Dahl R E, Holttum J, Trubnick L
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213.
J Am Acad Child Adolesc Psychiatry. 1994 Jul-Aug;33(6):834-41. doi: 10.1097/00004583-199407000-00009.
Although narcolepsy is rarely diagnosed before adulthood, symptoms often begin much earlier and can easily mimic psychiatric disorders in children and adolescents. Clinical experience from a pediatric sleep center is reviewed in 16 consecutive cases of polysomnographically proven narcolepsy with onset of symptoms by age 13 years. Only 1 of the 16 patients presented with the classic clinical tetrad of symptoms (sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis). Behavioral and emotional disturbances were present in 12 of 16 cases, with four patients appearing to have been misdiagnosed with a psychiatric disorder before recognition of the narcolepsy. Obesity appeared as an unexpected association in this case series, with 11 of the 16 narcoleptic patients found to be overweight at the time of diagnosis. The varied clinical presentations, polysomnographic findings, family history, and associated psychiatric symptoms are described. The importance of considering narcolepsy in the differential diagnosis of any child or adolescent with excessive sleepiness is emphasized.
尽管发作性睡病在成年前很少被诊断出来，但症状通常在更早的时候就开始出现，并且在儿童和青少年中很容易被误诊为精神疾病。本文回顾了一家儿科睡眠中心连续16例经多导睡眠图证实的发作性睡病患者的临床经验，这些患者在13岁之前就出现了症状。16例患者中只有1例表现出典型的四联征症状（嗜睡、猝倒、入睡前幻觉和睡眠麻痹）。16例中有12例存在行为和情绪障碍，其中4例在被诊断为发作性睡病之前似乎被误诊为精神疾病。在这个病例系列中，肥胖是一个意外的关联因素，16例发作性睡病患者中有11例在诊断时被发现超重。文中描述了各种临床表现、多导睡眠图结果、家族史和相关的精神症状。强调了在对任何嗜睡的儿童或青少年进行鉴别诊断时考虑发作性睡病的重要性。
