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病例报告:隐匿于阻塞性睡眠呼吸暂停低通气综合征(OSAS)背后的发作性睡病患者:2例报告及文献复习

Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review.

作者信息

Zou Simin, Zhang Xiaomei, Shen Yinping, Shen Zhongxia, Wang Zhong, Wang Benhong

机构信息

Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, China.

Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.

出版信息

Front Neurosci. 2025 Apr 11;19:1563912. doi: 10.3389/fnins.2025.1563912. eCollection 2025.


DOI:10.3389/fnins.2025.1563912
PMID:40292024
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12021909/
Abstract

Obstructive sleep apnea syndrome (OSAS) and narcolepsy are sleep disorders that commonly present with excessive daytime sleepiness (EDS). OSAS is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxia and sleep fragmentation. Narcolepsy is a chronic sleep-wake disorder characterized by EDS, cataplexy, vivid hallucinations, and sleep paralysis. The overlap of symptoms can lead to misdiagnosis and delayed appropriate treatment. We report two male patients who initially presented with symptoms suggestive of OSAS, including loud snoring, witnessed apneas, and significant daytime sleepiness. Despite appropriate OSAS management with continuous positive airway pressure (CPAP), both patients continued to experience EDS and reported episodes of cataplexy, sleep paralysis, and vivid dreams. Polysomnography (PSG) confirmed mild to moderate OSAS, and multiple sleep latency tests (MSLT) revealed mean sleep latencies of less than 5 min with multiple sleep-onset REM periods (SOREMPs). Based on the presence of cataplexy and MSLT findings, narcolepsy type 1 (NT1) was diagnosed in both cases. Treatment with modafinil in conjunction with CPAP therapy led to significant improvement in symptoms and quality of life. These cases highlight the importance of considering narcolepsy in patients with persistent EDS despite adequate OSAS treatment. Coexistence of NT1 and OSAS can obscure the diagnosis of narcolepsy, leading to delays in appropriate management. Comprehensive evaluation, including detailed patient history and sleep studies, is crucial. Combined therapy targeting both conditions may be effective in managing symptoms and improving patient outcomes.

摘要

阻塞性睡眠呼吸暂停综合征(OSAS)和发作性睡病是常见的伴有日间过度嗜睡(EDS)的睡眠障碍。OSAS的特征是睡眠期间反复出现上呼吸道阻塞,导致间歇性缺氧和睡眠片段化。发作性睡病是一种慢性睡眠-觉醒障碍,其特征为EDS、猝倒、生动的幻觉和睡眠瘫痪。症状的重叠可能导致误诊和适当治疗的延迟。我们报告了两名男性患者,他们最初表现出提示OSAS的症状,包括大声打鼾、目击性呼吸暂停和明显的日间嗜睡。尽管采用持续气道正压通气(CPAP)对OSAS进行了适当管理,但两名患者仍持续存在EDS,并报告有猝倒、睡眠瘫痪和生动梦境发作。多导睡眠图(PSG)证实为轻度至中度OSAS,多次睡眠潜伏期测试(MSLT)显示平均睡眠潜伏期小于5分钟,且有多次睡眠起始快速眼动期(SOREMPs)。基于猝倒的存在和MSLT结果,两例均诊断为1型发作性睡病(NT1)。莫达非尼联合CPAP治疗使症状和生活质量有显著改善。这些病例突出了在OSAS充分治疗后仍有持续EDS的患者中考虑发作性睡病的重要性。NT1与OSAS共存可能会掩盖发作性睡病的诊断,导致适当管理的延迟。全面评估,包括详细的患者病史和睡眠研究,至关重要。针对这两种情况的联合治疗可能对控制症状和改善患者预后有效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50cf/12021909/4c43bf9ca064/fnins-19-1563912-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50cf/12021909/4c43bf9ca064/fnins-19-1563912-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50cf/12021909/4c43bf9ca064/fnins-19-1563912-g001.jpg

相似文献

[1]
Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review.

Front Neurosci. 2025-4-11

[2]
Narcolepsy in the older adult: epidemiology, diagnosis and management.

Drugs Aging. 2003

[3]
Obstructive sleep apnea in narcolepsy.

Sleep Med. 2009-8-20

[4]
A false alarm of narcolepsy: obstructive sleep apnea masquerading as narcolepsy and depression.

Sleep Breath. 2019-9

[5]
Parkinsonism with excessive daytime sleepiness--a narcolepsy-like disorder?

J Neurol. 2005-2

[6]
The ICSD-3 and DSM-5 guidelines for diagnosing narcolepsy: clinical relevance and practicality.

Curr Med Res Opin. 2016-10

[7]
An Unusual Cause of Increasing Excessive Daytime Sleepiness in a CPAP-treated Obstructive Sleep Apnea Patient.

Sleep Sci. 2024-2-15

[8]
Polysomnography in patients with obstructive sleep apnea: an evidence-based analysis.

Ont Health Technol Assess Ser. 2006

[9]
Sleepiness and performance is disproportionate in patients with non-organic hypersomnia in comparison to patients with narcolepsy and mild to moderate obstructive sleep apnoea.

Neuropsychobiology. 2014

[10]
A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report.

Cureus. 2023-6-26

本文引用的文献

[1]
Comorbidity of obstructive sleep apnea and narcolepsy: A challenging diagnosis and complex management.

Sleep Med X. 2024-9-18

[2]
Excessive daytime sleepiness in obstructive sleep apnea: Indirect treatment comparison of wake-promoting agents in patients adherent/nonadherent to primary OSA therapy.

Sleep Med Rev. 2024-12

[3]
Recent insights into the pathophysiology of narcolepsy type 1.

Sleep Med Rev. 2024-12

[4]
REM sleep in narcolepsy.

Sleep Med Rev. 2024-10

[5]
Estimating the prevalence and clinical causality of obstructive sleep apnea in paediatric narcolepsy patients.

Sleep Breath. 2024-10

[6]
Association between sleep microarchitecture and cognition in obstructive sleep apnea.

Sleep. 2024-12-11

[7]
Navigating narcolepsy: exploring coping strategies and their association with quality of life in patients with narcolepsy type 1.

Sci Rep. 2024-5-23

[8]
Effects of modafinil on nocturnal sleep patterns in patients with narcolepsy: A cohort study.

Sleep Med. 2024-7

[9]
Modafinil, an atypical CNS stimulant?

Adv Pharmacol. 2024

[10]
Eating disorders in narcolepsy type 1: Evidence from a cross-sectional Italian study.

J Sleep Res. 2024-10

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