Narcolepsy
Integrating Basic and Clinical Knowledge
- 1st Edition - July 15, 2025
- Imprint: Academic Press
- Editors: Ahmed S. BaHammam, Amir Sharafkhaneh, Seithikurippu R. Pandi-Perumal
- Language: English
- Paperback ISBN:9 7 8 - 0 - 4 4 3 - 3 0 0 0 4 - 2
- eBook ISBN:9 7 8 - 0 - 4 4 3 - 3 0 0 0 5 - 9
Narcolepsy: Integrating Basic and Clinical Knowledge provides comprehensive coverage of narcolepsy-related topics. The book offers updated, deep coverage of its diagnosis, treatm… Read more
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Narcolepsy: Integrating Basic and Clinical Knowledge provides comprehensive coverage of narcolepsy-related topics. The book offers updated, deep coverage of its diagnosis, treatment, and impact on mental health based on the latest research findings and clinical practices. Its interdisciplinary approach brings together experts from different specialties, such as sleep medicine, psychology, and neurology to offer a more holistic understanding. This allows for a more nuanced discussion of how narcolepsy interacts with various aspects of health and well-being. Researchers and clinicians will find within this book novel information on pathophysiology and neurobiology, as well as behavioral and psychosocial considerations.
Users will find this to be a resource that takes a deep dive into narcolepsy, introducing topics never before discussed in books on the topic, including COVID-19 and sleep, as well as immunotherapy and gene therapy. It’s the cutting-edge medical volume professionals need, whether narcolepsy specialists or more casual readers.
Users will find this to be a resource that takes a deep dive into narcolepsy, introducing topics never before discussed in books on the topic, including COVID-19 and sleep, as well as immunotherapy and gene therapy. It’s the cutting-edge medical volume professionals need, whether narcolepsy specialists or more casual readers.
- Presents broad-based coverage of all aspects of narcolepsy, from the basics of sleep physiology to the latest developments in immunotherapy and gene therapy
- Emphasizes a patient-centered approach that emphasizes the lived experience of those with narcolepsy and the importance of self-care, coping strategies, and advocacy
- Features in-depth discussions of comorbidities, such as depression, anxiety, obesity, other comorbid sleep disorders, and their impact on narcolepsy management
Sleep physicians, neurologists, sleep physicians, sleep researchers, psychiatrists, sleep medicine trainees, sleep technologists, and any medical professional interested in the interdisciplinary areas of sleep science and medicine
List of contributors
About the editors
Foreword
Preface
Acknowledgments
Part I Pathophysiology and neurobiology
CHAPTER 1: Understanding sleep in narcolepsy: sleep physiology, neurobiology, and cognitive impairment mechanisms
Syed Shahid Habib
1.1 Introduction
1.2 Sleep physiology
1.3 Normal sleep architecture
1.4 Sleep stages and their transitions
1.4.1 N1 (Stage 1) sleep
1.4.2 N2 (Stage 2) sleep
1.4.3 N3 (Stage 3) deepest nonrapid eye movement or slow–wave sleep
1.5 Rapid eye movement sleep
1.6 Comparing sleep patterns of normal individuals with patients with narcolepsy
1.7 Brain networks regulating sleep and wakefulness
1.7.1 The concept of “flip–flop” switch
1.7.2 Sleep paralysis and cataplexy
1.8 Brain neurotransmitters in normal sleep and narcolepsy
1.8.1 Memory impairment and cognitive deficits in individuals with narcolepsy
1.9 Impact of narcolepsy on cognitive function
1.10 Conclusion
References
CHAPTER 2: Pathophysiology of narcolepsy: genetics and immune system
Shahrad Taheri
2.1 Introduction
2.2 Human leukocyte antigen genes and narcolepsy
2.3 Narcolepsy and nonhuman leukocyte antigen immune genes
2.4 Narcolepsy and environmental factors
2.5 Narcolepsy and humoral immunity
2.6 Summary
References
CHAPTER 3: Neurotransmitters, genetics, and animal models in narcolepsy: a comprehensive overview
Nada F. AlAhmady and Fadwa M. Alkhulaifi
3.1 The role of neurotransmitters in narcolepsy: a focus on hypocretin/orexin signaling pathways
3.2 The role of immunological and hormonal pathways in narcolepsy
3.2.1 The immune basis of narcolepsy
3.3 Genetic underpinnings of narcolepsy
3.4 The role of animal models in understanding narcolepsy
3.5 Common animal models in narcolepsy research
3.5.1 Canine narcolepsy
3.5.2 Rodent narcolepsy
3.5.3 Transgenic models
3.5.4 Zebrafish narcolepsy
3.6 Implications for treatment and future directions
References
CHAPTER 4: The gut–brain axis in narcolepsy: emerging research on microbiota, diet, and sleep
Fulong Xiao
4.1 Introduction
4.2 The gut microbiota and sleep disorders
4.3 Trends in research about gut microbiota and narcolepsy
4.4 Conclusion
References
Part II Clinical aspects
CHAPTER 5: Types of narcolepsy and their symptoms: differential diagnosis and misdiagnosis
Renata Riha
5.1 Types of narcolepsies
5.1.1 Type 1 narcolepsy
5.1.2 Type 2 narcolepsy
5.2 Controversies in the diagnosis of type 1 and type 2 narcolepsy
5.3 Phenotyping narcolepsy
5.4 Conclusion
References
CHAPTER 6: Delayed diagnosis of narcolepsy: causes and implications
Abdul Rouf Pirzada and Ahmed S. BaHammam
6.1 Introduction
6.2 Epidemiological insights into diagnostic delays in narcolepsy
6.2.1 Global perspective on diagnostic delay
6.2.2 Improvement in diagnostic delay in recent data
6.2.3 Access to healthcare services and diagnostic delay
6.3 Potential predictors of delayed diagnosis
6.3.1 Age
6.3.2 Cataplexy
6.3.3 Gender
6.4 Symptoms overlap with other disorders and prior misdiagnoses of patients with narcolepsy
6.4.1 Diagnostic delays and misdiagnosis trends
6.4.2 Comparative studies and misdiagnosis rates
6.4.3 Comorbidity and symptom complexity
6.4.4 Sleep disorders and narcolepsy overlap
6.4.5 Diagnostic challenges in pediatric narcolepsy
6.4.6 Logistical and diagnostic limitations
6.5 Diagnostic delay and clinical implications
6.5.1 Clinical and personal consequences of delayed diagnosis
6.5.2 Educational challenges
6.5.3 Economic and societal impacts
6.6 Conclusion
References
Chapter 7: Diagnostic tools for narcolepsy: sleep studies, multiple sleep latency test, and more
Ahmed S. BaHammam
7.1 Introduction
7.2 Overview of American Academy of Sleep Medicine diagnostic criteria for narcolepsy
7.2.1 Narcolepsy type 1
7.2.2 Narcolepsy type 2
7.2.3 Updates in the 2024 pediatric guidelines include
7.3 Emerging roles of CSF hypocretin-1 measurement in narcolepsy diagnosis
