![]() Clinicians should evaluate patients to uncover possible causes of their reported inability to stay awake during the day. Patients may refer to their EDS symptoms as fatigue, tiredness, or lack of energy, which are features of many conditions. ![]() 3ĮDS: The inability to maintain a wakeful state throughout the day, with involuntary lapses into sleep during waking hours. However, this allele is also present in 12% to 38% of the unaffected general population, limiting the current clinical utility of HLA typing. Up to 95% of patients with Type 1 narcolepsy have at least 1 HLA-DQB1*0602 allele. 3Ī second pathophysiologic mechanism in Type 1 narcolepsy is autoimmune with a genetic component. This explains the appearance of sleep paralysis in conjunction with hallucinations and cataplexy, all at the point of waking or falling asleep. ![]() 6 Decreased secretion of hypocretin not only reduces daytime alertness but also interferes with REM sleep, allowing for a blending of the sleep/wake states. 3,5,6 In patients with Type 1 narcolepsy associated with cataplexy, the number of Hcrt neurons in the hypothalamus are severely reduced thereby suppressing excitation of certain neurons that support differentiation of sleep/wake states. Research into Type 1 narcolepsy with cataplexy has revealed that many patients have a deficiency in hypocretin, also known as orexin or Hcrt, a neuropeptide hormone produced in the lateral hypothalamus that stabilizes the sleep/wake cycle and promotes wakefulness. ![]()
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