Cardiovascular and cardiometabolic comorbidities in central disorders of hypersomnolence: A narrative review.

Sleep disorders are increasingly associated with cardiovascular and cardiometabolic diseases. However, the relationship between rare central disorders of hypersomnolence, specifically narcolepsy and idiopathic hypersomnia, and the risk of cardiovascular and cardiometabolic diseases is underexplored. This narrative review examines the prevalence, risk factors, and potential mechanisms linking narcolepsy and idiopathic hypersomnia to increased risk of cardiovascular and cardiometabolic disease. Patients with narcolepsy and idiopathic hypersomnia show higher frequencies of cardiovascular and cardiometabolic comorbidities, including hypertension, diabetes, and major adverse cardiovascular events. While the mechanisms underlying the relationships between central disorders of hypersomnolence and cardiovascular and cardiometabolic disease risk are unknown, they may involve hypocretin deficiency, inflammation, and secondary effects of sleep disturbances, including disrupted nighttime sleep, excessive daytime sleepiness, and inactive lifestyle. Certain medications for treating narcolepsy and/or idiopathic hypersomnia, such as stimulants, alerting agents, or high-sodium oxybates, can potentially increase blood pressure due to the mechanism of action or sodium content and may also influence cardiovascular/cardiometabolic risk. Awareness of the increased cardiovascular and cardiometabolic risk of patients with central disorders of hypersomnolence, early risk assessment, and use of interventions tailored to individual patient profiles are needed to help improve outcomes in individuals with narcolepsy and idiopathic hypersomnia.