Clinical Symptoms in Children vs Adults with Narcolepsy and Cataplexy

Overworked businessman sitting in office, sleeping in front of laptop
Obesity, night eating, parasomnia, sleep talking and drunkenness, and ADHD symptoms are more frequent in children than adults at narcolepsy diagnosis.

The symptoms and sleep characteristics among patients with narcolepsy and cataplexy (NC) may differ according to the age at diagnosis. Complications including obesity, night eating, parasomnia, sleep talking, and attention-deficit/hyperactivity disorder (ADHD) are more common in children, while sleep paralysis, obstructive sleep apnea, and reduced quality of life are more common in adults, according to study results published in CNS Neuroscience & Therapeutics.

Study researchers sought to assess the clinical symptoms and sleep measures in de novo patients diagnosed with NC before and after 18 years of age. The cohort for this retrospective study included 46 children (median age, 12 years; 61% boys) and 46 adults (median age, 28.5 years; 61% men). All study participants completed a standardized questionnaire and interview, as well as a sleep study.

Mean body mass index was lower in children compared with adults (21.8 vs 25.5 kg/m2, respectively; P <.0001). While overweight was more frequent in adults than children (44% vs 13%, respectively; P =.002), obesity was more common in children than adults (54% vs 17%, respectively; P =.0004).

Regarding narcolepsy symptoms in participants with NC, sleep paralysis was more common in adults than children (55% vs 20%; P =.001). However, parasomnia (89% vs 43%; P <.0001), sleep talking (80% vs 34%; P <.0001), sleep drunkenness (69% vs 24%; P <.0001), and night eating (29% vs 7%; P =.01) were all more frequent in children than adults with NC.

Quality of life, which was mostly impacted by depression and fatigue, was significantly lower in adults compared with children with NC (SF36 health survey total score, 43 vs 59, respectively; P < .0001).

Symptoms of ADHD were recorded in about a quarter of children, while no such symptoms were reported in adults. The scores at the ADHD scale of Conners Parents Rating Scale-Revised were on average higher in children than in adults (50 vs 26, respectively; P <.0001).

Children had lower obstructive apnea/hypopnea index (OAHI) compared with adults, and a lower proportion of children had OAHI ≥ 5. There was a correlation between higher body mass index z-score with higher OAHI (P =.002).

The study had several limitations, including the retrospective design, the use of different questionnaires in children and adults, and some missing data. Additionally, not all patients had a lumbar puncture to confirm diagnosis.

“Such differences in clinical characteristics and complications according to age need to be considered in order to ensure a prompt diagnosis and better management to prevent such complications,” concluded the researchers.


Zhang M, Inocente CO, Villanueva C, et al. Narcolepsy with cataplexy: Does age at diagnosis change the clinical picture? CNS Neurosci Ther. Published online August 6, 2020. doi:10.1111/cns.13438