Sleep Disorders Centre, Guy's & St. Thomas' Hospitals, London, UK.
Sleep Disorders Centre, Guy's & St. Thomas' Hospitals, London, UK.
Sleep Med. 2020 Jun;70:50-54. doi: 10.1016/j.sleep.2020.02.013. Epub 2020 Feb 26.
Narcolepsy management usually requires lifelong pharmacotherapy. However, we know little about adherence to prescribed treatment in narcolepsy. We assessed adherence to wakefulness-promoting agents in narcolepsy patients.
We retrospectively assessed adherence to wakefulness promoting medication in patients with narcolepsy using the Medicines Possession Ratio (MPR). Three levels of adherence were defined: poor (≤50%), intermediate (51-79%), and good (≥80%). Refractory daytime sleepiness was defined as an Epworth sleepiness scale (ESS) score >12 despite trialling at least three wakefulness-promoting agents. We compared demographic and clinical factors, and prescribed medications between patients, stratified by levels of adherence, as well as by presence or not of refractory sleepiness.
We included 116 patients with narcolepsy (54.3% female, mean age 39.4 (±14) years). In sum, 93 (80.2%) patients had a diagnosis of narcolepsy type 1 (NT1), and 23 (19.8%) of type 2 (NT2). Suboptimal symptom control was common: 39.8% had refractory sleepiness, and 47.3% of NT1 patients had persistent cataplexy. Good adherence was seen in only 55.2% of patients, while 12.9% were intermediately and 31.9% poorly adherent. Patients with poor adherence were more likely to have a diagnosis of NT2, but adherence did not vary according to gender, age, the presence of psychiatric co-morbidity, or the presence of apparent intractable symptoms. Levels of good adherence to therapy were no better in patients with refractory sleepiness than in those with satisfactory symptom control (56.5% vs 54.3%; p = 0.81).
Suboptimal adherence to prescribed therapy is common in narcolepsy patients, including those with apparent intractable symptoms, and particularly in patients with NT2.
嗜睡症的管理通常需要终身药物治疗。然而，我们对嗜睡症患者遵医嘱治疗的情况知之甚少。我们评估了嗜睡症患者对促觉醒药物的依从性。
我们使用药物持有率（MPR）回顾性评估了嗜睡症患者对促觉醒药物的依从性。将依从性分为三个等级：差（≤50%）、中（51-79%）和优（≥80%）。难治性日间嗜睡定义为即使尝试了至少三种促觉醒药物，Epworth 嗜睡量表（ESS）评分仍>12。我们比较了不同依从性水平和有无难治性睡眠的患者之间的人口统计学和临床因素以及所开药物。
我们纳入了 116 例嗜睡症患者（54.3%为女性，平均年龄 39.4（±14）岁）。共有 93 例（80.2%）患者诊断为嗜睡症 1 型（NT1），23 例（19.8%）为 2 型（NT2）。症状控制不佳很常见：39.8%有难治性嗜睡，55.2%的 NT1 患者仍有猝倒。仅有 55.2%的患者依从性良好，12.9%为中等，31.9%为差。依从性差的患者更可能被诊断为 NT2，但依从性与性别、年龄、是否存在精神共病或是否存在明显的难治性症状无关。在有难治性睡眠的患者和症状控制满意的患者中，治疗的良好依从性水平并无差异（56.5%比 54.3%；p=0.81）。
在嗜睡症患者中，包括那些有明显难治性症状的患者，以及特别是在 NT2 患者中，不遵医嘱服药的情况很常见。
