Elevated Peripheral Visfatin Levels in Narcoleptic Patients

Abstract

ObjectiveNarcolepsy is a severe sleep disorder that is characterized by excessive daytime sleepiness, cataplexies and a tendency towards obesity. Recent discoveries indicate that the major pathophysiology is a loss of hypocretin (orexin) producing neurons due to immunologically mediated degeneration. Visfatin is a recently described proinflammatory adipokine. It is identical to the immune modulating pre-B-cell colony enhancing factor (PBEF). Our study examines the hypothesis that visfatin levels are altered in narcoleptic patients.MethodsFor the analysis, a total of n = 54 patients (n = 18 males and n = 36 females) with the diagnosis of narcolepsy according to DSM-IV and the International Classification of Sleep Disorders were examined (BMI mean 30.3±5.5, age mean 52.5±16.1 years). As a control group 39 unrelated (n = 12 males and n = 27 females) healthy volunteers with no sleep disorder according to DSM-IV were included (BMI mean 28.5±4.6, age mean 51.1±13.6 years). Peripheral visfatin levels were measured using a commercial enzyme immunoassay kit with a measurement range from 0.1–1000 ng/ml. Narcolepsy symptoms, severity and frequency of symptoms as well as the total duration of various aspects of the symptomatology were assessed by unstructured and structured clinical interviews in including the Stanford Center for Narcolepsy Sleep Inventory.ResultsCirculating visfatin was found to be significantly increased in HLA DR2 positive narcoleptic patients compared to controls.ConclusionTaken together, our results add to the evidence of disturbed immunological regulation in patients with narcolepsy.

Sleep Disturbance and Metabolic Dysfunction: The Roles of Adipokines

“…In sleep disorders (Table 1), visfatin was shown to be elevated in patients with narcolepsy (n = 56) when compared with age-and BMI-matched controls (n = 39), mainly driven by HLA DR2-positive narcolepsy patients [68]. Among patients with OSAS, levels of visfatin were positively correlated with sleep latency and negatively correlated with total sleep time, percentage of stage 2 sleep, and REM sleep [69].…”

Role of orexin in the regulation of glucose homeostasis

“…2001). In addition, blood visfatin level, a putative biomarker for metabolic syndrome, is elevated in human leucocyte antigen (HLA)‐DR2 allele‐positive narcoleptic patients who show diminished orexin levels, but not in HLA‐DR2‐negative narcoleptics who display normal orexin levels (Dahmen et al. 2008).…”

“…In humans, narcolepsy is accompanied by energy imbalance, such as decreased energy intake and increased body mass index, leading to an increased risk of type 2 diabetes (Honda et al 1986, Lammers et al 1996, Schuld et al 2000, Nishino et al 2001). In addition, blood visfatin level, a putative biomarker for metabolic syndrome, is elevated in human leucocyte antigen (HLA)-DR2 allele-positive narcoleptic patients who show diminished orexin levels, but not in HLA-DR2-negative narcoleptics who display normal orexin levels (Dahmen et al 2008). Orexin neurone-deficient mice also exhibit late-onset obesity, despite the reduction in food intake (Hara et al 2001), and gain more weight than wild-type mice on high-fat diet (Hara et al 2005).…”

The Modulation of Adipokines, Adipomyokines, and Sleep Disorders on Carcinogenesis

“…In one study, visfatin plasma levels in severe OSA, although not different than in the controls, correlated positively with disturbances in sleep architecture [ 173 ]. Interestingly, circulating visfatin levels were significantly increased in patients with narcolepsy: a disease associated with profound sleep architecture disturbances [ 174 ]. Similarly, short sleep duration and disturbed sleep architecture (short REM sleep duration) in patients without OSA were associated with increased visfatin serum levels [ 139 ].…”