7.4 Polysomnography
7.4.1 Role of polysomnography in narcolepsy diagnosis
7.4.2 Typical polysomnography findings in narcolepsy
7.4.3 Specific rapid eye movement sleep changes in narcolepsy
7.4.4 Limitations of polysomnography alone for diagnosis
7.5 Multiple sleep latency test
7.5.1 Purpose and procedure of multiple sleep latency test
7.5.2 Diagnostic criteria for narcolepsy based on multiple sleep latency test results
7.5.3 Pediatric considerations
7.5.4 Preparation for the multiple sleep latency test
7.5.5 Factors affecting multiple sleep latency test reliability
7.6 Daytime continuous polysomnography
7.7 Actigraphy
7.7.1 Limitations of actigraphy for narcolepsy diagnosis
7.8 Screening scales for narcolepsy
7.8.1 Ullanlinna Narcolepsy Scale
7.8.2 Swiss Narcolepsy Scale
7.8.3 Epworth Sleepiness Scale
7.8.4 Narcolepsy Severity Scale
7.8.5 The Pediatric Hypersomnolence Survey
7.8.6 Challenges and opportunities in the use of Narcolepsy Screening Scales
7.9 Emerging technologies and artificial intelligence
7.9.1 Wearables
7.9.2 Pupillometry as a potential biomarker for sleepiness
7.9.3 Home sleep testing for narcolepsy diagnosis: current limitations
7.9.4 Machine learning in narcolepsy diagnosis
7.9.5 Utilizing AI in phenotyping narcolepsy and hypersomnolence disorders
7.10 Diagnostic approach
7.11 Conclusion
References
Chapter 8: Narcolepsy in children and adolescents: diagnosis, management, and challenges
Binal Kancherla, Sonal Malhotra, Marlene Typaldos, Aleena Wasim, and Yousaf Khan
8.1 Medical history
8.2 Physical exam
8.3 Diagnostic testing
8.3.1 Sleep diary and actigraphy
8.3.2 Overnight polysomnography
8.3.3 Multiple sleep latency test
8.4 Laboratory testing and imaging
8.4.1 Hypocretin testing
8.4.2 HLA typing
8.4.3 Neuroimaging
8.5 Psychological, psychiatric, and social aspects
8.6 Differential diagnosis
8.7 Management
8.7.1 Education
8.7.2 Behavioral modification
8.7.3 Pharmacological
8.7.4 Medications for excessive daytime sleepiness
8.7.5 Medications for cataplexy
8.7.6 Other medications
8.8 Summary of management
Chapter 9: Narcolepsy and pregnancy: risks and strategies for management
Rosa Peraita-Adrados
9.1 Introduction
9.2 Narcolepsy in women
9.3 Sleep disorders in pregnancy
9.4 Narcolepsy in pregnancy
9.5 Medication management during pregnancy for narcolepsy patients
References
Chapter 10: Aging with narcolepsy: understanding the unique challenges for older adults
Natalie Cornay Manalo and Hrayr Attarian
10.1 Introduction
10.2 Narcolepsy onset after age 35
10.2.1 Case 1 (late onset)
10.3 Delayed diagnosis
10.3.1 Case 2 (delayed diagnosis)
10.4 Symptomatic narcolepsy
10.4.1 Case 3 (symptomatic narcolepsy)
10.5 Implications of narcolepsy in older adults and therapeutic challenges
10.5.1 Case 4 (management dilemma with age)
10.6 Conclusion
References
Chapter 11: Medical comorbidities of narcolepsy
Nikita Jambulingam, Nathaniel Yuan, and Alon Y. Avidan
11.1 Introduction
11.2 Neurological comorbidities
11.2.1 Migraines
11.2.2 Restless leg syndrome
11.2.3 Rapid eye movement sleep behavior disorder
11.3 Cardiovascular comorbidities
11.3.1 Cardiovascular events and stroke
11.3.2 Hypertension
11.4 Metabolic comorbidities
11.4.1 Obesity
11.4.2 Type 2 diabetes
11.4.3 Dyslipidemia
11.5 Autoimmune disease comorbidities
11.5.1 Autoimmune disease and human leukocyte antigen
11.5.2 Type 1 diabetes
11.5.3 Celiac disease
11.5.4 Rheumatoid arthritis
11.5.5 System lupus erythematosus
11.5.6 Sjögren’s syndrome
11.6 Narcolepsy and comorbidities: management perspectives
11.6.1 Comorbid neurological treatment considerations
11.6.2 Comorbid cardiovascular treatment considerations
11.6.3 Comorbid metabolic treatment considerations
11.6.4 Comorbid autoimmune disease treatment considerations
11.7 Conclusion
References
Chapter 12: Cardiovascular disease risk and comorbidities in narcolepsy
Ahmed S. BaHammam
12.1 Introduction
12.2 Epidemiological evidence of increased cardiovascular disease risk
12.3 Potential mechanisms linking narcolepsy and cardiovascular disease risk
12.3.1 Sleep disruption and autonomic dysfunction
12.3.2 The role of hypocretin
12.3.3 Metabolic dysfunction
12.3.4 Comorbid sleep disorders
12.3.5 Inflammation and endothelial dysfunction
12.4 Cardiovascular risk assessment and management in narcolepsy
12.4.1 Regular cardiovascular risk screening
12.4.2 Lifestyle modification
12.4.3 Management of comorbidities
12.4.4 Consideration of cardiovascular effects of narcolepsy medications
12.4.5 Sodium intake and cardiovascular risk in narcolepsy
12.5 Future research directions
12.6 Conclusion
References
Chapter 13: More than just narcolepsy: the importance of recognizing concurrent sleep disorders
Antara Mallampalli, MD
13.1 Introduction: comorbid sleep disorders in narcolepsy patients
13.2 Prevalence of comorbid sleep disorders in narcolepsy patients: an overview
13.3 Sleep-related breathing disorders in narcolepsy patients
13.3.1 Pathophysiology of sleep-related breathing disorders in narcolepsy
13.3.2 Clinical impact of sleep-related breathing disorders in narcolepsy
13.3.3 Summary
13.4 Insomnia in narcolepsy patients
13.5 Restless leg syndrome and periodic limb movement disorder in narcolepsy patients
13.5.1 Pathophysiology of periodic limb movements of sleep and restless leg syndrome in narcolepsy
13.5.2 Clinical impact of restless leg syndrome in narcolepsy
13.6 REM sleep behavior disorder and other parasomnias in narcolepsy patients
13.6.1 Clinical impact of REM sleep behavior disorder in narcolepsy
13.7 Conclusion and future research directions
References
Chapter 14: Narcolepsy and circadian rhythm disorders: diagnosis and management
Sona Nevsimalova
14.1 Introduction
14.2 Circadian and ultradian rhythms in narcolepsy
14.3 Hypocretin and circadian system
14.4 Circadian aspects of clinical manifestation in narcolepsy
14.5 Circadian rhythm disorders and narcolepsy
14.6 Recommendations for therapy, management, and future perspectives
References
Chapter 15: The hidden link between narcolepsy and autonomic dysfunction: a closer look
Fang Han
15.1 The orexin system and narcolepsy
15.2 Orexins in autonomic regulation
15.3 Role of orexins in cardiovascular regulation
15.4 Narcolepsy and autonomic dysfunction
15.5 Cardiovascular dysfunction in narcolepsy
15.6 Nondipper profile in narcolepsy with cataplexy
15.7 Treatment of narcolepsy on cardiovascular effects
References
Chapter 16: Narcolepsy and metabolic rate: what do we know?
