High sodium may pose added risks to people with narcolepsy

People with narcolepsy or idiopathic hypersomnia (IH) frequently have cardiovascular, metabolic, and kidney-related conditions that may increase their vulnerability to the effects of sodium exposure from diet or medications, according to a large U.S. study.

Researchers found that almost 70% of people with narcolepsy or IH had at least one sodium-relevant risk factor, with high blood pressure, diabetes, obesity, and chronic kidney disease among the conditions occurring significantly more often than in individuals without these sleep disorders.

“Careful consideration of overall health in the management of individuals with narcolepsy and IH, including strategies to reduce sodium intake from diet and medications, may help reduce clinical burden and improve patient outcomes,” the researchers wrote.

The study, “Sodium-relevant comorbidity risk factors are highly prevalent in individuals with narcolepsy or idiopathic hypersomnia,” was published in Sleep Medicine.

Narcolepsy is a neurological disorder that affects the brain’s ability to regulate sleep-wake cycles. Narcolepsy symptoms include excessive daytime sleepiness and sleep-related, cognitive, and mood issues.

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Studies have shown that people with narcolepsy or IH (excessive daytime sleepiness due to unknown causes) are often at an elevated risk for developing kidney, cardiovascular, and cardiometabolic (linking the cardiovascular and metabolic systems) issues. This risk may be further increased by sodium in food and medications.

Researchers used an administrative claims database to analyze sodium-relevant risk factors for clinical outcomes among individuals with either narcolepsy or IH between 2016 and 2024.  The risk factors were analyzed in the year before diagnosis.

The study involved 29,317 people with narcolepsy and 146,585 controls without the disease, with similar age, sex, and race/ethnicity. Participants with narcolepsy had a mean age of 41 and were mostly women (62.1%) and white (77.8%). Most had narcolepsy type 2 (75.8%).

The narcolepsy group more commonly had mental health conditions (40.9% vs. 15.7%), including anxiety, depression, and mood disorders, than those without the disease. They also more frequently had chronic lung disease (19.4% vs. 9.6%) and hypothyroidism (underactive thyroid, 14.7% vs 8.5%).

Overall, 69.2% of narcolepsy patients and 43.6% of controls had at least one sodium-relevant risk factor. Slightly less than half (45.1%) of the patients had two or more risk factors, and 29.6% had three or more. These included cardiovascular risk factors (40.8% vs. 27.8%) such as high blood pressure, atherosclerosis (hardening of arteries from plaque buildup) and heart failure; cardiometabolic risk factors (49.9% vs 35.8%) including diabetes/obesity, and high blood levels of fats; and kidney-related risk factors (5.3% vs. 3%) such as chronic kidney disease.

People with narcolepsy were also more likely to have sleep apnea, a condition in which breathing repeatedly stops and starts during sleep (35.7% vs. 5.1%) and liver cirrhosis, or irreversible liver scarring (0.4% vs. 0.2%). The most frequent combinations of risk factors included sleep apnea, hypertension, diabetes/obesity, and high blood levels of fats.

The study also enrolled 11,951 IH patients and 59,755 matched controls. Similar to the narcolepsy group, mental health issues, chronic lung disease, and hypothyroidism were more common in IH patients than in controls.

Those with IH also had a higher prevalence of at least one sodium-relevant risk factor relative to their controls (74.4% vs 43%), including cardiovascular (40.2% vs. 26.5%), cardiometabolic (51.8% vs. 35.3%), and kidney-related (4.2% vs 2.6%) conditions. Likewise, sleep apnea and liver cirrhosis were more frequent in this group, and their most common combinations of risk factors were the same as those identified in narcolepsy patients.

“This study highlights the high prevalence of sodium-relevant comorbidities in individuals with narcolepsy or IH,” the scientists concluded. “Those with pre-existing comorbidities may face a greater risk of complications over time, which can be worsened by excess sodium intake from diet or medications.”