La narcolepsie est une maladie rare, touchant une personne sur 2000. Elle se caractérise par l'association d'une somnolence diurne excessive, d'épisodes de cataplexie, de paralysies du sommeil, d'hallucinations hypnagogiques. et d'une fragmentation du sommeil. La narcolepsie sans cataplexie constitue un sous-type hétérogène. Le diagnostic de narcolepsie peut être clinique, mais bien souvent un Test Itératif de Latence d'Endormissement (T1LE), précédé d'une polysomnographie nocturne (NPSG). sont utilisés pour porter le diagnostic.La cause de la plupart des cas de narcolepsie avec cataplexie a été découverte au début des années 2000: la destruction, probablement d'origine auto-immune. des neurones à hypocrétine de l'hypothalamus. Un déficit en hypocrétine à la ponction lombaire constitue désormais un test de référence pour établir le diagnostic, ce qui offre l'opportunité d'optimiser les critères actuels et de tester de nouvelles hypothèses diagnostiques en regard de ce test de référence. Peu d'études ont à ce jour spécifiquement porté sur la narcolepsie sans cataplexie et son diagnostic. Nous avons donc cherché à identifier les prédicteurs du déficit en hypocrétine dans la narcolepsie sans cataplexie. De plus, dans la narcolepsie-cataplexie, l'utilisation comme critère diagnostique d'une latence courte d'apparition du sommeil paradoxal à la NPSG n'a jamais été évaluée en utilisant comme test de référence le déficit en hypocrétine, et nous avons donc cherché à en déterminer l'utilité diagnostic et la valeur-seuil optimale.Afin de mener à bien ces projets de recherche, nous avons initié et participé au développement du logiciel d'analyse ROC (Receiver Operating Characteristic) SoftROC. Dans la narcolepsie sans cataplexie. nous avons montré que les paramètres électrophysiologiques, plus que cliniques, différaient entre les patients avec un taux bas d'hypocrétine et ceux avec un taux normal. Dans la narcolepsie avec cataplexie. nous avons établi qu'une latence courte (< 15 minutes) d'apparition du sommeil paradoxal à la NPSG était un test diagnostique spécifique, mais peu sensible, pour la narcolepsie avec déficit en hypocrétine. Nos résultats ont contribué à la révision des classifications internationales des troubles du sommeil. / Narcolepsy is characterised by excessive diurnal sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations andsleep fragmentation. Narcolepsy without cataplexy is a heterogeneous subtype. Diagnosis can be established clinically,but a Mulitple Sleep Latency Test (MSLT) following a Nocturnal PolySomnoGraphy (NPSG), is used most of the time.Auto-immune loss of hypocretin cells is responsible for narcolepsy with cataplexy. Hypocretin deficiency at lumbarpuncture is a gold standard for diagnosis.Few studies have focused specifically on narcolepsy without cataplexy. Our aim was to identify predictors of hypocretindeficiency in this condition. Moreover, in narcolepsy with cataplexy, a short REM sleep latency at NPSG has never beenevaluated as a diagnostic test using hypocretin deficiency as a gold standard, and we therefore have aimed at assessing itsdiagnostic utility and optimal cut-off.In order to conduct our research, we have contributed to developing a ROC analysis software (SoftROC).In narcolepsy without cataplexy- objective (NPSG and MSLT) more than clinical parameters were predictors ofhypocretin-deficiency. In narcolepsy-cataplexy, a short (< 15 mins) REM latency at NPSG was a specific, but notsensitive. diagnostic test. Our results contributed to the revision of international diagnostic classifications.

