Mortality and comorbidities in narcolepsy – an Olmsted County, Minnesota community-based study (S14.005)

Objective: To assess the incidence, prevalence, mortality, and comorbidities of narcolepsy in Olmsted County, Minnesota. Background: Recent studies have suggested an increase in narcolepsy-associated morbidity and mortality; however, the design of these studies did not allow for verification of patients’ diagnoses or review of underlying sleep study data, limiting the generalizability of these important studies. As such, a need remains for a community-based study of narcolepsy-associated mortality and comorbidities capturing all narcolepsy patients within a defined population, with diagnoses verified by objective testing, and follow-up by sleep specialists over an extended period of time. Design/Methods: A community-based narcolepsy cohort was identified for the years 2000–2014. Age and sex-specific incidence and prevalence were computed and mortality was compared to the Olmsted County population and to a 4:1 age and sex-matched cohort also used to for comorbidity rate comparison. Results: The incidence of narcolepsy was 2.56 per 100,000 person-years; prevalence was 32.4 per 100,000. Age-adjusted narcolepsy-related mortality rate was non-significantly elevated when compared to an age and sex-matched cohort and to the Olmsted County population. At diagnosis and after prolonged follow-up, narcolepsy had more association [odds ratios (OR); 95% confidence interval, initial and after prolonged follow-up)] with psychiatric disorders (4.73, 2.49–9.01; 3.40, 1.94–5.98), endocrinopathies (4.15, 1.81–9.56; 2.45, 1.33–4.49), obstructive sleep apnea (69.25, 9.26–517.99; 13.55, 5.08–36.14), chronic low back pain (5.46, 2.46–12.11; 2.58, 1.39–4.77), depression (4.88, 2.45–9.73; 3.79, 2.12–6.79), and obesity (2.27, 1.13–4.56; 2.07, 1.15–3.7). Increased at diagnosis were anxiety (4.56, 1.99–10.44), thyroid disease (3.07, 1.19–7.90), hypertension (2.69, 1.22–5.93), and hyperlipidemia (2.49, 1.05–5.92). Increased after prolonged follow-up were peripheral neuropathy (11.21, 1.16–108.11), non-migrainous headache (6.00, 1.73–20.83), glucose intolerance (2.39, 1.05–5.45), and automobile-related trauma (2.43, 1.08–5.45). Conclusions: There was a non-significant increase in age-adjusted mortality with narcolepsy. Close attention should be given to the significantly increased comorbidities of obstructive sleep apnea, low back pain, depression, anxiety, and thyroid disease. Disclosure: Dr. Cohen has nothing to disclose. Dr. Mandrekar has nothing to disclose. Dr. St. Louis has received personal compensation for activities with Axovant, Inc. and Inspire, Inc. Dr. Silber has received royalty payments from UpToDate. Dr. Kotagal has received personal compensation for activities with INC Research. Dr. Kotagal has received royalty payments from UpToDate.