Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1.

STUDY

OBJECTIVES

This multicenter comparative cross-sectional study aimed to describe educational and occupational pathways, quantify effort/reward imbalance at work, and identify factors associated with professional prognosis in patients with narcolepsy type 1.

METHODS

Adult patients with narcolepsy type 1 and controls answered online questionnaires (Epworth Sleepiness Scale, Beck Depression Inventory II, Siegrist questionnaire, adult self-report, and a questionnaire on academic and professional trajectories) and were compared using sex- and age-adjusted logistic regressions. Clinical, demographic, and psycho-social factors associated with patients' professional prognosis, as assessed by a composite score based on occupational-related outcomes, were explored with a generalized linear model.

RESULTS

We included 235 patients (63.8% females, 36.4 ± 14.7 years, 86.5% treated, 66.4% with childhood onset) and 166 controls (69.9% females, 40.3 ± 14.4 years). No difference was observed between patients and controls for graduation, but patients reported more interruptions, absenteeism, and lateness during schooling. No difference was observed for employment rate (69.5% vs 77.0%), but income was lower in patients who reported more unwanted changes in position and part-time work, with increased effort-reward imbalance (odds ratio = 2.28 95% confidence interval [1.20-4.33], P = .01). Impaired professional prognosis was associated with depression (P < .0001) and attention disorders (P = .03), while being a person with narcolepsy during schooling was a protective factor (P = .02).

CONCLUSIONS

Most patients with narcolepsy type 1 manage to achieve their careers goals, but at the cost of an effort/reward imbalance. Early diagnosis might allow a better adjustment to the disease. The strong impact of psycho-cognitive comorbidities on professional outcomes stresses the need to consider psycho-cognitive-social dimensions in patient care.

CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: NARCOSCOL-NARCOVITAE; URL: https://clinicaltrials.gov/study/NCT03765892; Identifier: NCT03765892.

CITATION: Peter-Derex L, Fort E, Putois B, et al. Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1. J Clin Sleep Med. 2025;21(6):983-997.