Hamza O. Dhafar and Ahmed S. BaHammam
16.1 Introduction
16.2 Prevalence of obesity in patients with narcolepsy
16.3 Changes in metabolic rate in patients with narcolepsy
16.4 Exploring the possible underlying mechanisms of weight gain in narcolepsy
16.4.1 The role of orexin in metabolism
16.4.2 Orexin and eating behavior
16.4.3 Physical activity
16.4.4 Genetic factors
16.4.5 The role of leptin and ghrelin hormones
16.4.6 Metabolomics
16.4.7 The role of medications used for narcolepsy
16.5 Conclusions and future directions
References
Chapter 17: Narcolepsy and driving: safety issues and regulations
Tha A. Saw and Catherine A. McCall
17.1 Introduction
17.2 Narcolepsy and drowsy driving
17.3 Evaluating drowsy driving risk with narcolepsy
17.4 Legal and regulatory issues
17.5 Risk mitigation
17.5.1 Pharmacologic interventions
17.5.2 Nonpharmacologic interventions
17.5.3 Patient resources
17.6 Conclusion
References
Chapter 18: The natural history of narcolepsy: lessons from longitudinal studies
Salman A. Bahammam and Ahmed S. BaHammam
18.1 Introduction
18.2 Importance of understanding the natural history and time course of narcolepsy
18.2.1 Predicting disease progression
18.2.2 Identifying comorbidities
18.2.3 Developing targeted therapies and precision medicine
18.2.4 Enhancing patient education and support
18.3 Longitudinal studies on narcolepsy
18.3.1 Age of onset and gender differences
18.3.2 Progression of symptoms and clinical findings over time
18.3.3 Changes in sleep architecture over time based on sleep study findings
18.3.4 Longitudinal changes in orexin levels
18.3.5 Impact of narcolepsy on quality of life
18.3.6 Long-term data on safety and efficacy of narcolepsy medications
18.4 Developing targeted therapies based on natural course
18.5 Conclusion
References
Chapter 19: Neuroimaging in narcolepsy: advances in understanding pathophysiology and diagnosis
Kyung Min Kim, Jun-Sang Sunwoo, and Seung Bong Hong
19.1 Introduction
19.2 Voxel-based morphometry, volumetry, cortical thickness studies on narcolepsy
19.3 Diffusion tensor imaging and narcolepsy
19.4 Functional magnetic resonance imaging research on narcolepsy
19.5 Magnetic resonance spectroscopy studies on narcolepsy
19.6 Single photon emission computed tomography and PET studies in narcolepsy
19.7 Future directions
References
Chapter 20: The distinctive characteristics of REM sleep and dreams in narcolepsy
Serena Scarpelli and Luigi De Gennaro
20.1 Introduction
20.2 Rapid eye movement sleep features in narcolepsy
20.3 Dream activity in narcolepsy
20.4 Neural bases of dream recall
20.5 Lucid dreams, nightmares, and insights for treatment
20.6 Conclusions
References
Part III: Behavioral and psychosocial considerations
Chapter 21: The hidden burden of narcolepsy: anxiety and depression among patients
Berit Hjelde Hansen
21.1 Introduction
21.2 Anxiety disorders
21.3 Depressive disorders
21.4 Widening the scope—a potential role of neurodevelopmental disorders
21.5 Treatment
21.6 Importance of screening for anxiety and depression in narcolepsy
21.7 Summary
References
Chapter 22: Understanding psychosis and behavioral abnormalities in narcolepsy patients
Cyril Hanin
22.1 Introduction
22.2 Clinical presentation of psychosis in narcolepsy
22.2.1 Psychotic symptoms in narcolepsy
22.2.2 Group 1: hallucinations in typical narcolepsy
22.2.3 Group 2: narcolepsy with atypical psychotic-like symptoms
22.2.4 Group 3: challenges in diagnosing narcolepsy in schizophrenia patients
22.3 Impulsivity, emotional dysregulation, and social behavior in narcolepsy
22.3.1 Impulsivity in narcolepsy
22.3.2 Emotional dysregulation
22.3.3 Altered social behavior
22.4 Pathophysiology: linking narcolepsy and psychosis
22.4.1 REM-sleep intrusion and psychotic-like symptoms
22.4.2 Autoimmune and genetic mechanisms
22.4.3 Hypocretin system implications
22.4.4 Early-onset narcolepsy and schizophrenia: neurodevelopmental implications
22.4.5 Medication-induced psychosis in narcolepsy patients with or without comorbid psychotic disorder
22.4.6 Classical psychostimulants: methylphenidate and amphetamines
22.4.7 Modafinil and armodafinil
22.4.8 Sodium oxybate (gamma hydroxybutyrate)
22.4.9 Pitolisant and other emerging treatments
22.5 Clinical algorithm and management strategies
22.5.1 Initial assessment and categorization
22.5.2 Assessing drug-induced psychosis
22.6 Prognosis and long-term outcomes in narcolepsy patients with psychotic symptoms
AI disclosure
References
Chapter 23: Narcolepsy and cognitive impairment: causes and management
Meteb H. Alenazi
23.1 Introduction
23.2 Cognitive impairment in narcolepsy
23.2.1 Attention
23.2.2 Memory
23.2.3 Executive functions and higher cognitive functions
23.3 Clinical pictures of excessive daytime sleepiness and cognitive impairment
23.3.1 Hypersomnolence related to major depressive disorder with atypical features
23.4 Conclusion
AI disclosure
References
Chapter 24: Narcolepsy and relationships: navigating intimacy, family, and social life
Anne Marie Morse
24.1 Introduction
24.1.1 Early childhood and adolescence
24.1.2 Adulthood
24.2 Optimizing outcomes
24.2.1 Conclusion
References
Chapter 25: Narcolepsy and advocacy: awareness, education, and community building
Ahmed S. BaHammam
25.1 Introduction
25.2 The importance of narcolepsy advocacy
25.3 Raising awareness about narcolepsy
25.4 Educating the general public and healthcare providers about narcolepsy
25.4.1 Providing resources
25.4.2 Presentations and workshops
25.4.3 Correcting common myths
25.4.4 Importance of educating healthcare professionals
25.5 Building community and support
25.5.1 Connecting with other patients
25.5.2 Providing encouragement and sharing coping strategies
25.5.3 Advocating together for research and better treatments
25.6 Empowering patients to advocate for themselves
25.6.1 Gaining confidence to discuss narcolepsy
25.6.2 Communicating needs and challenges effectively
25.6.3 Partnering with healthcare providers
25.6.4 Understanding rights and accommodations
25.7 The impact of narcolepsy advocacy
25.8 Conclusion
References
Further reading
Chapter 26: The complexities of medico-legal assessment of disability in narcolepsy
Francesca Ingravallo and Annamaria Govi
26.1 The complexities of medico-legal assessment of disability in narcolepsy
26.2 The impact of narcolepsy on work and other major life activities
26.3 Aspects of functioning in people with narcolepsy identified by the International Classification of Functioning Core Set for Sleep Disorders
26.4 The complexity of medical-legal assessment of disability in narcolepsy
26.5 The role of sleep providers
26.6 Conclusions
References
Part IV: Specific management
Chapter 27: Current pharmacological treatments for narcolepsy
Ritwick Agrawal
27.1 Nonpharmacological interventions
27.1.1 Addressing comorbid disorders
27.1.2 Cognitive behavioral therapy and behavioral approaches to excessive daytime sleepiness
