Individuals with narcolepsy are at increased risk of developing cardiovascular disease (CVD) regardless of sleep apnea status, according to a retrospective cohort study published in SLEEP and presented at the recent SLEEP 2024 annual meeting.

The authors wrote, “Narcolepsy is a lifelong disabling disorder causing profound daytime sleepiness. Symptoms present as early as childhood and result in marked disturbances in the life course of many persons with narcolepsy (PWN). Further, PWN experience several health conditions, including cardiovascular disease (CVD). Importantly, PWN often present with several co-occurring sleep disorders, including obstructive sleep apnea, which is a prominent risk factor for CVD.”

The study’s objective was to investigate the correlation between narcolepsy and CVD, accounting for potential factors that could make PWN more susceptible to developing CVD. Patients in the study were followed until the end of enrollment or up to December 13, 2021.

Utilizing the International Classification of Diseases–Clinical Modification (ICD-9/10-CM) diagnosis codes, researchers employed data from the 2005–2021 IBM MarketScan Commercial and Medicare supplemental databases to find newly diagnosed PWN from a minimum of two outpatient claims. Additionally, the researchers identified a comparison cohort of persons without narcolepsy or other hypersomnolence disorders, employing propensity score (PS) matching (1: up to 3 ratios) to balance groups constructed on underlying demographics, the presence of relevant health conditions including sleep apnea and diabetes, and other factors.

Using Cox proportional hazard regression, hazard ratios (HR) with 95% CIs were measured to estimate CVD risk outcomes (including major adverse cardiovascular events [MACE], heart failure, stroke, atrial fibrillation, and myocardial infarction [MI]) for PWN compared with nonnarcolepsy.

The study cohort included 134,067 patients, which was comprised of individuals with (mean age = 40±16.8 years; 62% female). Of these patients, 34,562 were PWN, and 100,405 were matched nonnarcolepsy patients.

Compared with nonnarcolepsy patients, among those with narcolepsy, there was an association of a 77% augmented risk of any CVD (HR, 1.77; 95% CI, 1.65-1.89) and an 82% augmented risk of MACE (HR, 1.82; 95% CI, 1.66-1.99).

The results also demonstrated that when compared with individuals without narcolepsy, patients with narcolepsy had an augmented risk of heart failure (HR, 1.64; 95% CI, 1.47-1.83), stroke (HR, 2.04; 95% CI, 1.82-2.29), atrial fibrillation (HR, 1.58; 95% CI, 1.40-1.77), and MI (HR, 1.64; 95% CI, 1.37-1.96).

“Using a large representative commercial insurance claims database, our study provides evidence that narcolepsy is an independent risk factor of CVD after comprehensive matching and adjustment for relevant confounders, including sleep apnea,” concluded the authors.

In a separate analysis of the same study population that controlled for the use of stimulants, oxybates, wake-promoting agents at baseline, and time-varying stimulant use, individuals who have narcolepsy had an 89% greater risk of CVD and a 95% greater risk of MACE.

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