minutes, is most often triggered by positive emotions and occurs in up to 70% of cases. Narcolepsy, a disabling disorder that affects approximately 1 of 2000 people worldwide, is characterized by excessive daytime sleepiness (EDS) and frequent overwhelming urges to sleep or inadvertent daytime lapses into sleep.
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