Neurology practitioners should consider sodium intake and related cardiovascular impacts when making treatment plans for patients with narcolepsy, increasing evidence suggests. Presenting at the 2022 American Academy of Neurology Annual Meeting in Seattle, a study found the likelihood of cardiovascular events and risk factors is high for patients with narcolepsy.1 This finding was also seen among patients who do not have a history of any cardiovascular condition.

In the US, an estimated 135,000 to 200,000 people live with narcolepsy, a chronic disorder in which the brain’s ability to control sleep-wake cycles is disrupted.2 However, that range is thought to be a low estimate because the condition is often undiagnosed or misdiagnosed as an emotional or psychiatric disorder. Currently, patients have several treatment options, including, modafinil, a central nervous system stimulant, amphetamine-like stimulants like methylphenidate, and certain antidepressants that can control cataplexy. Sodium oxybate is also sometimes prescribed as a sedative for nighttime use. 

However, some medications may increase overall sodium levels in patients. Elevated sodium intake is associated with sleep issues and other health impacts, including cardiovascular disease, coronary heart disease, and stroke.3,4 

To better understand the risks of high sodium intake for patients with narcolepsy, we talked with Richard K. Bogan, MD, an associate clinical professor at the University of South Carolina School of Medicine in Columbia and associate clinical professor at the Medical University of South Carolina in Charleston.


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How does sodium consumption impact sleep and why should patients with narcolepsy monitor their intake?

Dr Bogan: Sodium consumption in the evening can lead to disrupted sleep, as high salt intake can be a cause of nocturia, or nighttime urination. Previous research has shown that reducing salt intake later in the day led to people reducing their need to get up during the night to urinate.4

The impact of excessive sodium consumption on cardiovascular health is well established. At the same time, [a 2016 study in the journal of Sleep Medicine] shows that people living with narcolepsy have an increased prevalence of cardiovascular comorbidities, including high blood pressure, cardiovascular disease, and diabetes.5 Therefore, [patients with narcolepsy] must be aware of the amount of sodium they consume.

How do treatment options for narcolepsy affect sodium intake?

Dr Bogan: A variety of medications can have high levels of sodium, which can impact people’s heart health.3 At the same time, the average American consumes too much sodium through food and drink6. As a result, it is important for clinicians to understand how certain medications might affect their patients’ heart health.

It’s important for patients with narcolepsy to be mindful of their sodium consumption and consult with their doctors on how best to think holistically about their sleep health and overall wellbeing.

What are some ways patients can reduce their sodium intake?

Dr Bogan: First and foremost, [patients with narcolepsy] should monitor the amount of sodium they consume. With this mindfulness of their sodium intake, patients can begin to take steps to reduce their sodium consumption. This includes eating a well-balanced diet that includes fruits and vegetables, whole grains, and lean meats, plus getting regular exercise throughout the week.

What are some of the challenges of treating this patient population?

Dr Bogan: A current challenge treating [patients with narcolepsy] is balancing their sleep and overall health and wellbeing. As we sleep, our blood pressure lowers naturally. Studies [suggest] that people who do not experience this lowering in blood pressure, which is prevalent in people with narcolepsy, have a heightened cardiovascular risk.7

Also, research has shown that inadequate sleep triggers a part of the brain that plays a role in hunger and appetite, which may cause obesity in [patients with narcolepsy], as individuals with sleep-wake abnormalities typically have a higher calorie intake.8,9

As a result, it is vital that clinicians educate their patients to prevent further damage to their overall health.

What other strategies are being used among clinicians to help patients better manage their narcolepsy?

Dr Bogan: To better manage their narcolepsy, clinicians should encourage their patients to develop healthy sleep habits. This can be difficult for people with narcolepsy based on the nature of the condition, which can include stress, mood disruptors, and pain. The best thing for sleepiness is sleep, and with [patients with narcolepsy] having a better understanding of the circadian sleep cycle, they can develop a sleep routine that could help with reducing stress levels before bed and comorbid risks.10,11

[Also,] clinicians need to educate their patients on the cardiovascular and metabolic comorbidities they face. By being mindful of the risks and any existing comorbidities they may have, clinicians can understand the best approach for those who need it the most.

References

  1. Ben-Joseph, R, Saad R, Black J, et al. CardioVascular Burden Of Narcolepsy Disease (CV-BOND): A Real-World Evidence Study. Presented at: the 2022 AAN Annual Meeting; April 2-7, 2022; Seattle, Washington; April 24-26, 2022; Virtual Meeting. Abstract S34.002.
  2. National Institute of Neurological Disorders and Stroke. Narcolepsy Fact Sheet. Updated November 15, 2022. Accessed April 26, 2022. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Narcolepsy-Fact-Sheet 
  3. Perrin G, Korb-Savoldelli V, Karras A, Danchin N, Durieux P, Sabatier B. Cardiovascular risk associated with high sodium-containing drugs: A systematic review. PLoS One. Published online July 6, 2017. doi:https://doi.org/10.1371/journal.pone.0180634
  4. Wise, J. Cutting salt could reduce need to urinate at night, study finds. BMJ. Published online March 27, 2017. doi:https://doi.org/10.1136/bmj.j1527
  5. Black J, Reaven NL, Funk SE, et al. Medical comorbidity in narcolepsy: findings from the Burden of Narcolepsy Disease (BOND) study. Sleep Med. Published online May 12, 2016. doi:https://doi.org/10.1016/j.sleep.2016.04.004
  6. Quader ZS, Zhao L, Gillespie C, et al. Sodium intake among persons aged ≥2 years — United States, 2013–2014. MMWR Morb Mortal Wkly Rep. 2017;66:324–238. doi:http://dx.doi.org/10.15585/mmwr.mm6612a3
  7. Dauvilliers Y, Jaussent I, Krams B, et al. Non-dipping blood pressure profile in narcolepsy with cataplexy. PLoS One. Published online June 29, 2012. doi:https://doi.org/10.1371/journal.pone.0038977
  8. Chabas D, Foulon C, Gonzalez J, et al. Eating disorder and metabolism in narcoleptic patients. Sleep. Published online October 1, 2007. doi:https://doi.org/10.1093/sleep/30.10.1267
  9. Centers for Disease Control and Prevention. Prevent Heart Disease. Updated April 21, 2020. Accessed March 2022. https://www.cdc.gov/heartdisease/prevention.htm
  10. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. Published online October 16, 2014. doi:https://doi.org/10.1016/j.smrv.2014.10.001
  11. Choi DW, Chun SY, Lee SA, Han KT, Park EC. Association between sleep duration and perceived stress: salaried worker in circumstances of high workload. Int J Environ Res Public Health. Published online April 19, 2018. doi:https://doi.org/10.3390/ijerph15040796



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