Characteristics of neuropsychological, sleep structure and distribution of HLA ⁃ DQB1 genotype of narcolepsy type 1

Abstract

Objective To analyse the neuropsychological characteristics, sleep structure and HLA ⁃ DQB1 gene distribution of narcolepsy type 1 (NT1) patients. Methods A total of 35 patients with NT1 admitted to Tianjin Medical University General Hospital, from August 2018 to November 2022 were included, all of whom underwent neuropsychological tests, noctural polysomnography (nPSG) monitoring, Multiple Sleep Latency Test (MSLT), narcolepsy evaluation and HLA ⁃ DQB1 gene detection. Results Neuropsychological tests showed the scores of Montreal Cognitive Assessment (MoCA; t = 3.159, P = 0.004) and the correct number of immediate recall of the first (t = 3.028, P = 0.004) and the second (t = 2.054, P = 0.044) of Hopkins Verbal Learning Test⁃Revised (HVLT⁃R) were lower of the NT1 group than those of the control group. Trail Making Test (TMT) ⁃B completion time (t = ⁃ 2.126, P = 0.019), Hamilton Anxiety Scale (HAMA) score (Z = ⁃ 5.109, P = 0.000), Hamilton Depression Scale⁃17 (HAMD⁃17) score (Z = ⁃ 3.204, P = 0.001), Epworth Sleepiness Scale (ESS) socre (t = ⁃ 13.609, P = 0.000) and Pittsburgh Sleep Quality Index (PSQI) score (Z = ⁃ 3.004, P = 0.003) were higher of the NT1 group than those of the control group. nPSG showed the total recording time (Z = ⁃ 4.491, P = 0.000), the proportion of non⁃rapid eye movement (NREM) 3 (Z = ⁃ 2.647, P = 0.008), the proportion of rapid eye movement (REM; t = 2.908, P = 0.005) and periodic limb movements of sleep index (PLMSI; Z = ⁃ 3.501, P = 0.000) were higher of the NT1 group than those of the control group. Sleep efficiency (t = ⁃ 2.489, P = 0.016), sleep latency (Z = ⁃ 4.112, P = 0.000), REM sleep latency (Z = ⁃ 4.318, P = 0.000) and the proportion of NREM2 (t = ⁃ 5.224, P = 0.000) were lower of the NT1 group than those of the control group. The clinical features of NT1 patients were excessive daytime sleepiness (97.14%, 34/35), cataplexy (97.14%, 34/35), other sleep disturbances (88.57%, 31/35), sleep hallucination (82.86%, 29/35), and sleep paralysis (68.57%, 24/35). And 34 cases (97.14%) carried the allele HLA ⁃ DQB1*0602. Conclusions Patients with NT1 have cognitive decline, mood change and sleep structure disorder, and the carrying rate of HLA⁃DQB1*0602 is high.

Keywords

• narcolepsy
• neuropsychological tests
• polysomnography
• hla⁃dq antigens