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Older adults with narcolepsy face complex comorbidities that can hinder care, highlighting the need for focused treatment and tailored pharmacologic plans.

“While narcolepsy typically first presents in young adulthood, it is a chronic but not disabling disorder,” researchers wrote in the Journal of Critical Medicine. “In the current decade, we are seeing patients with narcolepsy reaching their senior years. Little is known about the evolution of clinical features, the management of narcolepsy medications, and the development of comorbid conditions in this demographic.”

To address this knowledge gap, Martina Vendrame, MD, PhD, and colleagues aimed to present the clinical characteristics, therapeutic choices, and comorbidities in patients aged 65 years and older diagnosed with narcolepsy type I or II.

The findings show that older adults with narcolepsy have multiple comorbidities which can complicate treatment, underscoring the need for dedicated clinics for older adult patients.

Dr. Vendrame and colleagues based their findings on chart reviews of 21 older patients with a diagnosis of narcolepsy. The researchers reviewed and analyzed all clinical and polysomnographic data. Most patients (71%) were women and the median age of the cohort was 69 years.

Narcolepsy Symptoms & Comorbidities

Across the cohort, most patients (85.7%) had narcolepsy type II and 14.3% had narcolepsy type 1. The average age of symptom onset was 23 years, and the average age at diagnosis was 41 years. All patients were treated with narcolepsy medications at some time in their lives. Most patients (85.7%) were currently using wake-promoting agents, with more than half (55.6%) on modafinil.

A review of the most recent reported narcolepsy symptoms showed that 57% of patients complained of excessive daytime sleepiness. The researchers noted that no patients reported the need to take scheduled daytime naps.

An analysis of comorbidities showed that hypertension was the most common comorbid medical disorder, found in 57.1% of patients. Diabetes was the second most common cardiometabolic comorbidity, seen in 33.3% of patients. The most common sleep comorbidity was breathing disorders such as obstructive sleep apnea (28.6%), which was also diagnosed later in life. While the majority did not have a diagnosed psychiatric comorbidity, about a third of patients had been treated for depression at some point.

“Geriatricians must be educated on the medical management of narcolepsy, including appropriate pharmacologic options, potential drug interactions, and age-related changes in sleep architecture and medication metabolism,” Dr. Vendrame and colleagues wrote. “Integrating narcolepsy care into geriatric practice will not only improve symptom control and quality of life, but also ensure that comorbid conditions are managed holistically and safely in this vulnerable population.”