27.2 Pharmacological management
27.2.1 Primary goals of pharmacological management
27.2.2 Pretreatment considerations
27.2.3 Excessive daytime sleepiness treatment
27.2.4 Cataplexy and excessive daytime sleepiness management
27.2.5 Other narcolepsy symptoms
27.2.6 Adjustment of initial pharmacological intervention
27.3 Special populations
27.3.1 Children and young people
27.3.2 Pregnancy and lactation
27.4 Conclusion
AI disclosure
References
Chapter 28: Exploring the potential of cognitive behavioral therapy as an adjunct to medication in narcolepsy management
Sultan M. Alshahrani
28.1 Introduction
28.1.1 Cognitive behavioral therapy for narcolepsy
28.1.2 Psychotherapy and psychotherapeutic interventions
28.1.3 Education and psychoeducation
28.1.4 Conclusion
28.2 The psychosocial and psychosomatic aspects of narcolepsy
28.2.1 Introduction
28.2.2 Psychosocial aspects
28.2.3 Psychosomatic aspects
28.2.4 Summary
28.3 How can psychotherapy help cases with narcolepsy
28.3.1 Introduction
28.3.2 Mechanism of psychotherapy for individuals with narcolepsy
28.3.3 Summary
28.4 Cognitive behavioral therapy for narcolepsy
28.4.1 Introduction
28.4.2 Psychological models for narcolepsy
28.4.3 How does cognitive behavioral therapy work for narcolepsy
28.4.4 Components of cognitive behavioral therapy for narcolepsy
28.4.5 Techniques in cognitive behavioral therapy for narcolepsy patients
28.5 Diet and physical activity as components of psychotherapy in narcolepsy
28.5.1 Introduction
28.5.2 Diet applications for narcolepsy
28.5.3 Physical activity and exercise applications for narcolepsy
28.6 Other psychotherapeutic interventions for narcolepsy
28.6.1 Psychoanalysis for narcolepsy
28.6.2 Mindfulness-based interventions for narcolepsy
28.6.3 Supportive psychotherapy
28.6.4 Psychoeducational therapy (psychoeducation)
References
Chapter 29: Emerging therapies for narcolepsy: immunotherapy, gene therapy, and beyond
Todd J. Swick
29.1 Genetics and immunology of narcolepsy
29.2 Cell/gene therapy for narcolepsy
29.3 Orexin agonists
29.4 Conclusions
References
Chapter 30: Exploring the role of biomarkers and epigenetics in narcolepsy: implications for diagnosis and treatment
Ahmed S. BaHammam and Amir Sharafkhaneh
30.1 Introduction
30.2 Current biomarkers for narcolepsy diagnosis
30.2.1 Hypocretin-1 levels in cerebrospinal fluid
30.2.2 Genetic markers
30.2.3 Epigenetic biomarkers
30.2.4 Proteomic biomarkers
30.2.5 Other potential biomarkers
30.3 Epigenetic mechanisms in narcolepsy pathophysiology
30.3.1 Epigenetic changes in narcolepsy (histone modifications, DNA methylation)
30.3.2 Role of epigenetic alterations in narcolepsy development and progression
30.3.3 Integration of epigenetic mechanisms in narcolepsy pathophysiology
30.4 Epigenetic signatures as potential diagnostic markers
30.4.1 DNA methylation as a diagnostic biomarker
30.4.2 Potential for personalized medicine
30.5 Epigenetics in developing novel narcolepsy treatments
30.5.1 Epigenetic modulation of hypothalamic neuropeptides
30.5.2 Immunomodulatory approaches targeting epigenetic changes
30.5.3 Personalized therapy based on epigenetic profiling
30.6 Proteomics in narcolepsy pathogenesis
30.7 Proteomics in narcolepsy diagnosis
30.8 Proteomics in narcolepsy therapeutics
30.9 Challenges and limitations
30.10 Conclusions and future research directions
References
Chapter 31: Disease control in narcolepsy: use of telehealth and remote patient management technology
Javad Razjouyan, Amir Sharafkhaneh, Antara Mallampalli, Max Hirshkowitz, and Sharam Moghtader
31.1 Introduction
31.2 Telehealth for diagnosis and management of narcolepsy
31.2.1 Diagnosis of narcolepsy
31.3 Management of narcolepsy
31.3.1 Medication management
31.3.2 Narcolepsy multidisciplinary teams
31.3.3 Remote patient monitoring
31.4 Application of telesleep for management of obstructive sleep apnea co-occurring with narcolepsy
31.5 Application of telesleep for management of insomnia co-occurring with narcolepsy
31.6 Application of telesleep for management of psychiatric conditions co-occurring with narcolepsy
31.6.1 Technical aspects of telemedicine
References
Chapter 32: The future of narcolepsy treatment: what role will artificial intelligence play?
Arash Maghsoudi, Amin Ramezani, Javad Razjouyan, and Amir Sharafkhaneh
32.1 What is artificial intelligence?
32.2 The role of artificial intelligence in narcolepsy research
32.2.1 Artificial intelligence-driven analysis of narcolepsy: uncovering genetic markers
32.2.2 Machine learning models for predicting narcolepsy progression
32.3 Artificial intelligence in the diagnosis and management of narcolepsy
32.3.1 Enhancing diagnostic accuracy with artificial intelligence algorithms
32.3.2 Personalized medicine: artificial intelligence in developing customized treatment plans
32.4 Wearable technology and artificial intelligence monitoring
32.4.1 Smart devices and wearables: tracking sleep patterns and daytime sleepiness
32.4.2 Real-time monitoring and artificial intelligence: a new paradigm in narcolepsy management
32.5 Artificial intelligence and patient support systems
32.5.1 Chatbots and virtual assistants: providing round-the-clock support
32.5.2 Artificial intelligence-driven platforms for patient education and community building
32.6 Ethical considerations and future directions
32.6.1 Navigating the ethical landscape of artificial intelligence in healthcare
32.6.2 The future of artificial intelligence in narcolepsy treatment: innovations on the horizon
32.7 Conclusion
Funding
References
Chapter 33: Narcolepsy and chronic pain: implications and management
Zheng Liu, Man Min Zhu, and Hao Huang
33.1 Introduction
33.2 Epidemiology
33.3 Pathophysiological mechanisms
33.4 Bidirectional relationship between narcolepsy and chronic pain
33.5 Narcolepsy and chronic pain management
33.6 Future research directions
References
Chapter 34: Navigating the costs of narcolepsy in managed care
Shafaq Mansoor, Elli Allen, and Sudha Tallavajhula
34.1 Introduction
34.2 Economic burden of narcolepsy
34.3 Insurance considerations for approval of testing in narcolepsy
34.4 Pharmacotherapy considerations
34.5 Strategies to help patients navigate the landscape
34.6 Patient access to sleep medicine specialists
34.6.1 Strategic drug utilization
34.7 Summary
References
Further reading
Index
About the editors
Foreword
Preface
Acknowledgments
Part I Pathophysiology and neurobiology
CHAPTER 1: Understanding sleep in narcolepsy: sleep physiology, neurobiology, and cognitive impairment mechanisms
Syed Shahid Habib
1.1 Introduction
1.2 Sleep physiology
1.3 Normal sleep architecture
1.4 Sleep stages and their transitions
1.4.1 N1 (Stage 1) sleep
1.4.2 N2 (Stage 2) sleep
1.4.3 N3 (Stage 3) deepest nonrapid eye movement or slow–wave sleep
1.5 Rapid eye movement sleep
1.6 Comparing sleep patterns of normal individuals with patients with narcolepsy
1.7 Brain networks regulating sleep and wakefulness
