Observational Study

. 2025 Jun 1;21(6):983-997.

doi: 10.5664/jcsm.11598.

Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1

Laure Peter-Derex^{1

2}, Emmanuel Fort³, Benjamin Putois^{2

4}, Nora Martel⁵, François Ricordeau^{1

2}, Hélène Bastuji^{1

2}, Isabelle Arnulf⁶, Lucie Barateau⁷, Patrice Bourgin⁸, Yves Dauvilliers⁷, Rachel Debs⁹, Pauline Dodet⁶, Benjamin Dudoignon¹⁰, Patricia Franco^{2

11}, Sarah Hartley¹², Isabelle Lambert¹³, Michel Lecendreux¹⁰, Laurene Leclair-Visonneau¹⁴, Damien Léger¹⁵, Martine Lemesle-Martin¹⁶, Antoine Léotard¹², Smaranda Leu-Semenescu⁶, Nadège Limousin¹⁷, Régis Lopez⁷, Nicole Meslier¹⁸, Jean-Arthur Micoulaud-Franchi¹⁹, Christelle Charley-Mocana²⁰, Marie-Pia d'Ortho²¹, Pierre Philip¹⁹, Elisabeth Ruppert⁸, Sylvie de La Tullaye¹⁴, Manon Brigandet²², Jennnifer Margier²³, Benjamin Rolland^{2

24}, Barbara Charbotel³, Stéphanie Mazza²

Affiliations

¹ Centre for Sleep Medicine and Respiratory Diseases, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
² Lyon Neuroscience Research Centre, Institut National de la Santé et de la Recherche Médicale Unité 1028, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5292, Lyon, France.
³ Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement, T9405, University Lyon 1, Lyon, France.
⁴ Faculty of Psychology, Swiss Distance Learning University, Brig, Switzerland.
⁵ Clinical Research Center, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
⁶ National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Sleep Disorders Clinic, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris-Sorbonne University, Paris, France.
⁷ National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Sleep Unit, Department of Neurology, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier, France.
⁸ CIRCSom (International Research Center for ChronoSomnology), Sleep Disorders Center, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Strasbourg University Hospital, Strasbourg, France.
⁹ Sleep Unit, Department of Neurology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Pierre-Paul Riquet/Purpan University Hospital, Toulouse, France.
¹⁰ Pediatric Sleep Disorders Center, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹¹ Pediatric Sleep Unit and National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Mother-Children's Hospital, Hospices Civils de Lyon, Lyon, France.
¹² Sleep Unit, Physiology Department, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Groupes Hospitalo-Universitaires Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France.
¹³ Sleep Unit, Epileptology and Cerebral Rhythmology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
¹⁴ Department of Clinical Neurophysiology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Centre Hospitalier Universitaire de Nantes, Nantes, France.
¹⁵ Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Université Paris Cité, Vigilance Fatigue Sommeil et Santé Publique, Paris, France.
¹⁶ Department of Clinical Neurophysiology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, University Hospital of Dijon, Dijon, France.
¹⁷ Department of Neurology and Clinical Neurophysiology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, University Hospital Bretonneau, Tours, France.
¹⁸ Department of Respiratory and Sleep Medicine, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias Angers University Hospital, Angers, France.
¹⁹ Sleep Disorders department, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
²⁰ Neurophysiologie Clinique, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Hôpital Roger Salengro, Lille, France.
²¹ Service de Physiologie - Explorations Fonctionnelles, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, NeuroDiderot, Paris, France.
²² Association for Patients with Narcolepsy Cataplexy and Rare Hypersomnias, France.
²³ Pôle de Santé Publique, Service d' Évaluation Économique en Santé, Hospices Civils de Lyon, Lyon, France.
²⁴ Service Universitaire d'Addictologie de Lyon, Centre Hospitalier Le Vinatier, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.

PMID: 39943847
PMCID: PMC12134577 (available on 2026-06-01)
DOI: 10.5664/jcsm.11598

Observational Study

Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1

Laure Peter-Derex et al. J Clin Sleep Med. 2025.

. 2025 Jun 1;21(6):983-997.

doi: 10.5664/jcsm.11598.

