Establishing Daytime Sleepiness Rhythms in Children With Narcolepsy

Excessive daytime sleepiness (EDS) is the most disabling symptom in pediatric patients with narcolepsy, according to an article in Brain and Behavior. However, the article’s authors felt there was a lack of available data on the circadian rhythms of EDS in this population. They performed a study to identify those rhythms and also examine the impact of EDS in different time periods during the day for these patients.

Investigators found that daytime sleepiness in pediatric patients with narcolepsy demonstrated a specific circadian rhythm, which mirrored the rhythm of melatonin secretion in narcolepsy. Additionally, sleepiness severity in the afternoon showed the closest association to participants’ daily lives and their perceptions about sleepiness.

The pilot study enrolled 50 pediatric patients (36 male; 14 female) with narcolepsy with a mean age of 13.68 ± 2.75 years. Researchers performed interviews and children depression inventory and pediatric quality of life inventory assessments to collect data on daytime sleepiness.

Afternoon Sleepiness Significantly Burdens Patients

Patients had significantly different frequencies of sleep attacks in different intervals of the day, with higher frequencies observed in the morning period (P<.001). Sleepiness severity scores peaked at 4:00 pm and again at 11:00 pm.

Additionally, sleep attacks in the morning and in the afternoon were significantly associated with degree of impairment in class and level of concern over sleepiness (Spearman correlation coefficient, 0.289-0.496; P<.040). According to the authors, this finding highlighted the need to manage afternoon sleepiness even though sleep episodes occur more often in the morning.

The study was limited by its single-center and small sample size cohort, which the authors stated may have amplified negative findings and potentially limited the generalizability of the study’s results. This study was, to the authors’ knowledge, the first to examine the circadian rhythm of sleepiness attacks in a sizable group of pediatric patients.

“These findings may shed light on the treatment strategy based on the circadian rhythm of sleepiness and melatonin secretion in pediatric narcoleptic patients,” the authors concluded.

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