1.7.1 The concept of “flip–flop” switch
1.7.2 Sleep paralysis and cataplexy
1.8 Brain neurotransmitters in normal sleep and narcolepsy
1.8.1 Memory impairment and cognitive deficits in individuals with narcolepsy
1.9 Impact of narcolepsy on cognitive function
1.10 Conclusion
References
CHAPTER 2: Pathophysiology of narcolepsy: genetics and immune system
Shahrad Taheri
2.1 Introduction
2.2 Human leukocyte antigen genes and narcolepsy
2.3 Narcolepsy and nonhuman leukocyte antigen immune genes
2.4 Narcolepsy and environmental factors
2.5 Narcolepsy and humoral immunity
2.6 Summary
References
CHAPTER 3: Neurotransmitters, genetics, and animal models in narcolepsy: a comprehensive overview
Nada F. AlAhmady and Fadwa M. Alkhulaifi
3.1 The role of neurotransmitters in narcolepsy: a focus on hypocretin/orexin signaling pathways
3.2 The role of immunological and hormonal pathways in narcolepsy
3.2.1 The immune basis of narcolepsy
3.3 Genetic underpinnings of narcolepsy
3.4 The role of animal models in understanding narcolepsy
3.5 Common animal models in narcolepsy research
3.5.1 Canine narcolepsy
3.5.2 Rodent narcolepsy
3.5.3 Transgenic models
3.5.4 Zebrafish narcolepsy
3.6 Implications for treatment and future directions
References
CHAPTER 4: The gut–brain axis in narcolepsy: emerging research on microbiota, diet, and sleep
Fulong Xiao
4.1 Introduction
4.2 The gut microbiota and sleep disorders
4.3 Trends in research about gut microbiota and narcolepsy
4.4 Conclusion
References
Part II Clinical aspects
CHAPTER 5: Types of narcolepsy and their symptoms: differential diagnosis and misdiagnosis
Renata Riha
5.1 Types of narcolepsies
5.1.1 Type 1 narcolepsy
5.1.2 Type 2 narcolepsy
5.2 Controversies in the diagnosis of type 1 and type 2 narcolepsy
5.3 Phenotyping narcolepsy
5.4 Conclusion
References
CHAPTER 6: Delayed diagnosis of narcolepsy: causes and implications
Abdul Rouf Pirzada and Ahmed S. BaHammam
6.1 Introduction
6.2 Epidemiological insights into diagnostic delays in narcolepsy
6.2.1 Global perspective on diagnostic delay
6.2.2 Improvement in diagnostic delay in recent data
6.2.3 Access to healthcare services and diagnostic delay
6.3 Potential predictors of delayed diagnosis
6.3.1 Age
6.3.2 Cataplexy
6.3.3 Gender
6.4 Symptoms overlap with other disorders and prior misdiagnoses of patients with narcolepsy
6.4.1 Diagnostic delays and misdiagnosis trends
6.4.2 Comparative studies and misdiagnosis rates
6.4.3 Comorbidity and symptom complexity
6.4.4 Sleep disorders and narcolepsy overlap
6.4.5 Diagnostic challenges in pediatric narcolepsy
6.4.6 Logistical and diagnostic limitations
6.5 Diagnostic delay and clinical implications
6.5.1 Clinical and personal consequences of delayed diagnosis
6.5.2 Educational challenges
6.5.3 Economic and societal impacts
6.6 Conclusion
References
Chapter 7: Diagnostic tools for narcolepsy: sleep studies, multiple sleep latency test, and more
Ahmed S. BaHammam
7.1 Introduction
7.2 Overview of American Academy of Sleep Medicine diagnostic criteria for narcolepsy
7.2.1 Narcolepsy type 1
7.2.2 Narcolepsy type 2
7.2.3 Updates in the 2024 pediatric guidelines include
7.3 Emerging roles of CSF hypocretin-1 measurement in narcolepsy diagnosis
7.4 Polysomnography
7.4.1 Role of polysomnography in narcolepsy diagnosis
7.4.2 Typical polysomnography findings in narcolepsy
7.4.3 Specific rapid eye movement sleep changes in narcolepsy
7.4.4 Limitations of polysomnography alone for diagnosis
7.5 Multiple sleep latency test
7.5.1 Purpose and procedure of multiple sleep latency test
7.5.2 Diagnostic criteria for narcolepsy based on multiple sleep latency test results
7.5.3 Pediatric considerations
7.5.4 Preparation for the multiple sleep latency test
7.5.5 Factors affecting multiple sleep latency test reliability
7.6 Daytime continuous polysomnography
7.7 Actigraphy
7.7.1 Limitations of actigraphy for narcolepsy diagnosis
7.8 Screening scales for narcolepsy
7.8.1 Ullanlinna Narcolepsy Scale
7.8.2 Swiss Narcolepsy Scale
7.8.3 Epworth Sleepiness Scale
7.8.4 Narcolepsy Severity Scale
7.8.5 The Pediatric Hypersomnolence Survey
7.8.6 Challenges and opportunities in the use of Narcolepsy Screening Scales
7.9 Emerging technologies and artificial intelligence
7.9.1 Wearables
7.9.2 Pupillometry as a potential biomarker for sleepiness
7.9.3 Home sleep testing for narcolepsy diagnosis: current limitations
7.9.4 Machine learning in narcolepsy diagnosis
7.9.5 Utilizing AI in phenotyping narcolepsy and hypersomnolence disorders
7.10 Diagnostic approach
7.11 Conclusion
References
Chapter 8: Narcolepsy in children and adolescents: diagnosis, management, and challenges
Binal Kancherla, Sonal Malhotra, Marlene Typaldos, Aleena Wasim, and Yousaf Khan
8.1 Medical history
8.2 Physical exam
8.3 Diagnostic testing
8.3.1 Sleep diary and actigraphy
8.3.2 Overnight polysomnography
8.3.3 Multiple sleep latency test
8.4 Laboratory testing and imaging
8.4.1 Hypocretin testing
8.4.2 HLA typing
8.4.3 Neuroimaging
8.5 Psychological, psychiatric, and social aspects
8.6 Differential diagnosis
8.7 Management
8.7.1 Education
8.7.2 Behavioral modification
8.7.3 Pharmacological
8.7.4 Medications for excessive daytime sleepiness
8.7.5 Medications for cataplexy
8.7.6 Other medications
8.8 Summary of management
Chapter 9: Narcolepsy and pregnancy: risks and strategies for management
Rosa Peraita-Adrados
9.1 Introduction
9.2 Narcolepsy in women
9.3 Sleep disorders in pregnancy
9.4 Narcolepsy in pregnancy
9.5 Medication management during pregnancy for narcolepsy patients
References
Chapter 10: Aging with narcolepsy: understanding the unique challenges for older adults
Natalie Cornay Manalo and Hrayr Attarian
10.1 Introduction
10.2 Narcolepsy onset after age 35
10.2.1 Case 1 (late onset)
10.3 Delayed diagnosis
10.3.1 Case 2 (delayed diagnosis)
10.4 Symptomatic narcolepsy
10.4.1 Case 3 (symptomatic narcolepsy)
10.5 Implications of narcolepsy in older adults and therapeutic challenges
10.5.1 Case 4 (management dilemma with age)
10.6 Conclusion
References
Chapter 11: Medical comorbidities of narcolepsy
Nikita Jambulingam, Nathaniel Yuan, and Alon Y. Avidan
11.1 Introduction
11.2 Neurological comorbidities
11.2.1 Migraines
11.2.2 Restless leg syndrome
11.2.3 Rapid eye movement sleep behavior disorder
11.3 Cardiovascular comorbidities
11.3.1 Cardiovascular events and stroke
11.3.2 Hypertension
11.4 Metabolic comorbidities
11.4.1 Obesity
11.4.2 Type 2 diabetes
11.4.3 Dyslipidemia
11.5 Autoimmune disease comorbidities
11.5.1 Autoimmune disease and human leukocyte antigen
11.5.2 Type 1 diabetes
11.5.3 Celiac disease
11.5.4 Rheumatoid arthritis
11.5.5 System lupus erythematosus
11.5.6 Sjögren’s syndrome
11.6 Narcolepsy and comorbidities: management perspectives
11.6.1 Comorbid neurological treatment considerations
11.6.2 Comorbid cardiovascular treatment considerations
11.6.3 Comorbid metabolic treatment considerations
11.6.4 Comorbid autoimmune disease treatment considerations
