Discussing the Importance of Lowering Sodium for Narcolepsy Patients

At Jazz, we push ourselves and other stakeholders to think holistically about patients’ health to minimize the risk of patient co-morbidities and address significant unmet needs. As a pioneer in sleep medicine, Jazz has been at the forefront of providing therapies and support for people living with serious, debilitating neurologic disorders around the world, collaborating with leading physicians and supporting education on the needs of—and solutions for—people living with sleep disorders.

Narcolepsy is a chronic neurological condition that can have a far-reaching impact on an individual’s life, often requiring long-term treatment to help manage symptoms. Those with narcolepsy live with a complex and severe disorder, and often must combat excessive daytime sleepiness (EDS) and associated symptoms — but the challenges they face in living a healthy life are not only limited to sleep. Research has shown a higher prevalence of certain co-morbid medical conditions among people with narcolepsy, including hypertension, cardiovascular disease, obesity and diabetes.^1-4

It is crucial to raise awareness and increase education of the often-overlooked co-morbidities associated with narcolepsy among the greater narcolepsy community. To learn more about the disease burden patients face, Jazz’s own Todd Kirby, PhD, Senior Director, Global Development Lead, Sleep and CNS spoke with sleep specialist Richard K. Bogan, MD, FCCP, FAASM, Associate Clinical Professor at the University of South Carolina School of Medicine and Medical University of South Carolina in Charleston, South Carolina.

Todd Kirby, PhD, Senior Director, Global Development Lead, Sleep and CNS, Jazz Pharmaceuticals: Getting a good night’s sleep is an important piece of cardiovascular health, as it allows the body to rest. However, for those living with narcolepsy, getting healthy sleep can be tremendously difficult due to its debilitating symptoms.⁵ Can you share how narcolepsy affects the heart?

Richard K. Bogan, MD, FCCP, FAASM, Associate Clinical Professor at the University of South Carolina School of Medicine: The primary symptoms of narcolepsy include EDS, cataplexy, disrupted nighttime sleep, sleep-related hallucinations, and sleep paralysis.⁶ These symptoms may cause sleep interruptions in patients, which can have a negative impact on heart health. As we sleep, our blood pressure lowers naturally. Studies have shown that people who do not experience this lowering in blood pressure, which is prevalent in people with narcolepsy, have a heightened cardiovascular risk.⁷

Moreover, research has shown that inadequate sleep triggers a part of the brain that plays a role in hunger and appetite, which may cause obesity in narcolepsy patients, as individuals with sleep-wake abnormalities typically have a higher calorie intake.^8,9 Additional research is needed to better understand the link between narcolepsy and heart health, but existing studies show that its vital people living with the disorder are aware of the risks.

Dr. Todd Kirby: How can people living with narcolepsy work with their physicians to help manage their heart health?

Dr. Bogan: One way is knowing the importance of closely monitoring and reducing their sodium intake. The American Heart Association recommends a daily sodium intake not to exceed 2,300 milligrams, with an ideal limit of 1,500 milligrams.¹⁰ Guidance from the U.S. Food and Drug Administration on sodium reduction in food stated Americans consume on average 3,400 milligrams of sodium per day—nearly 50% more than the recommended limit for people 14 years and older.¹¹

Although food and beverages are common sources of sodium consumption, some medications, including one used to treat narcolepsy, can also have high levels of sodium, which can play a role in affecting the heart health of narcolepsy patients.^12,13 Given these risks, narcolepsy patients have to be aware of the amount of sodium they consume in their diet as well as the medications they take.

Dr. Todd Kirby: In addition to being mindful of sodium intake, what are some lifestyle choices that patients with narcolepsy can take to improve their heart health?

