Increased incidence of pediatric narcolepsy following the 2009 H1N1 pandemic: a report from the pediatric working group of the sleep research network

Narong Simakajornboon; Emmanuel Mignot; Kiran Maski; Judith Owens; Carol Rosen; Sally Ibrahim; Fauziya Hassan; Ronald D Chervin; Gayln Perry; Lee Brooks; Leila Kheirandish-Gozal; David Gozal; Thornton Mason; Althea Robinson; Beth Malow; Kamal Naqvi; Maida L Chen; Supriya Jambhekar; Ann Halbower; Katharina Graw-Panzer; Ehab Dayyat; Jenny Lew; Cecilia Melendres; Suresh Kotagal; Sejal Jain; Elizabeth Super; Thomas Dye; Md Monir Hossain; Dawit Tadesse

doi:10.1093/sleep/zsac137

Increased incidence of pediatric narcolepsy following the 2009 H1N1 pandemic: a report from the pediatric working group of the sleep research network

Sleep. 2022 Sep 8;45(9):zsac137. doi: 10.1093/sleep/zsac137.

Authors

Narong Simakajornboon^{1

2}, Emmanuel Mignot³, Kiran Maski⁴, Judith Owens⁴, Carol Rosen⁵, Sally Ibrahim⁵, Fauziya Hassan⁶, Ronald D Chervin⁶, Gayln Perry⁷, Lee Brooks⁸, Leila Kheirandish-Gozal⁹, David Gozal⁹, Thornton Mason⁸, Althea Robinson¹⁰, Beth Malow¹⁰, Kamal Naqvi¹¹, Maida L Chen¹², Supriya Jambhekar¹³, Ann Halbower¹⁴, Katharina Graw-Panzer¹⁵, Ehab Dayyat¹⁶, Jenny Lew¹⁷, Cecilia Melendres¹⁸, Suresh Kotagal¹⁹, Sejal Jain²⁰, Elizabeth Super²¹, Thomas Dye^{1

2}, Md Monir Hossain²², Dawit Tadesse²²

Affiliations

¹ Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
² Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA.
⁴ Department of Neurology, Boston Children's Hospital, Boston, MA, USA.
⁵ Department of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children's of University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
⁶ Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA.
⁷ Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
⁸ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁹ Department of Child health and Child Health Research Institute, University of Missouri Health Center, Columbia, MO, USA.
¹⁰ Sleep Disorders Center, Vanderbilt University, Nashville, TN, USA.
¹¹ Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA.
¹² Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.
¹³ Division of Pediatric Pulmonary and Sleep Medicine, University of Arkansas Medical Sciences, Little Rock, AR, USA.
¹⁴ Department of Pediatrics, Children hospital Colorado, University of Colorado, Denver, CO, USA.
¹⁵ Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
¹⁶ Division of Pediatric Neurology, Department of Pediatrics, Baylor Scott and White McLane Children's Specialty Clinics, Temple, TX, USA.
¹⁷ Division of Pulmonary and Sleep Medicine, Children's National Medical Center, George Washington University, Washington, DC, USA.
¹⁸ Department of Pediatrics, John Hopkins University, Baltimore, MD, USA.
¹⁹ Department of Neurology, Mayo Clinic, Rochester, MN, USA.
²⁰ Department of Pediatrics, University of Arizona, Tucson, AZ, USA.
²¹ Department of Pediatrics, Oregon Health and Sciences University, Portland, OR, USA.
²² Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

PMID: 35695235
DOI: 10.1093/sleep/zsac137

Abstract

This study was aimed to evaluate the yearly incidence of pediatric narcolepsy prior to and following the 2009 H1N1 pandemic and to evaluate seasonal patterns of narcolepsy onset and associations with H1N1 influenza infection in the United States. This was a multicenter retrospective study with prospective follow-up. Participants were recruited from members of the Pediatric Working Group of the Sleep Research Network including 22 sites across the United States. The main outcomes were monthly and yearly incident cases of childhood narcolepsy in the United States, and its relationship to historical H1N1 influenza data. A total of 950 participants were included in the analysis; 487 participants were male (51.3%). The mean age at onset of excessive daytime sleepiness (EDS) was 9.6 ± 3.9 years. Significant trend changes in pediatric narcolepsy incidence based on EDS onset (p < .0001) occurred over the 1998-2016 period, peaking in 2010, reflecting a 1.6-fold increase in narcolepsy incidence. In addition, there was significant seasonal variation in narcolepsy incident cases, with increased cases in spring (p < .05). Cross-correlation analysis demonstrated a significant correlation between monthly H1N1 infection and monthly narcolepsy incident cases (p = .397, p < .0001) with a lag time of 8 months. We conclude that there is a significant increase in pediatric narcolepsy incidence after the 2009 H1N1 pandemic in the United States. However, the magnitude of increase is lower than reported in European countries and in China. The temporal correlation between monthly H1N1 infection and monthly narcolepsy incidence, suggests that H1N1 infection may be a contributing factor to the increased pediatric narcolepsy incidence after the 2009 H1N1 pandemics.

Keywords: 2009 H1N1 pandemics; narcolepsy incidence; pediatric narcolepsy; risk factors for narcolepsy; seasonal variation of narcolepsy incidence.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Child
Disorders of Excessive Somnolence* / complications
Female
Humans
Incidence
Influenza A Virus, H1N1 Subtype*
Influenza Vaccines*
Influenza, Human* / complications
Influenza, Human* / epidemiology
Male
Narcolepsy* / epidemiology
Narcolepsy* / etiology
Prospective Studies
Retrospective Studies
Sleep
Vaccination / adverse effects

Substances

Influenza Vaccines