Demographics and Comorbidities of Patients With Narcolepsy: A Propensity Score–Matched Cohort Study
Marjorie Soltis1, Melissa Lipford2, Allison Smither3, Jennifer Gudeman4
1Duke University Medical Center, 2Mayo Clinic, 3nference, 4Avadel Pharmaceuticals
Objective:
This study used aggregate electronic health record (EHR) data to characterize the demographics and comorbidities of patients with narcolepsy.
Background:
Narcolepsy is a rare, chronic sleep disorder associated with decreased quality of life and multiple comorbid conditions.
Design/Methods:
An EHR-based search identified first-time Duke Health patients between January 1, 2012, to March 31, 2024. Included patients had ≥1 narcolepsy-specific ICD-9 (347.*) and ICD-10 (G47.4*) codes and ≥1 disease-supportive statement in clinical notes, identified using a natural language processing algorithm. A control cohort was propensity-matched for birth year, age at first institutional encounter, sex, race, number of diagnosis code instances, and mortality. Common comorbidities were compared and ranked between cohorts by odds ratio (OR). Statistical significance was determined using a chi-squared test; P values were corrected for multiple comparisons using Bonferroni correction.
Results:
Within the EHR database of 2,617,188 patients, 1659 patients with a narcolepsy diagnosis were identified (mean age at first presentation, 32.4 years; white, 69%; female, 69%); the propensity-matched control cohort included 1659 patients (mean age at first presentation, 32.3 years; white, 69%; female, 69%). Comorbidities that occurred statistically significantly more frequently (all P<0.0001) among the narcolepsy vs control cohort (OR [95% CI]) included sleep disorders: sleep-related movement disorders (26.26 [10.71, 64.40]), hypersomnia (16.56 [12.54, 21.87]), circadian rhythm sleep disorders (15.43 [6.73, 35.38]); psychiatric or mood disorders: post-traumatic stress disorder (3.08 [2.10, 4.52]), attention deficit hyperactivity disorder (2.90 [2.28, 3.68]), depression (2.66 [2.27, 3.11]); and pain disorders: trigeminal neuralgia (6.63 [2.80, 15.70]), fibromyalgia (5.30 [3.58, 7.85]), chronic pain syndrome (3.37 [2.46, 4.61]. Postural orthostatic tachycardia syndrome occurred statistically significantly more frequently in the narcolepsy vs control cohort (7.24 [3.59, 14.61]).
Conclusions:
Consistent with prior EHR research, sleep, psychiatric, and pain disorders were among the most frequently reported comorbidities of patients with narcolepsy.
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