Dear Editor,
In a recent issue of Translational Psychiatry, Takahashi et al.1 reported their analysis of shared polygenic risk scores suggest a shared genetic background for both attention deficit hyperactivity disorder (ADHD) and narcolepsy. By another method, we described a similar association between ADHD and narcolepsy. In a paper delivered at the 1995 American Academy of Neurology2, we reported three families each in two generations with concurrent ADHD, hypersomnia defined by pupillometry3 without sleep log evidence of sleep disorder and both HLA markers DR-2/DQw-1 employed at that time associated with narcolepsy (Fig. 1).
HLA typing using DR-2/DQw-1 markers, hypersomnia, ADHD ± Reading Disorder in two generations.
Our subsequent studies have suggested a frequency of HLA markers associated with narcolepsy more than double than anticipated in Caucasians in individuals with behavioral and cognitive evidence of ADHD4. Clinically, we have observed late adolescent ADHD patients who will not drive automobiles without their alerting medications for fear of falling asleep. We have additionally observed an increased frequency of these HLA markers as well as hypersomnia in individuals with dyslexia, both with and without ADHD5. However, either condition may occur independent of these HLA markers.
The social significance of such an association if valid is that an unknown percentage of ADHD children/adolescents/adults may require alerting medication to become safe adult drivers, as sleepiness increases the risk of motor vehicle accident by a factor of 2.56.
References
Takahashi, N. et al. Polygenic risk score analysis revealed shared genetic background in attention deficit hyperactivity disorder and narcolepsy. Transl. Psychiatry 10, 284 (2020).
Clark, M. & Duane, D. D. HLA-typing in three families with two generations of concurrent hypersomnia and attention deficit disorder. Neurology 45, a433 (1995).
Yoss, R., Moyer, R. & Ogle, K. N. The pupillogram and narcolepsy. A method to measure decreased levels of wakefulness. Neurology 19, 921–928 (1969).
Honda, Y. & Juji, T. (eds). HLA in Narcolepsy (Springer-Verlag, 1988).
Duane, D. D., Prete, K. M., Johnson, R. & Bailon, M. J. Alertness and HLA DR-2/DQw-1 in ADD—inattentive, hyperactive and reading disorder patients. Unpublished observations, 1997–2021.
Bioulac, S. et al. Risk of motor vehicle accidents related to sleepiness at the wheel: a systematic review and meta-analysis. Sleep 40, 1–10 (2017).
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Duane, D.D. Genetic links between narcolepsy and ADHD. Transl Psychiatry 11, 333 (2021). https://doi.org/10.1038/s41398-021-01420-9
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DOI: https://doi.org/10.1038/s41398-021-01420-9