本研究旨在探討猝睡症患者生活品質受症狀變化及神經認知功能改變的影響情況，以及不同層次影響因素對患者生活品質的初始狀態及後續變化軌跡的影響效果。 本研究於北部一所醫學中心睡眠障礙科及兒童心智科募集確診為猝睡症之患者，經同意後進行為期五年的長期研究，募集總人數168人，完成五年資料收集人數85人。本研究使用睡眠多項檢驗（polysomnography, PSG）、多段入睡測試（multiple sleep latency test, MSLT）、人類白血球抗原檢驗（human leukocyte antigen, HLA）為基本檢驗工具，以電腦化第二版康氏持續注意力測驗（Continuous Performance Test- II）及威斯康辛卡片分類測驗（Wisconsin Card Sorting Test, WCST）為檢測神經認知功能之工具，以自填艾普渥斯嗜睡程度量表（Epworth sleepiness scale, ESS）、史丹佛睡眠問卷（Stanford sleep inventory, SSI）及簡式生活品質量表（short from-36 items of health related quality of life, SF-36）做為症狀嚴重度及生活品質的依據。資料分析以描述統計及階層線性模式（hierarchical linear models , HLM）統計方法進行。主要結果如下： 一、 猝睡症患者生活品質分為生理與心理兩個層面，患者生理層面在五年期間維持相對穩定沒有顯著變化；心理層面中之不同向度則有不同變化趨勢，心理健康與活力向度隨時間有逐漸提高的趨勢，患者此二向度生活品質接受治療後有穩定上升的趨勢，而社會功能及情緒角色限制則呈現二次方曲線變化，以及呈現先增後減的發展軌跡，患者此二向度接受治療後顯著上升，第三年後有逐年下降的趨勢。 二、 患者嗜睡程度及猝倒嚴重度變化隨時間有顯著成長軌跡，呈二次方曲線發展，轉折點在第三年，接受治療前三年症狀呈現穩定降低的軌跡，但自第三年起逐年增加，此結果與藥物治療初期症狀獲得顯著改善，後期改善幅度相對減少，及藥物效果具有關聯。 三、 個體間層次變項僅疾病持續時間、HLA對患者生活品質具顯著解釋力，其中疾病持續時間越長，患者可能發展因應症狀之策略，從而降低疾病對生活品質之衝擊。而HLA則對症狀有不同影響，HLA陽性患者初始嗜睡程度較陰性者為低，且接受治療後改善效果較陰性者顯著，猝倒嚴重度起始值較陰性者高，且接受治療後的趕善幅度較陰性者小。 四、 疾病嚴重度變化對生活品質具顯著影響，完整模式分析中，時間主效應未達顯著，但可由症狀變化及神經認知功能改變進行更佳的解釋。嗜睡程度變化僅對身體疼痛向度變化不具有解釋力外，對其餘七個向度均具顯著影響；猝倒影響層面不及嗜睡程度，但亦可解釋生理量表、生理角色限制、心理量表、心理健康、情緒角色限制、活力等向度上的變化。 五、 神經認知功能改變與否對患者生活品質具有加成效果，分析顯示患者神經認知功能改善時，其生活品質提升速率較未改善者高，影響較顯著的包括注意力、警覺度及概念反應，此結果與下視丘泌素參與的維持注意力及前額葉功能有關。 本研究依據分析結果提出猝睡症患者生活品質受嗜睡症狀及猝倒嚴重度改變直接影響，同時受人類白血球抗原屬性及神經認知功能改變調節之假設模型，作為未來研究參考依據。並根據研究結果與限制，提出對臨床實務的應用與心理介入的建議，並對未來提升猝睡症患者生活品質相關研究提供建議。 / The current study aims to: (1) examine the change of eight domains of quality of life in narcoleptics within five years, (2) investigate the impact of the change of symptom severity on different dimension of quality of life, as well as the influence associated with the change of neuro-cognitive function. There were 168 participants recruited from a medical center in northern Taiwan. 85 of them completed the 5-year annual follow-up data collection. During the follow-ups, polysomnography (PSG), multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) test were conducted. Computerized neuropsychological tests of Conners’ Continuous Performance Test- II (CPT-II) and Wisconsin Card Sorting Test (WCST) were also administered to obtain attention and executive function data. The short from-36 items of health related quality of life (SF-36), Stanford sleep inventory (SSI) and Epworth sleepiness scale were applied to assess quality of life and symptom severity. Descriptive statistics and hierarchical linear models were applied for data analysis. The main results were: 1. The quality of life was divided into physical and psychological domains. The physical domain kept relatively stable during the 5-year follow up as opposed to the psychological domain. In psychological domain, the vitality and psychological health showed increasing tendency overtime. However, the social function and role functioning-emotion increased during the first 3 years then declined afterward. 2. The symptom severity also showed a tendency corresponded to quadratic curve. The daytime sleepiness together with cataplexy severity reduced immediately after treatment but rose after the third year. 3. The variables of individual characteristics that showed significant impact on quality of life were disease duration and HLA type. The longer the duration, the better quality of life one had. Positive HLA typing seemed to be a protective factor on severity of sleepiness. It also predicted better treatment outcomes, but worsen the severity of cataplexy and treatment effects. 4. The symptom severity could be a good explanation as a variable of quality of life. The daytime sleepiness altered all domain of SF-36 expect body pain. Cataplexy affected only psychological domain of SF-36. 5. The neuro-cognitive function was also found to affect quality of life. Those who improved in attention and executive function test got greater improvement on SF-36 as well. The vigilance on CPT-II and conceptualized response on WCST had most significant impact. I proposed a model of change of quality of life in patients with narcolepsy based on the results obtained. Several suggestions were also proposed for clinical and psychological intervention for narcolepsy to improve their quality of life.

