Feasibility and efficacy of exercise training on sleep symptoms and comorbidities in narcolepsy type 1: a prospective interventional study

Abstract

Current treatments for narcolepsy type 1 (NT1) have little impact on psychiatric, cognitive and metabolic comorbidities. Here, we evaluated the feasibility, safety and efficacy of a prospective Exercise Training (ET) program on sleep-related symptoms and comorbidities in NT1. Sedentary adult with NT1 participated in a 6-week supervised ET program followed by a 18-week self-directed program. Outcomes included the Narcolepsy Severity Scale (NSS), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), cardiometabolic parameters (body mass index [BMI], glycemia, insulin, CRP, lipid panel with insulin resistance [IR] [TG/HDL-C] and cardiovascular risk [Total-C/HDL-C] markers), cardiorespiratory fitness, and attention (Bron/Lyon Attention Stability Test). Wilcoxon tests compared baseline, 6-week, and 6-month data. Among 30 participants (73.3% women, 39.8±13.9 years, BMI=31.0±5.1 kg/m2), 25 completed the 6-month program. Of the 379 supervised sessions (84.2% attendance), only 7 partial cataplexies occurred. At 6 weeks, significant improvements were observed in median[IQR] NSS (-2.0[-4.0;0], p=0.046), ISI (-1.0[-3.0;1.0], p=0.050), triglycerides (-0.21[-0.46;-0.09]g/L, p=0.015), IR (-0.19[-0.46;-0.04], p=0,003), cardiorespiratory fitness ((+15.0[5.0;20.0]watts, p<0.001), and in most attention scores (stability, intensity, reaction time: p<0.05). At 6 months, NSS and ISI changes were no longer significant but anxiety (-1.0[-3.0;1.0], p=0.041) and depression (-2.0[-4.0;0.0], p=0.004) decreased. Improvements in IR (-0.27[-0.44;-0.11], p=0.002), triglycerides (-0.2[-0.4;0.0]g/L, p=0.033), cardiovascular risk (-0.16[-0.41;-0.02], p=0,019), and attention scores (intensity, reaction time, number of errors p<0.05) were sustained. VO2max and BMI showed no significant changes. Physical activity is feasible and safe in NT1, enabling improvements in narcolepsy symptoms, anxiety/depression, cognition, and cardiometabolic markers. Larger randomized controlled trials are needed to confirm these findings.

Keywords: Clinical Trial: NARCOSPORT NCT05460052; Anxiety; Cardiometabolic risk; Cataplexy; Cognition; Depression; Exercise training; Insomnia; Narcolepsy type 1; Physical activity.