11.7 Conclusion
References
Chapter 12: Cardiovascular disease risk and comorbidities in narcolepsy
Ahmed S. BaHammam
12.1 Introduction
12.2 Epidemiological evidence of increased cardiovascular disease risk
12.3 Potential mechanisms linking narcolepsy and cardiovascular disease risk
12.3.1 Sleep disruption and autonomic dysfunction
12.3.2 The role of hypocretin
12.3.3 Metabolic dysfunction
12.3.4 Comorbid sleep disorders
12.3.5 Inflammation and endothelial dysfunction
12.4 Cardiovascular risk assessment and management in narcolepsy
12.4.1 Regular cardiovascular risk screening
12.4.2 Lifestyle modification
12.4.3 Management of comorbidities
12.4.4 Consideration of cardiovascular effects of narcolepsy medications
12.4.5 Sodium intake and cardiovascular risk in narcolepsy
12.5 Future research directions
12.6 Conclusion
References
Chapter 13: More than just narcolepsy: the importance of recognizing concurrent sleep disorders
Antara Mallampalli, MD
13.1 Introduction: comorbid sleep disorders in narcolepsy patients
13.2 Prevalence of comorbid sleep disorders in narcolepsy patients: an overview
13.3 Sleep-related breathing disorders in narcolepsy patients
13.3.1 Pathophysiology of sleep-related breathing disorders in narcolepsy
13.3.2 Clinical impact of sleep-related breathing disorders in narcolepsy
13.3.3 Summary
13.4 Insomnia in narcolepsy patients
13.5 Restless leg syndrome and periodic limb movement disorder in narcolepsy patients
13.5.1 Pathophysiology of periodic limb movements of sleep and restless leg syndrome in narcolepsy
13.5.2 Clinical impact of restless leg syndrome in narcolepsy
13.6 REM sleep behavior disorder and other parasomnias in narcolepsy patients
13.6.1 Clinical impact of REM sleep behavior disorder in narcolepsy
13.7 Conclusion and future research directions
References
Chapter 14: Narcolepsy and circadian rhythm disorders: diagnosis and management
Sona Nevsimalova
14.1 Introduction
14.2 Circadian and ultradian rhythms in narcolepsy
14.3 Hypocretin and circadian system
14.4 Circadian aspects of clinical manifestation in narcolepsy
14.5 Circadian rhythm disorders and narcolepsy
14.6 Recommendations for therapy, management, and future perspectives
References
Chapter 15: The hidden link between narcolepsy and autonomic dysfunction: a closer look
Fang Han
15.1 The orexin system and narcolepsy
15.2 Orexins in autonomic regulation
15.3 Role of orexins in cardiovascular regulation
15.4 Narcolepsy and autonomic dysfunction
15.5 Cardiovascular dysfunction in narcolepsy
15.6 Nondipper profile in narcolepsy with cataplexy
15.7 Treatment of narcolepsy on cardiovascular effects
References
Chapter 16: Narcolepsy and metabolic rate: what do we know?
Hamza O. Dhafar and Ahmed S. BaHammam
16.1 Introduction
16.2 Prevalence of obesity in patients with narcolepsy
16.3 Changes in metabolic rate in patients with narcolepsy
16.4 Exploring the possible underlying mechanisms of weight gain in narcolepsy
16.4.1 The role of orexin in metabolism
16.4.2 Orexin and eating behavior
16.4.3 Physical activity
16.4.4 Genetic factors
16.4.5 The role of leptin and ghrelin hormones
16.4.6 Metabolomics
16.4.7 The role of medications used for narcolepsy
16.5 Conclusions and future directions
References
Chapter 17: Narcolepsy and driving: safety issues and regulations
Tha A. Saw and Catherine A. McCall
17.1 Introduction
17.2 Narcolepsy and drowsy driving
17.3 Evaluating drowsy driving risk with narcolepsy
17.4 Legal and regulatory issues
17.5 Risk mitigation
17.5.1 Pharmacologic interventions
17.5.2 Nonpharmacologic interventions
17.5.3 Patient resources
17.6 Conclusion
References
Chapter 18: The natural history of narcolepsy: lessons from longitudinal studies
Salman A. Bahammam and Ahmed S. BaHammam
18.1 Introduction
18.2 Importance of understanding the natural history and time course of narcolepsy
18.2.1 Predicting disease progression
18.2.2 Identifying comorbidities
18.2.3 Developing targeted therapies and precision medicine
18.2.4 Enhancing patient education and support
18.3 Longitudinal studies on narcolepsy
18.3.1 Age of onset and gender differences
18.3.2 Progression of symptoms and clinical findings over time
18.3.3 Changes in sleep architecture over time based on sleep study findings
18.3.4 Longitudinal changes in orexin levels
18.3.5 Impact of narcolepsy on quality of life
18.3.6 Long-term data on safety and efficacy of narcolepsy medications
18.4 Developing targeted therapies based on natural course
18.5 Conclusion
References
Chapter 19: Neuroimaging in narcolepsy: advances in understanding pathophysiology and diagnosis
Kyung Min Kim, Jun-Sang Sunwoo, and Seung Bong Hong
19.1 Introduction
19.2 Voxel-based morphometry, volumetry, cortical thickness studies on narcolepsy
19.3 Diffusion tensor imaging and narcolepsy
19.4 Functional magnetic resonance imaging research on narcolepsy
19.5 Magnetic resonance spectroscopy studies on narcolepsy
19.6 Single photon emission computed tomography and PET studies in narcolepsy
19.7 Future directions
References
Chapter 20: The distinctive characteristics of REM sleep and dreams in narcolepsy
Serena Scarpelli and Luigi De Gennaro
20.1 Introduction
20.2 Rapid eye movement sleep features in narcolepsy
20.3 Dream activity in narcolepsy
20.4 Neural bases of dream recall
20.5 Lucid dreams, nightmares, and insights for treatment
20.6 Conclusions
References
Part III: Behavioral and psychosocial considerations
Chapter 21: The hidden burden of narcolepsy: anxiety and depression among patients
Berit Hjelde Hansen
21.1 Introduction
21.2 Anxiety disorders
21.3 Depressive disorders
21.4 Widening the scope—a potential role of neurodevelopmental disorders
21.5 Treatment
21.6 Importance of screening for anxiety and depression in narcolepsy
21.7 Summary
References
Chapter 22: Understanding psychosis and behavioral abnormalities in narcolepsy patients
Cyril Hanin
22.1 Introduction
22.2 Clinical presentation of psychosis in narcolepsy
22.2.1 Psychotic symptoms in narcolepsy
22.2.2 Group 1: hallucinations in typical narcolepsy
22.2.3 Group 2: narcolepsy with atypical psychotic-like symptoms
22.2.4 Group 3: challenges in diagnosing narcolepsy in schizophrenia patients
22.3 Impulsivity, emotional dysregulation, and social behavior in narcolepsy
22.3.1 Impulsivity in narcolepsy
22.3.2 Emotional dysregulation
22.3.3 Altered social behavior
22.4 Pathophysiology: linking narcolepsy and psychosis
22.4.1 REM-sleep intrusion and psychotic-like symptoms
22.4.2 Autoimmune and genetic mechanisms
22.4.3 Hypocretin system implications
22.4.4 Early-onset narcolepsy and schizophrenia: neurodevelopmental implications
22.4.5 Medication-induced psychosis in narcolepsy patients with or without comorbid psychotic disorder
22.4.6 Classical psychostimulants: methylphenidate and amphetamines
22.4.7 Modafinil and armodafinil
22.4.8 Sodium oxybate (gamma hydroxybutyrate)
22.4.9 Pitolisant and other emerging treatments
