Kaufmann Christopher N, Riaz Munaza, Park Haesuk, Lo-Ciganic Wei-Hsuan, Wilson Debbie, Wickwire Emerson M, Malhotra Atul, Bhattacharjee Rakesh
Department of Health Outcomes and Informatics, College of Medicine University of Florida Gainesville FL.
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy University of Florida Gainesville FL.
J Am Heart Assoc. 2025 Jun 17;14(12):e039899. doi: 10.1161/JAHA.124.039899. Epub 2025 Apr 10.
Narcolepsy is linked to adverse cardiovascular disease (CVD) outcomes, but few studies have examined its associations with subclinical CVD, including in children. We assessed the relationship between narcolepsy and subclinical CVD outcomes, including hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.
We conducted a retrospective cohort study using MarketScan Commercial and Medicare Supplemental databases from January 1, 2005 to December 31, 2021. Patients included N=22 293 diagnosed with narcolepsy (NT1 and NT2) and N=63 709 propensity-score-matched without. Patients with narcolepsy were identified as those with ≥2 outpatient insurance claims for narcolepsy (type 1 or type 2) within a 1-year interval with 1 claim being nondiagnostic. Main outcomes were diagnosis of hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis following index date, as well as a composite measure for CVD and major adverse cardiovascular events. Compared with propensity-score-matched patients without narcolepsy, patients with narcolepsy had an increased risk for hypertension (hazard ratio [HR], 1.40 [95% CI, 1.34-1.47]), hyperlipidemia (HR, 1.41 [95% CI, 1.35-1.47]), diabetes (HR, 1.50 [95% CI, 1.38-1.64), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (HR, 1.48 [95% CI, 1.28-1.73]), CVD composite (HR,1.61 [95% CI, 1.35-1.47]), and major adverse cardiovascular events (HR,1.69 [95% CI, 1.43-2.00]). Results remained significant following adjustment for narcolepsy medications including stimulants, wake-promoting agents, and oxybates. Results stratified by age groups showed similar findings, including heightened risk for those <25 years old.
Narcolepsy is associated with greater risk of subclinical CVD even in patients as early as childhood. Detection of these outcomes early in the course of narcolepsy could help reduce the burden of adverse cardiovascular events later in life.
发作性睡病与不良心血管疾病（CVD）结局相关，但很少有研究探讨其与亚临床CVD的关联，包括在儿童中的情况。我们评估了发作性睡病与亚临床CVD结局之间的关系，这些结局包括高血压、高脂血症、糖尿病和非酒精性脂肪性肝病/非酒精性脂肪性肝炎。
我们使用2005年1月1日至2021年12月31日的MarketScan商业和医疗保险补充数据库进行了一项回顾性队列研究。患者包括N = 22293名被诊断为发作性睡病（NT1和NT2）的患者以及N = 63709名倾向评分匹配的无发作性睡病患者。发作性睡病患者被确定为在1年内有≥2次门诊保险索赔记录的发作性睡病（1型或2型）患者，其中1次索赔为非诊断性记录。主要结局为索引日期后高血压、高脂血症、糖尿病和非酒精性脂肪性肝病/非酒精性脂肪性肝炎的诊断，以及CVD综合指标和主要不良心血管事件。与倾向评分匹配的无发作性睡病患者相比，发作性睡病患者患高血压（风险比[HR]，1.40[95%置信区间，1.34 - 1.47]）、高脂血症（HR，1.41[95%置信区间，1.35 - 1.47]）、糖尿病（HR，1.50[95%置信区间，1.38 - 1.64]）、非酒精性脂肪性肝病/非酒精性脂肪性肝炎（HR，1.48[95%置信区间，1.28 - 1.73]）、CVD综合指标（HR，1.61[95%置信区间，1.35 - 1.47]）和主要不良心血管事件（HR，1.69[95%置信区间，1.43 - 2.00]）的风险增加。在对包括兴奋剂、促醒剂和羟丁酸钠在内的发作性睡病药物进行调整后，结果仍然显著。按年龄组分层的结果显示了类似的发现，包括25岁以下人群风险更高。
即使在儿童期患者中，发作性睡病也与亚临床CVD的更高风险相关。在发作性睡病病程早期检测这些结局有助于降低后期生活中不良心血管事件的负担。
