Audio Transcript Auto-generated
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Hi everyone.
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So I'm gonna be going over sleep wake disorders and specifically narcolepsy.
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So to begin what our sleep wake disorders.
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Well according to the Ds um there are disorders that
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cause problems with timing quality and or amount of sleep
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which can result in daytime distress or impairments in daily functioning.
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And in the D. S. M. There are 10 categories
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and for the most part they take on a lumping approach.
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But there are also some disorders such as narcolepsy, that have their own category
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and then for some history. So in the past even as far as ancient Greece,
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sleep disorders weren't considered
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mental disorders.
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Instead it was believed that physical illness
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or poor nutrition could lead to sleep problems
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and
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sleep is also seen as a passive process.
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But that changed in 1953 with the discovery of rapid eye movement
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which saw sleep as an active process.
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And then also during this time narcolepsy was the only sleep problems of interest
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and all others were seen as manifestations of psychiatric problems.
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And then in 1979 there was the first classification for sleep disorders
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called the diagnostic classification of sleep and arousal.
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And then in 1990 the American Academy of Sleep Medicine
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came out with the international classification of sleep disorders.
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And they are currently on their 3rd edition.
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So currently
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for diagnosing instead of just diagnosing symptoms.
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It's trying to move towards using biomarkers and electro physiological testing.
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So next I'll go over some of the criteria
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for being diagnosed with narcolepsy.
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So in the D. S. M.
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Five is characterized by excessive daytime sleepiness with one of the following.
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So cataplexy which I'll explain in the next slide
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and then cerebral spinal fluid hypocrite and efficiency.
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And then there's also some requirements for sleep latency
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based on the nocturnal polisario graph and the multiple sleep latency test.
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And that's basically how long it takes to fall asleep or how long it takes to reach. R.
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E. M.
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And then the I. C. S. D.
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Three has more objective data in addition to excessive daytime sleepiness.
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Um But the main difference from the D. S. M.
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Five is that there are distinct divisions of narcolepsy type one and type two.
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So next we'll go into the different types.
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So type one is diagnosed by either CSF hypocrite in one deficiency
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or a sleep a mean sleep latency of less than eight minutes.
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On the multiple sleep latency test. And there also has to be clear cataplexy
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which is more than one episode of brief
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sudden loss of muscle tone with retained consciousness
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and then type two it's the same sleep latency requirement but
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cataplexy has to be absent. And there can't be
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um
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CSF Hipaa creatine levels that meet type one.
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So then next for the ideology. So the peak ages are 14 and 15.
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But some research some researchers suggest a bimodal
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peak where peaks again at 35 years old
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and then hipaa creatine is a neuro peptide
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that promotes wakefulness food intake and energy expenditure.
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And as we've seen that's a main problem for those with Type one narcolepsy,
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there's also
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a gene that is linked to narcolepsy and it's a human leukocyte antigen or H. L. A.
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And
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this might act as an antigen
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presenter to T cell receptors
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which could result in narcolepsy susceptibility
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And this is on chromosome six
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and most of type one individuals have it
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And then half of type two individuals have it.
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Also there are polymorphisms that might affect immune regulatory response
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and there's speculation that the autoimmune processes might have a
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crucial role in the loss of hypocrisy in neurons.
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In addition,
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infections and vaccines might trigger autoimmune mediated mechanisms
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and I'll talk more about that in the next slide.
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So for the epidemiology,
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so the incidence is less than two people per year globally get diagnosed with it
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and that's mainly for type one because type two is under reported
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and the prevalence is 20 to 50 in
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Every 100,000 people. So it's a pretty rare disorder
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and there are some areas that have higher and lower prevalence is,
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So the lowest prevalence is seen in Israel which is .23 out of every 100,000 people
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and then the highest is seen in japan
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And they have a prevalence of 163 out of 100,000 people.
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And there have been increases in
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the amount of cases of narcolepsy after the h. one n. One pandemic
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and then
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narcolepsy is predominantly a sporadic disorder.
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So
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that means that there really isn't
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a pattern
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and it's diagnosed pretty infrequently.
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Um but there is a higher risk for relatives.
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So for first degree relatives there's about a 1-2% risk
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which is 10-40 times greater than the general population.
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And then for Mona's exotic twins, it's a 32% concordance rate.
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So then that means that environment plays a really
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crucial role in the development of this disorder.
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So some cultural considerations before the H. one n.
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One pandemic European Children should the highest incidence rate.
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But after it started to shift towards the asian population.
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And then in the US there's a higher frequency seen in
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females non hispanic blacks and individuals living in the south.
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But again this it's kind of unknown why this is because it is a sporadic disorder.
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So next some treatments
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for excessive daytime sleepiness.
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There are some behavioral strategies that are recommended and
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that includes avoiding sedentary activities
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maintaining regular sleep schedule,
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avoid driving or dangerous work situations
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and then caffeine might help to combat excessive daytime sleepiness.
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But that has a limited effect. And
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there aren't really any behavioral strategies for cataplexy.
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Um It's suggested that they try to avoid situations
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that might trigger tax but that's rarely effective.
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So for medications the first line of treatment is
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modafinil
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for excessive daytime sleepiness and this is FDA approved.
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Um It may enhance activity of wake promoting
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neurons by increasing extra cellular concentration of dopamine
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but the mechanism of action is unclear.
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And then for excessive daytime sleepiness and cataplexy.
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The FDA approved sodium oxide bait
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and
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this can improve sleep quality,
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increased slow wave sleep
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and promote wakefulness.
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But this has to be used with caution because sodium oxide
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is also known as the date rape drug.
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Um And then antidepressants can also be used. But this isn't FDA approved
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but
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by blocking norepinephrine and serotonin re uptake it can help too
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reduced rem sleep and cataplexy.
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And then for type two there aren't any
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studies that specifically focus on Type two patients.
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But because excessive daytime sleepiness is the main
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symptom
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this
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The specific treatments for excessive daytime sleepiness can be used for type two.
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So modafinil
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So for the future what needs to be done?
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So it really isn't known why the H1N1 vaccine
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or the pandemic in general caused increased cases.
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So further investigation needs to be done especially
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because we're currently going through another pandemic.
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Also in terms of path of physiology.
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T cell mediated autoimmune processes seem to be the main pathway, but more
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research needs to be done
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and animal models can
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help with that.
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Also in general
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For type two there isn't unknown ideology
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and overall there is limited information.
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So more research needs to be focused on
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Type two and on the cause
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And then for treatments because for type one.
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Hipaa creatine deficiency is the main is one of the main causes
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um treatments based on
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HipAA cretins specifically like replacement therapy or hypocrite in
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cell transplantation or hypocrisy in gene therapy might be helpful
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so far.
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A lot of it has been successful in animal models,
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but it's been less successful for humans.
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And then
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immune based therapies might also want to be
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research further
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because of
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the
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potential for vaccines
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and infections to cause narcolepsy.
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So I mean based therapies might reverse the effects of the
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of the vaccines or the infection
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and then psycho stimulants have also been researched to
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help with the symptoms of
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narcolepsy.
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And then here are my references.