La narcolepsie de type 1 (NT1) est une maladie neurologique rare caractérisée par une hypersomnolence diurne et des cataplexies - pertes de tonus musculaire pendant l'éveil provoqué par une émotion forte. Chez l'homme, la NT1 est due à la mort spécifique et postnatale des neurones à orexine (Orex) promoteurs de l'éveil, et est considérée comme une pathologie de l'éveil. Toutefois, les observations cliniques suggèrent une dérégulation du sommeil paradoxal (SP) dans cette pathologie. Les patients NT1 ont une latence d'apparition du SP très courte et de fréquents endormissements en SP. De plus, la similitude entre l'atonie musculaire de la cataplexie et celle caractéristique du SP nous mène à penser que la narcolepsie serait également une pathologie du SP. Cette hypothèse a été testée à travers deux études menées sur un modèle murin de narcolepsie : la souris Orex-KO. Dans une 1ère étude nous avons objectivé que malgré une régulation homéostasique du SP intacte, la souris Orex-KO a une propension élevée à faire du SP pendant la phase active. Nous avons alors suggéré un nouveau rôle pour le neuropeptide Orex, celui d'inhibition du SP. Puis, nous avons cherché à déterminer si le réseau neuronal de l'atonie musculaire du SP était recruté pendant les cataplexies. Nos données suggèrent que contrairement à l'hypothèse généralement admise, les neurones glutamatergiques du noyau sublatérodorsal (SLD) ne sont pas suffisants à la mise place des cataplexies et ne seraient que partiellement impliqués dans ce symptôme. Ce travail de thèse a permis de mieux comprendre le rôle des Orex dans la NT1, et d'approfondir nos connaissances sur les mécanismes neurobiologiques de la cataplexie / Narcolepsy type 1 (NT1) is a rare neurological disease characterized by an excessive daytime sleepiness and episodes of cataplexy – a sudden loss of muscular tone triggered by strong emotions during wakefulness. In humans, NT1 is due to the specific and postnatal loss of orexin (Orex) neurons involved in wake promotion. It led to describe NT1 as a wake disease. However, clinical observations have suggested a disrupted regulation of paradoxical (or REM) sleep in narcolepsy. Indeed, NT1 patients have shorter latency to enter REM sleep and frequent sleep onset in REM sleep. More, muscular atonia observed in cataplexy is one of the main feature of REM sleep. Together, those data led to the hypothesis that narcolepsy would be also a REM sleep disease. We’ve investigated this hypothesis in two different studies performed on a recognize model of murine narcolepsy: the Orex-KO mouse. In a 1st study, we found that despite an intact REM sleep homeostasic regulation, Orex-KO mice had an increased REM sleep propensity during active phase. We’ve suggested a new role of REM sleep inhibition for the neuropeptide Orex. Then, we aimed to determine whether REM sleep atonia and cataplexy shared the same neuronal network. In contrast to the currently admitted hypothesis, we demonstrate that glutamatergic neurons of the sublaterodorsal nucleus (SLD) are not sufficient to generate cataplexy, and are only partially involved in this symptom. Taken together, data harvested during this thesis help us to better understand the role of Orex in NT1 and to improve our knowledge about the neurobiological mechanisms of cataplexy

No description available.

