Clinical course of H1N1-vaccine-related narcolepsy

Sarkanen, Tomi; Alakuijala, Anniina; Partinen, Markku

doi:10.1016/j.sleep.2015.11.005

Cited by 21 publications

(19 citation statements)

References 31 publications

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“…Szakacs et al found that psychiatric symptoms seemed to be more frequent in PPN patients, but as there were 31 PPN and only 7 SN patients comparison between the groups was difficult (95).Our findings in Paper III, showing overweight /obesity in 54% of the children and 61% of the adults is in line with previous prevalence reports on BMI in patients with SN(12, 13,101). They also found a greater BMI in the SN group than in the PN group which they suspected was due to a greater age and longer disease durations in the SN group(165). The mean disease duration in our study was longer than in the study of Sarkanen, differing approximately 2 years.…”

supporting

confidence: 90%

Obesity and other medical comorbidities among NT1 patients after the Norwegian H1N1 influenza epidemic and vaccination campaign

Nordstrand

Juvodden

Viste

et al. 2019

Sleep

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Study Objectives Narcolepsy type 1 (NT1) may be complicated by comorbidities. We aimed to study the extent of obesity and other medical comorbidities in a Norwegian population of NT1 patients with debut of symptoms after the 2009 H1N1 influenza epidemic and vaccination campaign. We also aimed to explore factors associated with obesity. Methods Ninety-one patients (48 children and 43 adults) were included in this cross-sectional study, 80 of whom were H1N1-vaccinated. All participants were hospitalized and underwent sleep investigation and physical examination, and completed a semi-structured clinical interview. Results In children, 16 females (70%) and 10 males (40%) were classified as overweight or obese. Twenty children (42%) had a co-existing medical disorder. Medical comorbidity was significantly positively associated with BMI in children (p = .032). In adults, 19 females (58%) and 7 males (70%) were classified as overweight or obese. Twenty-six adults (61%) had a co-existing medical disorder. We found no factors significantly associated with BMI in adults. On a fatigue scale from 0 to 100, lower scores indicating more fatigue, we found a mean (SD) total fatigue score of 50 (17) in children and 39 (16) in adults. Conclusion In a cohort of predominantly H1N1-vaccinated NT1 patients, we found a high prevalence of overweight or obesity. Half of the cohort presented with one or more additional medical comorbidities, and patients reported a clinically relevant degree of fatigue. Our findings highlight the importance of carefully monitoring patients with NT1 with regard to the development of obesity, which is a significant risk factor for cardiovascular disorders.

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supporting

confidence: 90%

Obesity and other medical comorbidities among NT1 patients after the Norwegian H1N1 influenza epidemic and vaccination campaign

Nordstrand

Juvodden

Viste

et al. 2019

Sleep

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“…It is possible that subjects with a more severe phenotype are diagnosed earlier after the vaccination than those with milder symptoms ( Table 4). The disease course between idiopathic and Pandemrix-associated narcolepsy seemed similar in a recent study [57]. Vaccine associated cases are characterized by high frequency of HLA DQB1*06:02, cataplexy and hypocretin deficiency.…”

Section: Discussionmentioning

confidence: 58%

Incidence of narcolepsy after H1N1 influenza and vaccinations: Systematic review and meta-analysis

Sarkanen

Alakuijala

Dauvilliers

et al. 2018

Sleep Medicine Reviews

181

125

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An increased incidence of narcolepsy was seen in many countries after the pandemic H1N1 influenza vaccination campaign in 2009-2010. The H1N1 vaccine - narcolepsy connection is based on observational studies that are prone to various biases, e.g., confounding by H1N1 infection, and ascertainment, recall and selection biases. A direct pathogenic link has, however, remained elusive. We conducted a systematic review and meta-analysis to analyze the magnitude of H1N1 vaccination related risk and to examine if there was any association with H1N1 infection itself. We searched all articles from PubMed, Web of Science and Scopus, and other relevant sources reporting the incidence and risk of post-vaccine narcolepsy. In our paper, we show that the risk appears to be limited to only one vaccine (Pandemrix). During the first year after vaccination, the relative risk of narcolepsy was increased 5 to 14-fold in children and adolescents and 2 to 7-fold in adults. The vaccine attributable risk in children and adolescents was around 1 per 18,400 vaccine doses. Studies from Finland and Sweden also appear to demonstrate an extended risk of narcolepsy into the second year following vaccination, but such conclusions should be interpreted with a word of caution due to possible biases. Benefits of immunization outweigh the risk of vaccination-associated narcolepsy, which remains a rare disease.

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“…Thus, we do not know how consistent UNS scores are between two visits without a change in health or symptoms of narcolepsy (test-retest reliability). We saw in our previous longitudinal study that there are great individual differences and heterogeneity in the evolution of UNS scores between individuals [18]. The result could also mirror heterogeneity of the disease itself.…”

Section: Discussionmentioning

confidence: 84%

Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy

Sarkanen

Alakuijala

Partinen

2018

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Study objectives: To validate Ullanlinna Narcolepsy Scale (UNS) as a screening tool for narcolepsy in a clinical population and to compare it with Swiss Narcolepsy Scale (SNS) and Epworth Sleepiness Scale (ESS). Methods: UNS questionnaires of 267 participants visiting Helsinki Sleep Clinic were analyzed. The diagnoses of the participants were narcolepsy type 1 (NT1, n = 89), narcolepsy type 2 (NT2, n = 10), other hypersomnias (n = 24), sleep apnea (n = 37), restless legs syndrome or periodic limb movement disorder (n = 56), and other sleep-related disorders (n = 51). In addition, ESS and SNS scores in a subset of sample (total N = 167) were analyzed and compared to UNS. Results: Mean UNS score in NT1 was 22.0 (95% confidence interval [CI] = 20.4 to 23.6, range 9-43), which was significantly higher than in other disorders, including NT2 (mean 13.7, 95% CI = 10.3 to 17.1, range 7-21, p = .0013). Sensitivity and specificity of UNS in separating NT1 from other disorders were 83.5% and 84.1%, respectively. Positive and negative predictive values were 82.5% and 85.1%, respectively. Sensitivities of SNS and ESS in NT1 were 77.2% and 88.6%, and specificities 88.6% and 45.5%, respectively. There were no differences in receiver operating characteristic curves between UNS and SNS. UNS had moderate negative correlation with hypocretin-1 levels (r s =-.564, p < .001), and mean sleep latency in multiple sleep latency test (r s =-.608, p < .001). Conclusions: UNS has high specificity and sensitivity for NT1 in a sleep clinic setting. UNS scores below 9 strongly suggest against the diagnosis of narcolepsy.

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Clinical course of H1N1-vaccine-related narcolepsy

Cited by 21 publications

References 31 publications

Obesity and other medical comorbidities among NT1 patients after the Norwegian H1N1 influenza epidemic and vaccination campaign

Obesity and other medical comorbidities among NT1 patients after the Norwegian H1N1 influenza epidemic and vaccination campaign

Incidence of narcolepsy after H1N1 influenza and vaccinations: Systematic review and meta-analysis

Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy

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