ADVERTISEMENT
CURRENT ISSUE
AUGUST 2014
KINDLE EDITION



SEARCH JOURNAL ARCHIVES


SEARCH PUBMED


MANUSCRIPT SUBMISSIONS


SUBSCRIBE TO SLEEP

CONTINUING MEDICAL EDUCATION


ADVERTISE WITH US


ABOUT SLEEP

ABSTRACT SUPPLEMENTS


ACCEPTED PAPERS
Bookmark and Share         RSS Feed

VOLUME 28, ISSUE 06


Risks of High-Dose Stimulants in the Treatment of Disorders of Excessive Somnolence: A Case-Control Study

R. Robert Auger, MD1,2; Scott H. Goodman, MD1,3; Michael H. Silber, MBChB1,3; Lois E. Krahn, MD4; V. Shane Pankratz, PhD5; Nancy L. Slocumb1

1Sleep Disorders Center, Mayo Clinic College of Medicine, Rochester, MN; 2Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN; 3Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN; 4Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Scottsdale, AZ; 5Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN



  Expand  Table of Contents    
Text size:  
Study Objectives:

To ascertain complications associated with high-dose stimulant therapy in patients with narcolepsy or idiopathic hypersomnia.

Design:

Case-control, retrospective chart review.

Setting:

Sleep center in an academic hospital.

Patients:

116 patients with narcolepsy or idiopathic hypersomnia were individually matched by sex, diagnosis, age of onset, and duration of followup from both onset and diagnosis. Members of the high-dose group (n = 58) had received at least 1 stimulant at a dosage ≥ 120% of the maximum recommended by the American Academy of Sleep Medicine Standards of Practice Committee. The standard-dose control group (n = 58) had received stimulants at a dosage ≤ 100% of the American Academy of Sleep Medicine guidelines.

Interventions:

N/A.

Measurements and Results:

The prevalence of psychosis (odds ratio = 12.0 [1.6-92.0]), alcohol or polysubstance misuse (odds ratio = 4.3 [1.2- 15.2]), and psychiatric hospitalization (odds ratio = 3.2 [1.1-10.0]) was significantly increased in the high-dose group. More high-dose patients also experienced tachyarrhythmias (odds ratio = 3.3 [0.92-12.1] and anorexia or weight loss (odds ratio = 11.0 [1.4-85.2]). The frequency of physiciandiagnosed depression, drug-seeking and suicide-related behaviors, hypertension, and cardiovascular disease did not differ significantly between the groups.

Conclusions:

This study demonstrated a significantly higher occurrence of psychosis, substance misuse, and psychiatric hospitalizations in patients using high-dose stimulants compared to those using standard doses. Tachyarrhythmias and anorexia or weight loss were also more common in this group as compared with controls. Clinicians should be very cautious in prescribing dosages that exceed maximum guidelines.

Expand  Table of Contents
ADVERTISEMENT
Classifieds View SLEEP 2011 Poster Presentations Online