Dr. Bogan: In addition to lowering sodium intake, it’s important for those with narcolepsy to make healthy lifestyle choices to maximize their heart health. This includes eating a heart-healthy diet that includes fruits and vegetables, whole grains and lean meats, plus getting regular exercise throughout the week.¹⁴

Further, they should try to develop healthy sleep habits. This can be difficult for people with narcolepsy based on the nature of the condition, which can include stress, mood disruptors and pain. The best thing for sleepiness is sleep, and with narcolepsy patients having a better understanding of the circadian sleep cycle, they can develop a sleep routine that could help with reducing stress levels before bed and co-morbid risks.^15,16 If we can protect a patient’s heart through education and conversation, it goes a long way in preventing further damage to their overall health.

For more information on the co-morbid risks in narcolepsy, patients should visit MoreThanTired.com.

References

1. Black J, Reaven NL, Funk SE, et al. Medical comorbidity in narcolepsy: findings from the Burden of Narcolepsy Disease (BOND) study. Sleep Med. 2017;33:13-18. doi:10.1016/j.sleep.2016.04.004.
2. Ohayon MM. Narcolepsy is complicated by high medical and psychiatric comorbidities: a comparison with the general population. Sleep Med. 2013;14(6):488-492. doi:10.1016/j.sleep.2013.03.002.
3. Cohen A, Mandrekar J, St Louis EK, Silber MH, Kotagal S. Comorbidities in a community sample of narcolepsy. Sleep Med. 2018;43:14-18. doi:10.1016/j.sleep.2017.11.1125.
4. Jennum P, Ibsen R, Knudsen S, Kjellberg J. Comorbidity and mortality of narcolepsy: a controlled retro- and prospective national study. Sleep. 2013;36(6):835-840. doi:10.5665/sleep.2706.
5. Ahmed I, Thorpy, M. Clinical Features, Diagnosis and Treatment of Narcolepsy. Clin Chest Med. 2010;31(2):371-381.
6. National Institute of Neurological Disorders and Stroke (NINDS). Narcolepsy Fact Sheet. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/fact-sheets/narcolepsy-fact-sheet. Accessed March 2022.
7. Dauvilliers Y, Jaussent I, Krams B, et al. Non-dipping blood pressure profile in narcolepsy with cataplexy. PLoS One. 2012;7(6):e38977. doi:10.1371/journal.pone.0038977.
8. Chabas D, Foulon C, Gonzalez J, et al. Eating disorder and metabolism in narcoleptic patients. Sleep. 2007;30(10):1267-1273. doi:10.1093/sleep/30.10.1267.
9. Centers for Disease Control and Prevention. Prevent Heart Disease. https://www.cdc.gov/heartdisease/prevention.html. Accessed March 2022.
10. U.S. Food and Drug Administration. Sodium in Your Diet: Use the Nutrition Facts Label and Reduce Your Intake. Silver Spring, MD: U.S. Food and Drug Administration; 2016. Accessed March 2022.
11. Center for Food Safety and Applied Nutrition. Sodium Reduction. U.S. Food and Drug Administration; 2021. Accessed March 2022.
12. Perrin G, Korb-Savoldelli V, Karras A, Danchin N, Durieux P, Sabatier B. Cardiovascular risk associated with high sodium-containing drugs: A systematic review. PLoS One. 2017;12(7):e0180634. Published 2017 Jul 6. doi:10.1371/journal.pone.0180634.
13. Quader ZS, Zhao L, Gillespie C, et al. Sodium intake among persons aged ≥2 years — United States, 2013–2014. MMWR Morb Mortal Wkly Rep. 2017;66:324–238. DOI: http://dx.doi.org/10.15585/mmwr.mm6612a3.
14. Centers for Disease Control and Prevention. Prevent Heart Disease. https://www.cdc.gov/heartdisease/prevention.html. Accessed March 2022.
15. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23-36. doi:10.1016/j.smrv.2014.10.001.
16. Choi DW, Chun SY, Lee SA, Han KT, Park EC. Association between sleep duration and perceived stress: salaried worker in circumstances of high workload. Int J Environ Res Public Health. 2018;15(4):796. doi:10.3390/ijerph15040796.