# Spotlight on Seniors with Narcolepsy: Comorbidities and Management

## TL;DR

This study examines how narcolepsy affects seniors, focusing on their symptoms, comorbidities, and treatment over time.

## Contribution

The paper provides insights into the clinical management and comorbidities of narcolepsy in senior patients, a previously understudied group.

## Key findings

- Most seniors with narcolepsy had type II narcolepsy and hypertension as a common comorbidity.
- Many seniors no longer required wake-promoting medications for narcolepsy.
- Diagnosis often occurred decades after symptom onset, with a long delay in identification.

## Abstract

Background/Objectives: Narcolepsy was first described in the late 19th century, and in the current decade, narcolepsy patients are reaching their senior years. Little is known about the evolution of clinical features, the management of narcolepsy medications, and the development of comorbid conditions. We aimed to present the clinical characteristics, comorbidities, and therapeutic choices of seniors with narcolepsy. Methods: We extracted 21 charts of patients older than 65 with a diagnosis of narcolepsy according to the International Classification of Sleep Disorders Third Edition. We reviewed and analyzed all clinical and available polysomnographic data. Results: A total of 21 patients (median age 69 years. 67.0–71.0 interquartile range IQR; 71% female) were included. Three (14.3%) had type I and 18 (85.7%) had type II narcolepsy. The average age at symptom onset was 23 years (IQR 19.5–27.5). Diagnosis was made at an average age of 41 years (IQR 33–45), between 1990 and 2002. Median time from onset to diagnosis was 13.7 years (IQR 9.5–19). The most prevalent cardiovascular/metabolic comorbidity was hypertension (57.1%). All patients were historically using narcolepsy medications. Fewer patients were currently on wake-promoting agents (85.7%), with over half on modafinil (55.6%). None currently reported the need to nap during the daytime. Conclusions: Narcolepsy is a lifelong, but not progressive disorder, that has yet to be well-characterized in the senior population. A few seniors appear to outgrow the disorder and to no longer need wake-promoting agents. It is important to consider cardiometabolic comorbidities in the management of narcolepsy in this population. Geriatricians should be educated on narcolepsy with specific programs for these seniors.