22.5 Clinical algorithm and management strategies
22.5.1 Initial assessment and categorization
22.5.2 Assessing drug-induced psychosis
22.6 Prognosis and long-term outcomes in narcolepsy patients with psychotic symptoms
AI disclosure
References
Chapter 23: Narcolepsy and cognitive impairment: causes and management
Meteb H. Alenazi
23.1 Introduction
23.2 Cognitive impairment in narcolepsy
23.2.1 Attention
23.2.2 Memory
23.2.3 Executive functions and higher cognitive functions
23.3 Clinical pictures of excessive daytime sleepiness and cognitive impairment
23.3.1 Hypersomnolence related to major depressive disorder with atypical features
23.4 Conclusion
AI disclosure
References
Chapter 24: Narcolepsy and relationships: navigating intimacy, family, and social life
Anne Marie Morse
24.1 Introduction
24.1.1 Early childhood and adolescence
24.1.2 Adulthood
24.2 Optimizing outcomes
24.2.1 Conclusion
References
Chapter 25: Narcolepsy and advocacy: awareness, education, and community building
Ahmed S. BaHammam
25.1 Introduction
25.2 The importance of narcolepsy advocacy
25.3 Raising awareness about narcolepsy
25.4 Educating the general public and healthcare providers about narcolepsy
25.4.1 Providing resources
25.4.2 Presentations and workshops
25.4.3 Correcting common myths
25.4.4 Importance of educating healthcare professionals
25.5 Building community and support
25.5.1 Connecting with other patients
25.5.2 Providing encouragement and sharing coping strategies
25.5.3 Advocating together for research and better treatments
25.6 Empowering patients to advocate for themselves
25.6.1 Gaining confidence to discuss narcolepsy
25.6.2 Communicating needs and challenges effectively
25.6.3 Partnering with healthcare providers
25.6.4 Understanding rights and accommodations
25.7 The impact of narcolepsy advocacy
25.8 Conclusion
References
Further reading
Chapter 26: The complexities of medico-legal assessment of disability in narcolepsy
Francesca Ingravallo and Annamaria Govi
26.1 The complexities of medico-legal assessment of disability in narcolepsy
26.2 The impact of narcolepsy on work and other major life activities
26.3 Aspects of functioning in people with narcolepsy identified by the International Classification of Functioning Core Set for Sleep Disorders
26.4 The complexity of medical-legal assessment of disability in narcolepsy
26.5 The role of sleep providers
26.6 Conclusions
References
Part IV: Specific management
Chapter 27: Current pharmacological treatments for narcolepsy
Ritwick Agrawal
27.1 Nonpharmacological interventions
27.1.1 Addressing comorbid disorders
27.1.2 Cognitive behavioral therapy and behavioral approaches to excessive daytime sleepiness
27.2 Pharmacological management
27.2.1 Primary goals of pharmacological management
27.2.2 Pretreatment considerations
27.2.3 Excessive daytime sleepiness treatment
27.2.4 Cataplexy and excessive daytime sleepiness management
27.2.5 Other narcolepsy symptoms
27.2.6 Adjustment of initial pharmacological intervention
27.3 Special populations
27.3.1 Children and young people
27.3.2 Pregnancy and lactation
27.4 Conclusion
AI disclosure
References
Chapter 28: Exploring the potential of cognitive behavioral therapy as an adjunct to medication in narcolepsy management
Sultan M. Alshahrani
28.1 Introduction
28.1.1 Cognitive behavioral therapy for narcolepsy
28.1.2 Psychotherapy and psychotherapeutic interventions
28.1.3 Education and psychoeducation
28.1.4 Conclusion
28.2 The psychosocial and psychosomatic aspects of narcolepsy
28.2.1 Introduction
28.2.2 Psychosocial aspects
28.2.3 Psychosomatic aspects
28.2.4 Summary
28.3 How can psychotherapy help cases with narcolepsy
28.3.1 Introduction
28.3.2 Mechanism of psychotherapy for individuals with narcolepsy
28.3.3 Summary
28.4 Cognitive behavioral therapy for narcolepsy
28.4.1 Introduction
28.4.2 Psychological models for narcolepsy
28.4.3 How does cognitive behavioral therapy work for narcolepsy
28.4.4 Components of cognitive behavioral therapy for narcolepsy
28.4.5 Techniques in cognitive behavioral therapy for narcolepsy patients
28.5 Diet and physical activity as components of psychotherapy in narcolepsy
28.5.1 Introduction
28.5.2 Diet applications for narcolepsy
28.5.3 Physical activity and exercise applications for narcolepsy
28.6 Other psychotherapeutic interventions for narcolepsy
28.6.1 Psychoanalysis for narcolepsy
28.6.2 Mindfulness-based interventions for narcolepsy
28.6.3 Supportive psychotherapy
28.6.4 Psychoeducational therapy (psychoeducation)
References
Chapter 29: Emerging therapies for narcolepsy: immunotherapy, gene therapy, and beyond
Todd J. Swick
29.1 Genetics and immunology of narcolepsy
29.2 Cell/gene therapy for narcolepsy
29.3 Orexin agonists
29.4 Conclusions
References
Chapter 30: Exploring the role of biomarkers and epigenetics in narcolepsy: implications for diagnosis and treatment
Ahmed S. BaHammam and Amir Sharafkhaneh
30.1 Introduction
30.2 Current biomarkers for narcolepsy diagnosis
30.2.1 Hypocretin-1 levels in cerebrospinal fluid
30.2.2 Genetic markers
30.2.3 Epigenetic biomarkers
30.2.4 Proteomic biomarkers
30.2.5 Other potential biomarkers
30.3 Epigenetic mechanisms in narcolepsy pathophysiology
30.3.1 Epigenetic changes in narcolepsy (histone modifications, DNA methylation)
30.3.2 Role of epigenetic alterations in narcolepsy development and progression
30.3.3 Integration of epigenetic mechanisms in narcolepsy pathophysiology
30.4 Epigenetic signatures as potential diagnostic markers
30.4.1 DNA methylation as a diagnostic biomarker
30.4.2 Potential for personalized medicine
30.5 Epigenetics in developing novel narcolepsy treatments
30.5.1 Epigenetic modulation of hypothalamic neuropeptides
30.5.2 Immunomodulatory approaches targeting epigenetic changes
30.5.3 Personalized therapy based on epigenetic profiling
30.6 Proteomics in narcolepsy pathogenesis
30.7 Proteomics in narcolepsy diagnosis
30.8 Proteomics in narcolepsy therapeutics
30.9 Challenges and limitations
30.10 Conclusions and future research directions
References
Chapter 31: Disease control in narcolepsy: use of telehealth and remote patient management technology
Javad Razjouyan, Amir Sharafkhaneh, Antara Mallampalli, Max Hirshkowitz, and Sharam Moghtader
31.1 Introduction
31.2 Telehealth for diagnosis and management of narcolepsy
31.2.1 Diagnosis of narcolepsy
31.3 Management of narcolepsy
31.3.1 Medication management
31.3.2 Narcolepsy multidisciplinary teams
31.3.3 Remote patient monitoring
31.4 Application of telesleep for management of obstructive sleep apnea co-occurring with narcolepsy
31.5 Application of telesleep for management of insomnia co-occurring with narcolepsy
31.6 Application of telesleep for management of psychiatric conditions co-occurring with narcolepsy
31.6.1 Technical aspects of telemedicine
References
Chapter 32: The future of narcolepsy treatment: what role will artificial intelligence play?
