Early-Onset Cardiovascular Risks Linked to Narcolepsy, Suggests Study

The findings were published online in the Journal of the American Heart Association on 10 April 2025.

Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness, sudden loss of muscle tone (cataplexy), and disrupted nighttime sleep. While its impact on quality of life is well documented, emerging evidence suggests that narcolepsy may also be linked to adverse CVD outcomes. However, limited research has explored its associations with subclinical CVD, particularly in pediatric populations.

In this context, Rakesh Bhattacharjee, Department of Pediatrics, University of California San Diego School of Medicine, Rady Children's Hospital, La Jolla, CA, and colleagues aimed to assess the relationship between narcolepsy and early indicators of cardiovascular and metabolic dysfunction, including hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH), to better understand the broader health implications of the disorder from an early age.

For this purpose, the researchers conducted a retrospective cohort study using data from the MarketScan databases (2005–2021), including 22,293 patients with narcolepsy (types 1 and 2) and 63,709 matched controls. Narcolepsy was defined by at least two outpatient claims within one year, with one being nondiagnostic. The study evaluated the incidence of hypertension, hyperlipidemia, diabetes, NAFLD/NASH, and a composite measure of cardiovascular disease and major adverse cardiovascular events.

Based on the study, the researchers reported the following findings:

• Patients with narcolepsy had a 40% higher risk of developing hypertension compared to matched controls (HR 1.40).
• The risk of hyperlipidemia was 41% higher in the narcolepsy group (HR 1.41).
• Diabetes risk was elevated by 50% among those with narcolepsy (HR 1.50).
• The likelihood of developing NAFLD/NASH was 48% higher in patients with narcolepsy (HR 1.48).
• The risk for the composite cardiovascular disease outcome was increased by 61% (HR 1.61).
• Major adverse cardiovascular events were 69% more likely in individuals with narcolepsy (HR 1.69).
• These associations remained significant even after adjusting for narcolepsy medications, including stimulants, wake-promoting agents, and oxybates.
• There were similar elevated risks across all age groups, including patients younger than 25.

The study confirms that narcolepsy is linked to a higher risk of developing subclinical cardiovascular conditions—such as hypertension, hyperlipidemia, diabetes, and NAFLD/NASH—even as early as childhood. These associations remain significant regardless of other health conditions like obesity, sleep apnea, or depression and are not influenced by narcolepsy medications.

"The findings emphasize the importance of early cardiovascular monitoring in individuals with narcolepsy to help prevent serious heart-related complications later in life," the authors concluded.

Reference:

Kaufmann CN, Riaz M, Park H, Lo-Ciganic WH, Wilson D, Wickwire EM, Malhotra A, Bhattacharjee R. Narcolepsy Is Associated With Subclinical Cardiovascular Disease as Early as Childhood: A Big Data Analysis. J Am Heart Assoc. 2025 Apr 10:e039899. doi: 10.1161/JAHA.124.039899. Epub ahead of print. PMID: 40207482.