Narcolepsy in African Americans.

Abstract

STUDY OBJECTIVES:

Although narcolepsy affects 0.02-0.05% of individuals in various ethnic groups, clinical presentation in different ethnicities has never been fully characterized. Our goal was to study phenotypic expression across ethnicities in the United States.

DESIGN/SETTING:

Cases of narcolepsy from 1992 to 2013 were identified from searches of the Stanford Center for Narcolepsy Research database. International Classification of Sleep Disorders, Third Edition diagnosis criteria for type 1 and type 2 narcolepsy were used for inclusion, but subjects were separated as with and without cataplexy for the purpose of data presentation. Information extracted included demographics, ethnicity and clinical data, HLA-DQB1*06:02, polysomnography (PSG), multiple sleep latency test (MSLT) data, and cerebrospinal fluid (CSF) hypocretin-1 level.

PATIENTS:

182 African-Americans, 839 Caucasians, 35 Asians, and 41 Latinos with narcolepsy.

RESULTS:

Sex ratio, PSG, and MSLT findings did not differ across ethnicities. Epworth Sleepiness Scale (ESS) score was higher and age of onset of sleepiness earlier in African Americans compared with other ethnicities. HLA-DQB1*06:02 positivity was higher in African Americans (91.0%) versus others (76.6% in Caucasians, 80.0% in Asians, and 65.0% in Latinos). CSF hypocretin-1 level, obtained in 222 patients, was more frequently low (≤ 110 pg/ml) in African Americans (93.9%) versus Caucasians (61.5%), Asians (85.7%) and Latinos (75.0%). In subjects with low CSF hypocretin-1, African Americans (28.3%) were 4.5 fold more likely to be without cataplexy when compared with Caucasians (8.1%).

CONCLUSIONS:

Narcolepsy in African Americans is characterized by earlier symptom onset, higher Epworth Sleepiness Scale score, higher HLA-DQB1*06:02 positivity, and low cerebrospinal fluid hypocretin-1 level in the absence of cataplexy. In African Americans, more subjects without cataplexy have type 1 narcolepsy.

• Authors: Makoto Kawai, Ruth O'Hara, Mali Einen, Ling Lin, Emmanuel Mignot
• Journal: Sleep (Sleep) Vol. 38 Issue 11 Pg. 1673-81 (Nov 01 2015) ISSN: 1550-9109 [Electronic] United States
• PMID: 26158891 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: © 2015 Associated Professional Sleep Societies, LLC.

Chemical References

• HLA-DQ beta-Chains
• HLA-DQB1 antigen
• Orexins

Topics

• Adult
• Black or African American (genetics, statistics & numerical data)
• Cataplexy (epidemiology)
• Female
• HLA-DQ beta-Chains (genetics)
• Hispanic or Latino (genetics, statistics & numerical data)
• Humans
• Male
• Narcolepsy (epidemiology)
• Orexins (cerebrospinal fluid)
• Polysomnography
• Sex Ratio
• Sleep Stages
• United States (epidemiology)
• White People (genetics, statistics & numerical data)