Multidimensional symptoms and comprehensive diagnosis of pediatric narcolepsy combined with sleep apnea and two years follow-up: a case report

Abstract

Introduction: The characteristics of narcolepsy onset in children differs significantly from those of adults, and easily misdiagnosed for their multidimensional symptoms and concomitant diseases. Case Report and Results: A 6-year-old girl with multidimensional symptoms: typical symptoms of mood disorder, atypical symptoms of narcolepsy combined with rapid eye movement (REM) sleep behavioral disorder (RBD) and periodic limb movement (PLM), was diagnosed with narcolepsy type 1 and complex sleep apnea. Obstructive sleep apnea (OSA) caused by adenoid and tonsillar hypertrophy at baseline and central sleep apnea (CSA) after surgery of adenoid and tonsillar. After adenoidectomy and tonsillectomy, OSA remitted, excessive daytime sleepiness (EDS), RBD symptoms, mental symptoms and sleep structure were improved, but more PLMs and CSA presented and SORE multiple sleep latency test (MSLT) increased in this patient. During 2 years follow up, only behavioral managements were performed. The child had good social function, significant improvement in subjective EDS, occasional nocturnal sleep behavior abnormalities rated by scales two years later. Conclusion: It was important to monitor in time with multidimensional symptoms and follow up for a longer time during multidisciplinary treatments in children with narcolepsy. Exploration of regular personalized behavioral interventions might be benefit for them.