Autonomic symptoms, cardiovascular and sudomotor evaluation in de novo type 1 narcolepsy

Clin Auton Res. 2020 Dec;30(6):557-562. doi: 10.1007/s10286-020-00718-w. Epub 2020 Aug 27.

Abstract

Purpose: To evaluate cardiovascular and sudomotor function during wakefulness and to assess autonomic symptoms in de novo patients with type 1 narcolepsy compared to healthy controls.

Methods: De novo patients with type 1 narcolepsy (NT1) and healthy controls underwent cardiovascular function tests including head-up tilt test, Valsalva maneuver, deep breathing, hand grip, and cold face, and sudomotor function was assessed through Sudoscan. Autonomic symptoms were investigated using the Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT) questionnaire.

Results: Twelve de novo patients with NT1 and 14 healthy controls were included. In supine rest condition and at 3 min and 10 min head-up tilt test, the systolic blood pressure values were significantly higher in the NT1 group than in controls (p < 0.05). A lower Valsalva ratio (p < 0.01), significantly smaller inspiratory-expiratory difference in deep breathing (p < 0.05), and lower delta heart rate in the cold face test (p < 0.01) were also observed in the NT1 group. The mean hand electrochemical skin conductance values were significantly lower (p < 0.05) and the mean SCOPA-AUT total scores were significantly higher in patients with NT1 than in healthy subjects (p < 0.001), with greater involvement of cardiovascular and thermoregulatory items.

Conclusion: De novo patients with NT1 exhibit blunted parasympathetic activity during wakefulness, mild sudomotor dysfunction, and a large variety of autonomic symptoms.

Keywords: Autonomic nervous system (ANS); Cardiovascular reflexes; Narcolepsy type 1 (NT1); Scales for Outcomes in Parkinson’s Disease–Autonomic Dysfunction questionnaire (SCOPA-AUT); Sudomotor function.

MeSH terms

  • Autonomic Nervous System Diseases* / diagnosis
  • Cardiovascular System*
  • Hand Strength
  • Heart Rate
  • Humans
  • Narcolepsy* / diagnosis
  • Tilt-Table Test