To ascertain complications associated with high-dose
stimulant therapy in patients with narcolepsy or idiopathic hypersomnia.
Case-control, retrospective chart review.
Sleep center in an academic hospital.
116 patients with narcolepsy or idiopathic hypersomnia were individually
matched by sex, diagnosis, age of onset, and duration of followup
from both onset and diagnosis. Members of the high-dose group (n =
58) had received at least 1 stimulant at a dosage ≥ 120% of the maximum
recommended by the American Academy of Sleep Medicine Standards
of Practice Committee. The standard-dose control group (n = 58) had received
stimulants at a dosage ≤ 100% of the American Academy of Sleep
Measurements and Results:
The prevalence of psychosis (odds ratio =
12.0 [1.6-92.0]), alcohol or polysubstance misuse (odds ratio = 4.3 [1.2-
15.2]), and psychiatric hospitalization (odds ratio = 3.2 [1.1-10.0]) was significantly
increased in the high-dose group. More high-dose patients also
experienced tachyarrhythmias (odds ratio = 3.3 [0.92-12.1] and anorexia
or weight loss (odds ratio = 11.0 [1.4-85.2]). The frequency of physiciandiagnosed
depression, drug-seeking and suicide-related behaviors, hypertension,
and cardiovascular disease did not differ significantly between
This study demonstrated a significantly higher occurrence
of psychosis, substance misuse, and psychiatric hospitalizations
in patients using high-dose stimulants compared to those using standard
doses. Tachyarrhythmias and anorexia or weight loss were also more
common in this group as compared with controls. Clinicians should be
very cautious in prescribing dosages that exceed maximum guidelines.