Blackwell, JE

Elphick, HE

Kingshott, RN

Nash, HM

Weighall, AR

White Rose Research Online

This is a repository copy of Sleep architecture in children with narcolepsy treated with sodium oxybate.White Rose Research Online URL for this paper:http://eprints.whiterose.ac.uk/123150/Version: Accepted VersionConference or Workshop Item:Blackwell, JE orcid.org/0000-0002-5878-8959, Kingshott, RN, Weighall, AR et al. (2 more authors) (Accepted: 2017) Sleep architecture in children with narcolepsy treated with sodium oxybate. In: Brighton Sleep 2017 (The British Sleep Society), 12-14 Oct 2017, Brighton, UK. This is an author produced version of a paper presented in Brighton Sleep 2017 (The British Sleep Society).eprints@whiterose.ac.ukhttps://eprints.whiterose.ac.uk/Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Sleep architecture in children with narcolepsy treated withSodium OxybateJane E Blackwell1, Ruth N Kingshott2, Anna R Weighall1, Heather E Elphick2 & Hannah M Nash1CONCLUSIONS1School of Psychology, University of Leeds, UK.2Sheffield Children’s NHS Foundation Trust, UK.INTRODUCTIONAIMAs part of this descriptive study, we aimed to investigate thedifferences in sleep architecture between:• Children with narcolepsy treated with sodium oxybate• Children with narcolepsy not treated with sodium oxybate• Gender and age matched healthy controlsMETHODS• 23 children with narcolepsy (age: 8-15 years) and 23 healthy gender and age-matched controls were recruited from England and the Republicof Ireland. There were 15 males and 8 females in both groups.• From this sample, 4 children with narcolepsy treated with sodium oxybate (age:10-15 years), 3 children with narcolepsy not treated withsodium oxybate (age:10-12) and their matched controls were selected.• Children underwent home polysomnography (PSG) using a portable PSG system (Embla® Systems-Embletta MPR PG & ST+ Proxy was usedwith 9 children and Micromed-Morpheus was used with 2 children). A standard montage was used to measure sleep architecture with 9 EEGchannels (F3, F4, C3, Cz, C4, O1, O2, M1, M2), two electro-oculography (EOG) and two electromyography (EMG) channels. Children were setup in their own homes and medication was taken as usual.To follow the project: Scan here:The Paediatric Narcolepsy Project@ThePNarcolepsyP @ JaneBlackwell21J.E.Blackwell14@leeds.ac.ukFunding sources:ReferencesMamelak, M., Black, J.,Montplaisir, J., & Ristanovic, R.(2004).A pilot study on the effects ofsodium oxybate on sleeparchitecture and daytime alertnessin narcolepsy.Sleep, 27(7), 1327-1334.In 2016 NHS England’s specialised services announced that they will routinely commission sodium oxybate for symptom control in post-pubertal children with narcolepsy with cataplexy.In adults with narcolepsy, sodium oxybate has been shown to increase slow wave sleep (SWS) and subsequently improve daytime symptoms (Mamelak et al., 2004).The paediatric narcolepsy project is a case-control study, with 23 children with narcolepsy and 23 age-and-gender matched controls. This study examined the relationship between sleep,activity, school performance and well-being in children with narcolepsy.• Our case series suggests that the children with narcolepsy treated with sodium oxybate spend more time in slow wave sleep than those not treated with sodium oxybate and healthy controls.• The hypnograms of the children with narcolepsy look visually more disrupted than the healthy controls (Figure 1 provides an example).• This research suggests that sodium oxybate has an effect on the normal cycling of sleep stages in children.• Further work is needed to examine the impact of the changes to the sleep hypnogram in a larger sample size.• We are currently conducting further work in this area at Sheffield Children’s Hospital by examining the differences in sleep architecture of children with narcolepsy before they began sodium oxybate treatmentand after treatment commenced.Figure 1The sleep architecture of a child with narcolepsy treated with sodium oxybate vs ahealthy control child and a child with narcolepsy not treated with sodium oxybate12 year old female with narcolepsy with cataplexy not treated with sodium oxybate13 year old female with narcolepsy with cataplexy treated with sodium oxybate13 year old healthy femaleRESULTS• All of the children with narcolepsy were being treated with medication (methylphenidate preparations (n=5), modafinil (n=2), clonidine (n=2), clomipramine (n=1), venlafaxine (n=2), fluoxetine (n=1)).• All four of the children with narcolepsy treated with sodium oxybate were taking it twice during the night, once at bed time and once in the middle of the night.• Table 1 displays the average sleep architecture in the three groups. Statistics were not performed due to the small numbers in this case series.Table 1Summary of the differences in the sleep architecture of children with narcolepsy(treated with sodium oxybate and not treated with sodium oxybate) and healthymatched controlsSleep variableMean ± SDAge & gendermatched healthycontrols(n=4)Age & gendermatched childrenwith narcolepsy nottreated with sodiumoxybate (n=3)Children withnarcolepsy treatedwith sodiumoxybate(n=4)Age (years) 12.5 ± 2.1 11.3 ± 1.2 12.5 ± 2.1Sleep Onset Latency(minutes)30.9 ± 20.2 23.3 ± 22.7 23. 9 ± 27.9Sleep Efficiency (%) 89.5 ± 3.5 82.6 ± 7.8 85.5 ± 9.0Total Sleep Time(minutes)500.6 ± 45.2 533.0 ± 87.2 442.8 ± 92.4% N1 Sleep 3.5 ± 1.4 10.4 ± 7.2 4.4 ± 1.0% N2 Sleep 48.7 ± 5.2 43.7 ± 5.7 35.4 ± 5.4% Slow Wave Sleep 27.6 ± 2.9 33.2 ± 7.1 44.9 ± 10.4% Rapid Eye MovementSleep20.2 ± 4.9 12.6 ± 9.0 15.5 ± 7.3Arousal Frequency Index(/hr slept)6.9 ± 1.7 8.5 ± 2.7 8.1 ± 3.4

Sleep architecture in children with narcolepsy treated with sodium oxybate

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Sleep architecture in children with narcolepsy treated with sodium oxybate

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