Which clinical history findings are characteristic of narcolepsy?

Updated: Sep 04, 2019
  • Author: Sagarika Nallu, MD; Chief Editor: Selim R Benbadis, MD  more...
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The classic tetrad of narcolepsy consists of excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Children rarely manifest all 4 symptoms. [1] EDS is the primary symptom of narcolepsy and must be present for at least 3 months to justify the diagnosis.

Sleepiness is a normal experience that cycles and invariably occurs after prolonged wakefulness. In healthy persons, mild sleepiness is apparent only during boring, sedentary situations (eg, falling asleep while watching television). In persons with narcolepsy, severe EDS leads to involuntary somnolence during activities that normally engage attention, such as driving, eating, or talking. Sleepiness in narcolepsy may be severe and constant, with paroxysms during which patients may fall asleep without warning (ie, sleep attacks).

Patients with narcolepsy tend to take short and refreshing naps (ie, rapid eye movement [REM]-type naps) during the day. Their daytime naps may be accompanied by dreams.

A significant number of narcolepsy patients have trouble sleeping at night. [2] In addition, patients may have nocturnal compulsive behaviors, including sleep-related eating disorder and nocturnal smoking. [3]

Obesity is another common feature of narcolepsy. The combination of narcolepsy and obesity may promote the development of obstructive sleep apnea.

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