Sleepiness and performance in narcolepsy

Previous attempts to investigate the relationship between sleepiness and performance for subjects with narcolepsy have been limited by both the ability of narcoleptic subjects to contain their sleepiness for brief testing periods and the potential lack of sensitivity of routine performance tasks to sleepiness induced changes. The present study developed a research protocol which allowed subjects with narcolepsy to express states of sleepiness and non sleepiness and to then compare the performance of subjects with narcolepsy to age, gender and IQ matched controls on tasks evaluating automatic, attentional and complex cognitive functioning. The results indicated that at high arousal subjects with narcolepsy performed as well as controls on automatic tasks suggesting that the capacity to perform for narcolepsy subjects is not restricted by physiological factors but is secondary to the effects of sleepiness. Comparison of both the within subject effects for narcolepsy subjects of the transition between high and low arousal states, and the between subject effects of low arousal for narcolepsy subjects compared to controls indicate that complex cognitive tasks are the most sensitive to arousal fluctuation. This study provides support for the subjective experiences of subjects with narcolepsy of diminished cognitive function associated with the disorder.