Catathrenia under sodium oxybate in narcolepsy with cataplexy

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This study aims to report on catathrenia occurring in narcolepsy with cataplexy (NC) patients under sodium oxybate (SO) treatment. Catathrenia is a parasomnia characterized by groaning and an abnormal respiratory pattern during sleep.


Fifty-one patients with NC and starting SO therapy underwent a baseline overnight polysomnography (PSG) to detect any sleep-related breathing disorders (SRBD). To avoid risks due to a possible central respiratory control depression by SO, all patients with concomitant obstructive sleep apnea (OSA) were treated with a nasal continuous positive airway pressure (nCPAP) device. After 2 months of treatment with SO, all patients underwent a follow-up overnight PSG to investigate possible newly occurring SRBD. They also underwent a semi-structured clinical interview to monitor other potential SO side effects.


At baseline, four out of 51 patients showed simple snoring, and eight, mild to severe OSA. After a titration PSG night, patients with OSA received a nCPAP device. After 2 months of SO treatment, 28 patients (54.9%) showed SO-related side effects, including SRBD in 11 (21.6%). The follow-up PSG showed a respiratory pattern characteristic of catathrenia in seven patients (13.7%) as a newly observed and possibly benign SO side effect, and ruled out a worsening of OSA.


Catathrenia should be considered a possible side effect in NC patients under SO treatment and should be accurately identified to prevent unnecessary SO withdrawal.

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We thank Ms. A. Collins for the English revision and Ms. A. Laffi for helping in manuscript editing (Department of Neurological Sciences, University of Bologna, Italy).

Conflict of interest

Michael Thorpy is a consultant for Cephalon and Jazz Pharmaceuticals. Giuseppe Plazzi is a consultant for Cephalon and UCB Pharma. The other authors declare that they have no conflict of interest.

Author information

Correspondence to Giuseppe Plazzi.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Catathrenia video clip showing catathrenia episodes in a NC patient after 2 months under SO treatment (MPG 13,479 kb).


Catathrenia video clip showing catathrenia episodes in a NC patient after 2 months under SO treatment (MPG 13,479 kb).

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Poli, F., Ricotta, L., Vandi, S. et al. Catathrenia under sodium oxybate in narcolepsy with cataplexy. Sleep Breath 16, 427–434 (2012).

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  • Groaning
  • Parasomnia
  • Sleep apnea
  • Sleep-related breathing disorders
  • Side effect