High bicarbonate levels in narcoleptic children
Patricia Franco1,2,3, Aurelie Junqua1,2,3,4, Anne Guignard-Perret1,2,3
1Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, University Lyon1, Lyon, France.
Insights
Narcoleptic children show higher plasma bicarbonate levels, potentially indicating hypoventilation. This finding may serve as a screening tool for prioritizing pediatric sleep evaluations.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Respiratory Physiology
Background:
- Narcolepsy is a chronic neurological disorder affecting sleep-wake regulation.
- Understanding associated physiological markers in pediatric narcolepsy is crucial for diagnosis and management.
- Previous research has not extensively explored plasma bicarbonate levels in children with narcolepsy.
Purpose of the Study:
- To investigate and compare plasma bicarbonate levels in children diagnosed with narcolepsy versus healthy controls.
- To explore the potential correlation between bicarbonate levels and narcolepsy symptoms or related conditions like obesity.
- To assess the utility of plasma bicarbonate levels as a potential biomarker for hypoventilation in pediatric narcolepsy.
Main Methods:
- Retrospective analysis of clinical and electrophysiological data from a pediatric reference center.
- Inclusion of 51 de-novo narcolepsy patients and 23 age- and sex-matched control subjects.
- Measurement and comparison of plasma bicarbonate, PCO2, and venous pH, alongside assessment of obesity and cataplexy prevalence.
Main Results:
- Narcoleptic children exhibited significantly higher plasma bicarbonate (P=0.02) and PCO2 (P<0.01), with lower venous pH (P<0.01) compared to controls.
- Elevated bicarbonate levels (>27 mmol L⁻¹) were observed in 41.2% of narcoleptic children versus 4.2% of controls (P=0.001).
- Higher bicarbonate levels correlated with increased sleepiness scores and were more prevalent in non-obese narcoleptic children.
Conclusions:
- Pediatric narcolepsy patients demonstrate elevated plasma bicarbonate levels compared to healthy children.
- These findings suggest potential hypoventilation contributing to respiratory acidosis, compensated by increased bicarbonate.
- Plasma bicarbonate may serve as a simple, valuable screening tool for identifying children who may benefit from sleep laboratory evaluation.
Abstract:
The objective of this study was to evaluate the levels of plasma bicarbonate levels in narcoleptic children. Clinical, electrophysiological data and bicarbonate levels were evaluated retrospectively in children seen in our paediatric national reference centre for hypersomnia. The cohort included 23 control subjects (11.5 ± 4 years, 43% boys) and 51 patients presenting de-novo narcolepsy (N) (12.7 ± 3.7 years, 47% boys). In narcoleptic children, cataplexy was present in 78% and DQB1*0602 was positive in 96%. The control children were less obese (2 versus 47%, P = 0.001). Compared with control subjects, narcoleptic children had higher bicarbonate levels (P = 0.02) as well as higher PCO2 (P < 0.01) and lower venous pH gas (P < 0.01). Bicarbonate levels higher than 27 mmol L(-1) were found in 41.2% of the narcoleptic children and 4.2% of the controls (P = 0.001). Bicarbonate levels were correlated with the Adapted Epworth Sleepiness Scale (P = 0.01). Narcoleptic patients without obesity often had bicarbonate levels higher than 27 mmol L (-1) (55 versus 25%, P = 0.025). No differences were found between children with and without cataplexy. In conclusion, narcoleptic patients had higher bicarbonate plasma levels compared to control children. This result could be a marker of hypoventilation in this pathology, provoking an increase in PCO2 and therefore a respiratory acidosis, compensated by an increase in plasma bicarbonates. This simple screening tool could be useful for prioritizing children for sleep laboratory evaluation in practice.
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