Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review
Obstructive sleep apnea syndrome (OSAS) and narcolepsy are sleep disorders that commonly present with excessive daytime sleepiness (EDS). OSAS is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxia and sleep fragmentation. Narcolepsy is a chronic sleep-w...
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Frontiers Media S.A.
2025-04-01
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| author | Simin Zou Xiaomei Zhang Yinping Shen Zhongxia Shen Zhong Wang Benhong Wang |
| author_facet | Simin Zou Xiaomei Zhang Yinping Shen Zhongxia Shen Zhong Wang Benhong Wang |
| author_sort | Simin Zou |
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| description | Obstructive sleep apnea syndrome (OSAS) and narcolepsy are sleep disorders that commonly present with excessive daytime sleepiness (EDS). OSAS is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxia and sleep fragmentation. Narcolepsy is a chronic sleep-wake disorder characterized by EDS, cataplexy, vivid hallucinations, and sleep paralysis. The overlap of symptoms can lead to misdiagnosis and delayed appropriate treatment. We report two male patients who initially presented with symptoms suggestive of OSAS, including loud snoring, witnessed apneas, and significant daytime sleepiness. Despite appropriate OSAS management with continuous positive airway pressure (CPAP), both patients continued to experience EDS and reported episodes of cataplexy, sleep paralysis, and vivid dreams. Polysomnography (PSG) confirmed mild to moderate OSAS, and multiple sleep latency tests (MSLT) revealed mean sleep latencies of less than 5 min with multiple sleep-onset REM periods (SOREMPs). Based on the presence of cataplexy and MSLT findings, narcolepsy type 1 (NT1) was diagnosed in both cases. Treatment with modafinil in conjunction with CPAP therapy led to significant improvement in symptoms and quality of life. These cases highlight the importance of considering narcolepsy in patients with persistent EDS despite adequate OSAS treatment. Coexistence of NT1 and OSAS can obscure the diagnosis of narcolepsy, leading to delays in appropriate management. Comprehensive evaluation, including detailed patient history and sleep studies, is crucial. Combined therapy targeting both conditions may be effective in managing symptoms and improving patient outcomes. |
| format | Article |
| id | doaj-art-dbb5007d69f3422a977ce2b35ce6027b |
| institution | OA Journals |
| issn | 1662-453X |
| language | English |
| publishDate | 2025-04-01 |
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| series | Frontiers in Neuroscience |
| spelling | doaj-art-dbb5007d69f3422a977ce2b35ce6027b2025-08-20T02:09:35ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2025-04-011910.3389/fnins.2025.15639121563912Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature reviewSimin Zou0Xiaomei Zhang1Yinping Shen2Zhongxia Shen3Zhong Wang4Benhong Wang5Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, ChinaDepartment of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, ChinaDepartment of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, ChinaDepartment of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, ChinaPeking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, ChinaDepartment of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, ChinaObstructive sleep apnea syndrome (OSAS) and narcolepsy are sleep disorders that commonly present with excessive daytime sleepiness (EDS). OSAS is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxia and sleep fragmentation. Narcolepsy is a chronic sleep-wake disorder characterized by EDS, cataplexy, vivid hallucinations, and sleep paralysis. The overlap of symptoms can lead to misdiagnosis and delayed appropriate treatment. We report two male patients who initially presented with symptoms suggestive of OSAS, including loud snoring, witnessed apneas, and significant daytime sleepiness. Despite appropriate OSAS management with continuous positive airway pressure (CPAP), both patients continued to experience EDS and reported episodes of cataplexy, sleep paralysis, and vivid dreams. Polysomnography (PSG) confirmed mild to moderate OSAS, and multiple sleep latency tests (MSLT) revealed mean sleep latencies of less than 5 min with multiple sleep-onset REM periods (SOREMPs). Based on the presence of cataplexy and MSLT findings, narcolepsy type 1 (NT1) was diagnosed in both cases. Treatment with modafinil in conjunction with CPAP therapy led to significant improvement in symptoms and quality of life. These cases highlight the importance of considering narcolepsy in patients with persistent EDS despite adequate OSAS treatment. Coexistence of NT1 and OSAS can obscure the diagnosis of narcolepsy, leading to delays in appropriate management. Comprehensive evaluation, including detailed patient history and sleep studies, is crucial. Combined therapy targeting both conditions may be effective in managing symptoms and improving patient outcomes.https://www.frontiersin.org/articles/10.3389/fnins.2025.1563912/fullnarcolepsyobstructive sleep apnea syndromeexcessive daytime sleepinesscataplexymodafinil |
| spellingShingle | Simin Zou Xiaomei Zhang Yinping Shen Zhongxia Shen Zhong Wang Benhong Wang Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review Frontiers in Neuroscience narcolepsy obstructive sleep apnea syndrome excessive daytime sleepiness cataplexy modafinil |
| title | Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review |
| title_full | Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review |
| title_fullStr | Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review |
| title_full_unstemmed | Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review |
| title_short | Case Report: Narcolepsy patients masked behind obstructive sleep apnea syndrome (OSAS): report of 2 cases and literature review |
| title_sort | case report narcolepsy patients masked behind obstructive sleep apnea syndrome osas report of 2 cases and literature review |
| topic | narcolepsy obstructive sleep apnea syndrome excessive daytime sleepiness cataplexy modafinil |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2025.1563912/full |
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