Real-world Idiopathic Hypersomnia Total Health Model (RHYTHM): Clinical Burden of Patients Diagnosed with Idiopathic Hypersomnia
Prasheel Lillaney1, Ragy Saad1, Deb Profant1, Douglas Fuller2, Trevor Alvord3, Patricia Prince3, Marisa Whalen2, Wayne Macfadden2, Weiyi Ni2, Jed Black4
1Formerly Jazz Pharmaceuticals, 2Jazz Pharmaceuticals, 3Aetion, Inc., 4Stanford University Center for Sleep Sciences and Medicine
Objective:
To compare comorbid conditions between patients with idiopathic hypersomnia (IH) and matched non-IH controls.
Background:
IH is a rare neurologic disorder characterized by excessive daytime sleepiness; sleep inertia; prolonged nighttime sleep; long, unrefreshing naps; and cognitive dysfunction. Limited research investigates the clinical burden of IH.
Design/Methods:
Merative MarketScan claims were analyzed (study period, 12/31/2013–2/29/2020; index period, 12/31/2014–3/1/2019). Eligible patients with IH were ≥18 years of age, continuously enrolled (gaps ≤30 days allowed), and without cataplexy. Patients entered the IH cohort upon receipt of their earliest medical claim with a diagnosis for IH in any position. Patients with IH were matched 1:5 with non-IH controls on age, sex, region, payer, and cohort entry date. Odds ratios (ORs) of comorbid conditions during the 2-year period (365 days before and after cohort entry) were compared using logistic regression; matching criteria were included as model covariates. ORs and 95% confidence intervals (CIs) were reported.
Results:
Final cohorts included 11,412 patients with IH and 57,058 matched non-IH controls. Most patients were female (65.0%), and median age was 45 years. Patients with IH had higher odds of experiencing comorbid conditions across multiple clinical categories, from neoplasms (OR, 1.59 [1.52-1.66]) to nervous system diseases (OR, 4.36 [4.13-4.60]), than non-IH controls. Odds of comorbid sleep conditions in patients with IH, including sleep apnea (OR, 25.43 [24.11-26.82]), periodic limb movement (OR, 32.99 [28.02-38.85]), and rapid eye movement behavior disorder (OR, 46.43 [28.80-80.21]), were higher than in matched non-IH controls. Patients with IH had higher odds of comorbid cardiovascular conditions, including stroke (OR, 2.07 [1.87-2.29]), major adverse cardiovascular events (OR, 2.08 [1.89-2.30]), and history of cardiovascular disease (OR, 2.26 [2.14-2.38]).
Conclusions:
Patients with IH experience several comorbid conditions, including cardiovascular and sleep conditions, and nervous system diseases. Consideration of patients’ comorbidities may be relevant when evaluating treatment options for patients with IH.