Rising pressure to understand the risks of hypertension in children with narcolepsy type 1

Most children/adolescents with narcolepsy type 1 (NT1) are treated with stimulants or modafinil, yet the cardiovascular effects of these medications have not been investigated in this population. We compared vital signs in youth with NT1 before and after exposure to stimulants/modafinil to test the hypotheses that these medications increase rates of elevated blood pressure (BP) and hypertension and that body mass index influences these outcomes.

In this retrospective study, we collected electronic medical data including vital signs and polysomnography/Multiple Sleep Latency Test results from 39 youth with NT1 aged 7-18 at 3 points over a 20-month period: baseline (drug-naïve/weaned), after initiating treatment, and after treatment optimization. We performed stepwise regression to determine predictors of baseline elevated BP/hypertension. We used McNemar's test and generalized estimating equations to assess the effects of stimulant/modafinil exposure on vital signs.

The prevalence of elevated BP/hypertension at baseline was 51% in our cohort and increased 21% from baseline to the final visit (P = .03). Systolic BP increased significantly with stimulant/modafinil exposure (P < .05), while diastolic BP and heart rate showed nonsignificant increases. Body mass index was associated with increased systolic BP and heart rate across the 3 time points but not at baseline.

Youth with NT1 are at risk for elevated BP/hypertension, particularly after stimulant/modafinil treatment. We recommend revising clinical guidelines to address this risk and advocate for controlled studies to better understand the cardiovascular risks and implications of these treatments in pediatric NT1.

Montesano E, Garcia ME, Lyon S, et al. Rising pressure to understand the risks of hypertension in children with narcolepsy type 1. J Clin Sleep Med. 2025;21(6):1081-1091.