High prevalence of ADHD symptoms in unmedicated youths with post-H1N1 narcolepsy type 1

Berit Hjelde Hansen; Hilde T Juvodden; Sebjørg Hesla Nordstrand; Rannveig Viste; Per M Thorsby; David Swanson; Kristian B Nilsen; Terje Nærland; Stine Knudsen-Heier

doi:10.1016/j.sleep.2020.06.014

High prevalence of ADHD symptoms in unmedicated youths with post-H1N1 narcolepsy type 1

Sleep Med. 2020 Nov:75:171-180. doi: 10.1016/j.sleep.2020.06.014. Epub 2020 Jun 18.

Authors

Berit Hjelde Hansen¹, Hilde T Juvodden², Sebjørg Hesla Nordstrand³, Rannveig Viste², Per M Thorsby⁴, David Swanson⁵, Kristian B Nilsen⁶, Terje Nærland², Stine Knudsen-Heier⁷

Affiliations

¹ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway. Electronic address: bihn@ous-hf.no.
² Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
³ Institute of Clinical Medicine, University of Oslo, Norway; Department of Pediatrics, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Ullevål Hospital, Norway.
⁴ Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker Hospital, Oslo, Norway.
⁵ Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Norway.
⁶ Department of Neurology, Section for Clinical Neurophysiology, Oslo University Hospital, Ullevål Hospital, Norway.
⁷ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway.

PMID: 32858357
DOI: 10.1016/j.sleep.2020.06.014

Abstract

Objectives: To characterize attention deficit-hyperactivity disorder (ADHD) symptoms in unmedicated post-H1N1 narcolepsy type 1 (NT1) youths, and explore associations between ADHD symptoms and the narcolepsy phenotype.

Methods: A total of 50 consecutively enrolled post-H1N1 NT1 youths (7-20 years, 62% females, 98% HLA-DQB1∗06:02-positive, 98% CSF hypocretin-1 deficient, 88% vaccinated) were assessed after two weeks off medication for ADHD (ADHD diagnosis pre/post-narcolepsy, parent-rated ADHD symptoms) and narcolepsy-phenotyped (semi-structured interview, Stanford Sleep Questionnaire, Epworth Sleepiness Scale, polysomnography (PSG), Multiple Sleep Latency Test (MSLT)).

Results: In sum, 26 (52%) and 15 (30%) of participants had ADHD symptoms above and below the clinical significant cut-off, respectively, while 9 (18%) had no ADHD symptoms. High values were found for ADHD total score (mean (SD), 17.9 (9.5)) and ADHD subscores (inattentive score, 11.0 (6.3); hyperactive/impulsivity score, 6.9 (4.7)). These were significantly higher than previously reported in a mainly medicated narcolepsy cohort (p < 0.0001). Age, gender and disease duration did not influence scores. Two participants (4%) had ADHD diagnosis prior to narcolepsy onset. ADHD symptoms were correlated with parent-rated, but not with patient rated ESS scores, objective sleepiness (mean sleep latency), sleep fragmentation (sleep stage shift index, awakening index), or CSF hypocretin-1 level.

Conclusion: Comorbid ADHD symptoms were more prevalent in unmedicated post-H1N1 NT1 youths than previously reported in mainly medicated pediatric narcolepsy cohorts. The high prevalence was not due to pre-existing ADHD and generally not correlated with core narcolepsy sleep/wake phenotype characteristics, indicating that the ADHD symptoms were not a direct consequence of disturbed sleep or daytime sleepiness.

Keywords: ADHD symptoms; H1N1; Narcolepsy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity* / epidemiology
Child
Female
Humans
Influenza A Virus, H1N1 Subtype*
Male
Narcolepsy* / epidemiology
Polysomnography
Prevalence