TOPLINE: 

Narcolepsy was not associated with increased mortality risk compared to not having the condition, even among patients with psychiatric comorbidities, a new retrospective cohort study showed. The findings held for all-cause mortality as well as mortality from specific causes, such as accidents or suicides, which researchers said contradicts earlier findings.

METHODOLOGY:

• Researchers assessed data for more than 3000 patients with narcolepsy (mean age, 29.5 years; 52.5% men) and nearly 13,000 age- and sex-matched control individuals from the Taiwan National Health Insurance Research Database between 2001 and 2022.
• Patients with narcolepsy had at least two clinical diagnoses of the disease by neurologists or psychiatrists and were aged 6 years or older at initial diagnosis. They were followed until death or the conclusion of the study, whichever occurred first.
• The primary outcome was all-cause mortality, and the secondary outcome was cause-specific mortality due to natural or unnatural causes, including accidents and suicides.
• A sibling cohort analysis was also conducted, which included more than 2000 patients with narcolepsy and more than 3000 siblings without narcolepsy, to address familial confounding.

TAKEAWAY:

• Patients with narcolepsy had a higher lifetime prevalence of psychiatric comorbidities compared to matched controls, including neurodevelopmental disorders (17.1% vs 2.5%, respectively), depression (36.6% vs 6.8%), and anxiety (33.1% vs 6.7%).
• Crude all-cause mortality rates were not significantly different between groups: 44.3 per 10,000 person-years for patients with narcolepsy vs 38.1 per 10,000 person-years for controls (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.8-1.2). Additionally, no significant increases were observed for mortality due to natural causes (aHR, 0.9; 95% CI, 0.7-1.1) or unnatural causes (aHR, 1.4; 95% CI, 0.8-2.4), including accidents (aHR, 1.4; 95% CI, 0.6-3.00) and suicides (aHR, 1.4; 95% CI, 0.6-3.2).
• Compared with their siblings without the disease , patients with narcolepsy had no increased risk for all-cause mortality (aHR, 1.14; 95% CI, 0.63-2.06) or mortality due to natural causes (aHR, 0.66; 95% CI, 0.28-1.56) or unnatural causes (aHR, 2.08; 95% CI, 0.87-4.98) , including accidents (aHR, 1.61; 95% CI, 0.48-5.37) and suicides (aHR, 3.43; 95% CI, 0.88-13.28).
• Age-stratified analysis revealed higher risks for crude all-cause mortality and mortality due to natural causes in adults aged 65 years or older with epilepsy compared to control individuals, but the differences were not significant after adjusting for confounders and comorbidities.

IN PRACTICE:

"These findings reduce immediate clinical concern, but the wide 95% CIs suggest that a modest increase in risk cannot be excluded; replication in other populations with longer follow-up is warranted," the investigators wrote.

SOURCE:

The study was led by Chih-Wei Hsu, MD, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. It was published online on October 9 in JAMA Network Open.

LIMITATIONS: 

Key lifestyle and occupational factors potentially affecting mortality were not captured in the registry. The relatively young cohort at baseline and the limited follow-up time may have prevented the detection of late mortality associated with comorbidities. The database could not reliably distinguish between narcolepsy with and without cataplexy, and although polysomnography and multiple sleep-latency testing are routinely used in Taiwan, these objective sleep examination results were not recorded. Additionally, as the study was conducted exclusively in Taiwan, the generalizability of the findings was limited.

DISCLOSURES:

The study was funded by the Taiwan National Science and Technology Council. Hsu reported receiving grants from the Chang Gung Medical Foundation outside the submitted work. The other seven investigators reported no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.