Ask AI
Back Back
Narcolepsy and Idiopathic Hypersomnia
Why Are Patients With Narcolepsy and Idiopathic Hypersomnia at Increased Cardiovascular Risk?

Released: July 11, 2025

Expiration: July 10, 2026

Virend Somers
Virend Somers, MBChB, DPhil
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • The American Heart Association recently recognized the importance of good quality sleep as a key contributor to cardiovascular (CV) health by including sleep as one of Life’s Essential 8.
  • Patients with narcolepsy and idiopathic hypersomnia (IH) are at increased risk of cardiometabolic and CV comorbidities such as diabetes, hyperlipidemia, hypertension, heart attack, and stroke.
  • Treatment initiation with high-sodium oxybate may increase the risk for new-onset hypertension.
  • Emerging data suggest that replacing high-sodium oxybate with low-sodium oxybate may lower 24-hour blood pressure.
  • CV risk evaluation and management are not part of the standard of care in narcolepsy and IH, suggesting that these patients may experience enormous potential benefit from a revised and holistic approach to their care. 
  • Healthcare professionals should consider aggressive CV risk factor modification and implications of pharmacologic therapy to mitigate heightened CV risk in patients with narcolepsy and patients with IH.

Studies show that patients with narcolepsy have an increased cardiovascular (CV) risk, including heart attack, stroke, and hypertension. In the cross-sectional BOND study comparing people with narcolepsy (n = 9312) and matched control patients (n = 46,559) using 5 years of administrative insurance claims data, patients with narcolepsy experienced a 2-fold increase in healthcare utilization (eg, inpatient admissions, emergency department, and outpatient visits). Subsequently, the CV-BOND study sought to build upon these earlier findings to determine whether patients with narcolepsy were at increased risk for new-onset CV events. Data from patients with narcolepsy (n = 12,816) and matched control patients (n = 38,441) confirmed a higher prevalence of baseline comorbidities, including diabetes, obesity, hyperlipidemia, and prior cardiovascular disease (CVD) in narcolepsy. Furthermore, the likelihood of patients having new-onset heart failure, stroke, or major adverse cardiac events (MACE) was significantly increased in the narcolepsy group after adjusting for age, sex, region, insurance type, and relevant comorbidities. These findings were confirmed in a similar recent study comparing patients with narcolepsy (n >34,000) and non-narcolepsy control patients (n >100,000). Significant findings included an increased risk of 100% in stroke, 82% in MACE, 77% in any CVD, 64% in heart failure, 64% in myocardial infarction, and 58% in atrial fibrillation.

Like narcolepsy, patients with idiopathic hypersomnia (IH) also have a heightened likelihood of CVD, CV procedures, and metabolic diseases such as hyperlipidemia and diabetes. In an administrative claims study of patients with IH (n >11,000) vs closely matched control patients (n >57,000), IH was associated with heightened risk of hypertension, stroke, myocardial infarction, MACE, heart failure, and atrial fibrillation.

Pharmacotherapy for Narcolepsy and Increased CV Risk
The role of medications in increased CV risk remains to be fully defined. Narcoleptic medications may increase blood pressure via sympathetic stimulation or high levels of sodium. Indeed, recent data from an administrative claims analysis suggest that those with narcolepsy initiating treatment with high-sodium oxybate face an increased risk of new-onset hypertension compared with those not being treated with high-sodium oxybate. In addition, this risk was evident among those without a history of CVD. Recent data suggest that replacing high-sodium oxybate with low-sodium oxybate may lower 24-hour ambulatory blood pressure. 

The mechanisms underlying this increased prevalence and incidence of CVD among patients with narcolepsy and patients with IH must be better understood. For example, factors such as short sleep duration, poor sleep quality, excessive daytime somnolence, and narcolepsy type I–associated orexin abnormalities may be implicated. From a blood pressure perspective, in these patients, the normal reduction of blood pressure during sleep may be impaired because of a nondipping blood pressure profile. There are compelling data that link nondipping blood pressure patterns to an increased overall CV risk.

In summary, data discussed here strongly suggest that healthcare professionals should consider aggressive CV risk factor modification and careful choice of pharmacotherapy to mitigate evident and heightened CV risk in patients with narcolepsy or IH.  

Your Thoughts?
In treating patients with narcolepsy or IH, have you modified their treatment to address increased CV risk? Get involved in the conversation by answering the polling question or posting a comment below.

Continue

Poll

1.

When making treatment decisions for a patient with narcolepsy or IH, how frequently do you consider CV risk?

Submit