Authors

Affiliations

¹ Centre for Sleep Medicine and Respiratory Diseases, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
² Lyon Neuroscience Research Centre, Institut National de la Santé et de la Recherche Médicale Unité 1028, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5292, Lyon, France.
³ Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement, T9405, University Lyon 1, Lyon, France.
⁴ Faculty of Psychology, Swiss Distance Learning University, Brig, Switzerland.
⁵ Clinical Research Center, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
⁶ National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Sleep Disorders Clinic, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris-Sorbonne University, Paris, France.
⁷ National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Sleep Unit, Department of Neurology, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier, France.
⁸ CIRCSom (International Research Center for ChronoSomnology), Sleep Disorders Center, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Strasbourg University Hospital, Strasbourg, France.
⁹ Sleep Unit, Department of Neurology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Pierre-Paul Riquet/Purpan University Hospital, Toulouse, France.
¹⁰ Pediatric Sleep Disorders Center, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹¹ Pediatric Sleep Unit and National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Mother-Children's Hospital, Hospices Civils de Lyon, Lyon, France.
¹² Sleep Unit, Physiology Department, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Groupes Hospitalo-Universitaires Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France.
¹³ Sleep Unit, Epileptology and Cerebral Rhythmology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
¹⁴ Department of Clinical Neurophysiology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Centre Hospitalier Universitaire de Nantes, Nantes, France.
¹⁵ Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Université Paris Cité, Vigilance Fatigue Sommeil et Santé Publique, Paris, France.
¹⁶ Department of Clinical Neurophysiology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, University Hospital of Dijon, Dijon, France.
¹⁷ Department of Neurology and Clinical Neurophysiology, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, University Hospital Bretonneau, Tours, France.
¹⁸ Department of Respiratory and Sleep Medicine, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias Angers University Hospital, Angers, France.
¹⁹ Sleep Disorders department, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
²⁰ Neurophysiologie Clinique, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Hôpital Roger Salengro, Lille, France.
²¹ Service de Physiologie - Explorations Fonctionnelles, National Competence Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, NeuroDiderot, Paris, France.
²² Association for Patients with Narcolepsy Cataplexy and Rare Hypersomnias, France.
²³ Pôle de Santé Publique, Service d' Évaluation Économique en Santé, Hospices Civils de Lyon, Lyon, France.
²⁴ Service Universitaire d'Addictologie de Lyon, Centre Hospitalier Le Vinatier, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.

PMID: 39943847
PMCID: PMC12134577 (available on 2026-06-01)
DOI: 10.5664/jcsm.11598

Abstract

Study objectives: This multicenter comparative cross-sectional study aimed to describe educational and occupational pathways, quantify effort/reward imbalance at work, and identify factors associated with professional prognosis in patients with narcolepsy type 1.

Methods: Adult patients with narcolepsy type 1 and controls answered online questionnaires (Epworth Sleepiness Scale, Beck Depression Inventory II, Siegrist questionnaire, adult self-report, and a questionnaire on academic and professional trajectories) and were compared using sex- and age-adjusted logistic regressions. Clinical, demographic, and psycho-social factors associated with patients' professional prognosis, as assessed by a composite score based on occupational-related outcomes, were explored with a generalized linear model.

Results: We included 235 patients (63.8% females, 36.4 ± 14.7 years, 86.5% treated, 66.4% with childhood onset) and 166 controls (69.9% females, 40.3 ± 14.4 years). No difference was observed between patients and controls for graduation, but patients reported more interruptions, absenteeism, and lateness during schooling. No difference was observed for employment rate (69.5% vs 77.0%), but income was lower in patients who reported more unwanted changes in position and part-time work, with increased effort-reward imbalance (odds ratio = 2.28 95% confidence interval [1.20-4.33], P = .01). Impaired professional prognosis was associated with depression (P < .0001) and attention disorders (P = .03), while being a person with narcolepsy during schooling was a protective factor (P = .02).

Conclusions: Most patients with narcolepsy type 1 manage to achieve their careers goals, but at the cost of an effort/reward imbalance. Early diagnosis might allow a better adjustment to the disease. The strong impact of psycho-cognitive comorbidities on professional outcomes stresses the need to consider psycho-cognitive-social dimensions in patient care.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: NARCOSCOL-NARCOVITAE; URL: https://clinicaltrials.gov/study/NCT03765892; Identifier: NCT03765892.

Citation: Peter-Derex L, Fort E, Putois B, et al. Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1. J Clin Sleep Med. 2025;21(6):983-997.

Keywords: education; employment; epidemiology; narcolepsy; psycho-social.

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Conflict of interest statement

All authors have seen and approved the manuscript. This work was performed in the Reference and Competence Centers for Narcolepsy and Rare Hypersomnia Network in France (n = 18 centers, listed in the authors affiliations). The project was funded by a research grant from the Rare Disease Foundation (2017). The authors have no competing interests to declare that are relevant to the content of this article.

References

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Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1

Affiliations

Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Supplementary concepts

Associated data

LinkOut - more resources

Full Text Sources

Medical