Narcolepsy Type 2 in an Adolescent With Childhood Obstructive Sleep Apnea and Coexisting Absence Epilepsy: A Case Report
Abstract
Narcolepsy is a chronic neurological disorder of sleep-wake regulation whose cardinal features include pathological daytime somnolence and dysregulation of rapid eye movement (REM) sleep. It is frequently underdiagnosed in adolescents owing to symptom overlap with psychiatric, behavioral, and prior sleep disorders, including childhood obstructive sleep apnea (OSA). Narcolepsy type 2 (NT2), defined by excessive daytime sleepiness (EDS) without cataplexy, poses particular diagnostic challenges due to the absence of a single pathognomonic feature. We report an 18-year-old female who presented with a four-year history of persistent EDS, hypnopompic hallucinations, sleep paralysis, and automatic behaviors during microsleeps, including episodes of irrelevant writing during examinations. Subjective daytime somnolence was severe, with an Epworth Sleepiness Scale (ESS) score of 19/24. Past history was notable for childhood OSA managed with adenoidectomy, with residual mild snoring. Physical and neurological examinations were unremarkable. Polysomnography (PSG) demonstrated markedly short sleep latency, multiple sleep-onset REM periods (SOREMPs), and periodic limb movements without apneic episodes or nocturnal desaturation. The Multiple Sleep Latency Test (MSLT) confirmed severe objective hypersomnolence with a mean sleep latency of 1.25 minutes and SOREMPs in three out of four naps. Electroencephalography (EEG) revealed findings consistent with absence seizures, an uncommonly…
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