Arash Maghsoudi, Amin Ramezani, Javad Razjouyan, and Amir Sharafkhaneh
32.1 What is artificial intelligence?
32.2 The role of artificial intelligence in narcolepsy research
32.2.1 Artificial intelligence-driven analysis of narcolepsy: uncovering genetic markers
32.2.2 Machine learning models for predicting narcolepsy progression
32.3 Artificial intelligence in the diagnosis and management of narcolepsy
32.3.1 Enhancing diagnostic accuracy with artificial intelligence algorithms
32.3.2 Personalized medicine: artificial intelligence in developing customized treatment plans
32.4 Wearable technology and artificial intelligence monitoring
32.4.1 Smart devices and wearables: tracking sleep patterns and daytime sleepiness
32.4.2 Real-time monitoring and artificial intelligence: a new paradigm in narcolepsy management
32.5 Artificial intelligence and patient support systems
32.5.1 Chatbots and virtual assistants: providing round-the-clock support
32.5.2 Artificial intelligence-driven platforms for patient education and community building
32.6 Ethical considerations and future directions
32.6.1 Navigating the ethical landscape of artificial intelligence in healthcare
32.6.2 The future of artificial intelligence in narcolepsy treatment: innovations on the horizon
32.7 Conclusion
Funding
References
Chapter 33: Narcolepsy and chronic pain: implications and management
Zheng Liu, Man Min Zhu, and Hao Huang
33.1 Introduction
33.2 Epidemiology
33.3 Pathophysiological mechanisms
33.4 Bidirectional relationship between narcolepsy and chronic pain
33.5 Narcolepsy and chronic pain management
33.6 Future research directions
References
Chapter 34: Navigating the costs of narcolepsy in managed care
Shafaq Mansoor, Elli Allen, and Sudha Tallavajhula
34.1 Introduction
34.2 Economic burden of narcolepsy
34.3 Insurance considerations for approval of testing in narcolepsy
34.4 Pharmacotherapy considerations
34.5 Strategies to help patients navigate the landscape
34.6 Patient access to sleep medicine specialists
34.6.1 Strategic drug utilization
34.7 Summary
References
Further reading
Index
- Edition: 1
- Published: July 15, 2025
- Imprint: Academic Press
- Language: English
AB
Ahmed S. BaHammam
Ahmed S. BaHammam is a tenured Professor of Pulmonary and Sleep Medicine at King Saud University, Riyadh, Saudi Arabia. He has published over 450 peer-reviewed articles and book chapters, and authored or edited seven books in the fields of sleep medicine and respiratory disorders. Professor BaHammam is editor-in-chief of Nature and Science of Sleep and serves on the editorial board of several sleep medicine journals. He is the President-Elect of the Asian Society of Sleep Medicine. His research spans topics such as narcolepsy, hypersomnia, obesity hypoventilation syndrome, and the effects of intermittent fasting and mealtime on sleep and circadian rhythms. With more than three decades of dedicated experience in sleep medicine, Professor BaHammam has made lasting contributions to the understanding, diagnosis, and management of narcolepsy and other central hypersomnolence disorders. He is has received the King Saud University Lifetime Achievement Award for his contributions to sleep medicine research. Professor BaHammam also holds leadership roles as Executive Director of Academic Affairs at King Saud University Medical City and Director of both the Prince Naif Health Research Center and the University Sleep Research Center
Affiliations and expertise
King Saud University, Saudi ArabiaAS
Amir Sharafkhaneh
Dr. Amir Sharafkhaneh is a Professor of Medicine (tenured) at Baylor College of Medicine and a leading authority in sleep medicine. He completed his medical degree at Tehran University of Medical Sciences, followed by an internal medicine residency at Long Island College Hospital and a fellowship in Pulmonary, Critical Care, and Sleep Medicine at Baylor College of Medicine, where he also earned a PhD in medical research. With over 25 years of clinical and academic experience, Dr. Sharafkhaneh has authored numerous peer-reviewed publications and book chapters in the fields of pulmonary and sleep medicine. He founded the first accredited sleep medicine fellowship program in Texas and has since trained more than 100 sleep specialists. His work has been supported by multiple federal grants, including initiatives to develop telemedicine programs that expand access to sleep care in underserved areas. Dr. Sharafkhaneh currently co- chairs the VA clinical practice guideline committees for obstructive sleep apnea, insomnia, asthma, and COPD. His research team applies artificial intelligence and advanced data analytics to large-scale electronic health record data to advance the understanding and treatment of sleep and respiratory disorders. He also co-leads .the AI Interest Group of the World Sleep Society
Affiliations and expertise
Baylor College of Medicine, USASP
Seithikurippu R. Pandi-Perumal
S.R. Pandi-Perumal, MSc., is the President and Chief Executive Officer of Somnogen Canada Inc., a Canadian corporation. Pandi is popular among the sleep community. He is a world- acclaimed sleep researcher and has authored over 300 publications and has edited over 25 high-profile academic volumes dealing with various sleep-related topics. His name is also on the list of the top 2% of scientists in the world, compiled by Stanford University, Elsevier, and SciTech Strategies. Drawn to the benefits and significance of the sleep cycle, his personal and professional careers have been involved in advocating/achieving a good night’s slumber. Further details about the editor can be viewed at https:// pandi-perumal.blogspot.com; https://scholar.google.com/citations?hl=en&user=MO90ZXkAAAAJ
Affiliations and expertise
President and Chief Executive Officer, Somnogen Canada Inc, Canada