How are narcolepsy and idiopathic CNS hypersomnia treated during pregnancy?

Updated: Aug 20, 2019
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Daytime sleepiness is another common symptom during pregnancy, but its severity and effect on well-being have not been thoroughly studied. Hormonal changes are suspected to be a contributing factor in the first trimester. After this period, disrupted nighttime sleep may be a substantial factor. Sleep apnea may be the cause in an obese woman who snores.

Particularly in the presence of hypertension, nocturnal polysomnography (multichannel sleep study) may be warranted to diagnose the disorder. NCPAP therapy may be started if indicated, depending on the severity of the condition.

Patients with previously diagnosed narcolepsy or idiopathic CNS hypersomnia may become pregnant and require changes in their treatment. Commonly used stimulants have not been shown to be safe in pregnancy, and these agents should be withdrawn from most patients before conception. An inability to drive safely and an overall decline in functional status may result. For the stimulants dextroamphetamine, methylphenidate, and modafinil, the level of risk to the fetus is category C.

Since 2002, sodium oxybate (gamma-hydroxybutyrate; GHB) has been available to treat narcolepsy. It is a highly sedating compound that is known as a drug of abuse. Sodium oxybate is taken only at night and reduces both cataplexy and daytime sleepiness through unknown mechanisms. The absence of teratogenicity in animal studies has led to it being classified as category B.

Thus, sodium oxybate might be preferable to stimulants during pregnancy, but whether this is so has not been established in clinical trials. Because of its potential for respiratory suppression, sodium oxybate could be harmful to pregnant women with sleep apnea, hypoxemia, or hypoventilation. The maximum recommended dosage is a daily sodium load of 1.6 g, which may be undesirable in pregnant women with edema or hypertension.


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