Narcolepsy in children Relationship to the H1N1 influenza vaccination, association with psychiatric and cognitive impairments and consequences in daily life Attila Szakács Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg Gothenburg, 2016 1 Cover: the figure illustrates the role of hypocretin (HCRT) in the regulation of awake-sleep. The brain model is illustrated by Attila Szakács. Narcolepsy in children – relationship to the H1N1 influenza vaccination, association with psychiatric and cognitive impairments and consequences in daily life © Attila Szakács, 2016
[email protected] ISBN 978-91-628-9902-8 (print) ISBN 978-91-628-9903-5 (PDF) Printed in Gothenburg, Sweden, 2016 Ineko AB, Gothenburg 2 To my angel and lovely wife, Valéria, and our wonderful daughters, Beatrix and Brigitta 3 4 ABSTRACT Background/aims: Narcolepsy is a lifelong sleep disorder with an onset most frequently in the second decade of life. The cardinal symptoms are excessive daytime sleepiness, cataplexy, hypnagogic and hypnopompic hallucinations sleep paralysis and disturbed nighttime sleep. The purpose of this thesis was to study a population-based cohort of children and adolescents with narcolepsy in western Sweden to determine the incidence and relationship with the H1N1 influenza vaccination, psychiatric comorbidity, cognitive profile, health-related quality of life, adaptive behavior and parenting stress. Methods: We aimed to identify all individuals below 18 years of age who developed narcolepsy between January 1, 2000, and December 31, 2010. Post-H1N1 influenza vaccination (PHV) narcolepsy was considered in patients with clinical onset within 10 months of vaccination. Psychiatric comorbidity was investigated using a test battery of semi-structured interviews and screening tools.