Bakgrund: Efter Pandemrix-vaccinationen år 2009 i Sverige insjuknade ett stort antal unga individer i den koniska sjukdomen narkolepsi. Syfte: Kartlägga aktivitetsvanor, stillasittande, tilltro till egen förmåga att klara fysisk aktivitet samt undersöka samband mellan aktivitetsnivå och tilltro till egen förmåga att klara fysisk aktivitet. Metod: Undersökningsgruppen var 120 individer över 18 år, från Narkolepsiföreningen, som drabbats i samband med Pandemrix-vaccinationen år 2009. Datainsamling genomfördes via enkät.   Resultat: 47,1 procent uppnådde WHO:s rekommenderade aktivitetsnivå. 25,2 procent var fysiskt aktiva mindre än en gång i månaden eller aldrig. Genomsnittlig stillasittandetid var sju timmar och nio minuter/dag. Medianen för tilltro till egen förmåga att klara fysisk aktivitet var 19 på en skala mellan 9-36. Ett signifikant måttligt samband mellan tilltro till egen förmåga att klara fysisk aktivitet och aktivitetsnivå förelåg. Konklusion: Studiens resultat talar för att narkolepsidrabbade bör öka sin aktivitetsnivå och för att uppnå det även öka tilltro till egen förmåga att klara fysisk aktivitet. / Backgroud: After the Pandemrix-vaccination in 2009 a sudden increase in childhood narcolepsy was observed in Sweden. Scientific research focusing on the level of physical activity within this group is scarce. Purpose: Identifying the level of physical activity and physical exercise, sedentary behavior, self-efficacy to perform physical activity, as well as examine the correlation between physical activity level and self-efficacy to perform physical activity. Method: 120 individuals, over 18 years of age, who developed narcolepsy due to the Pandemrix-vaccination and were members of the Swedish Narcolepsy Association participated in the study. The data collection was conducted through a survey. Results: 47.1 percent of the participants achieved the WHO recommendations for physical activity. 25.2 percent were physically active less than once a month or never. The duration of the participants average time of sedentary behavior was seven hours and nine minutes per day. The median for self-efficacy to perform physical activity was 19 on a scale between 9-36. There was a significant moderate correlation between the participants self-efficacy to perform physical activity and their level of physical activity . Conclusion: The results of this study indicates that individuals suffering from narcolepsy should increase their level of physical activity as well as increase their self-efficacy to perform physical activity.

Narcolepsia é uma doença neurológica crônica caracterizada por sonolência diurna excessiva e ataques de sono. Ocorre na população de uma para cada mil pessoas. Fenômenos de sono REM (rapid eye movement), cataplexia, paralisia do sono e alucinações hipnagógicas podem também ocorrer. Afeta todos os aspectos da vida e pode causar dificuldades para os pacientes em manter seus empregos, nos relacionamentos interpessoais e riscos de acidentes devido à sonolência excessiva e à cataplexia. Acredita-se que seja causada por um interjogo de fatores genéticos e ambientais. O risco para familiares de primeiro grau é estimado em de 1-2%. Recentemente foi demonstrado que os pacientes com narcolepsia têm uma deficiência de hipocretina também chamada de orexina na parte lateral do hipotálamo. O presente trabalho teve como objetivos: a) caracterizar os aspectos psicodinâmicos mais freqüentes da amostra; b) verificar a eficácia adaptativa do ego; c) verificar o equilíbrio e o funcionamento psíquico e relacionar com aspectos clínicos dos pacientes. A amostra foi de 23 pacientes portadores de narcolepsia, 15 mulheres e 8 homens, com média de idade de 44 anos. Eles foram avaliados através da Escala Diagnóstica Adaptativa Operacionalizada (EDAO), de R. Simon. O Questionário do Sono, de Giglio, foi utilizado para levantar os principais problemas no sono e as conseqüências na qualidade de vida dos pacientes. A Escala de Sonolência Epworth avaliou a intensidade da sonolência diurna. A dinâmica do funcionamento mental foi avaliada através do Teste das Relações Objetais de Phillipson (TRO), segundo os pressupostos teóricos da psicanálise. Os resultados mostraram que: 1) a narcolepsia está associada a sério prejuízo na eficácia adaptativa, com diagnóstico de Adaptação Ineficaz Moderada e Severa na maioria dos sujeitos; 2) sonolência severa excessiva diurna, ataques de sono e sono noturno fracionado; 3) a análise do funcionamento psíquico revelou que estes pacientes apresentam respostas, as quais, na maioria das vezes, impedem seu desenvolvimento. Os principais mecanismos de defesa, mais freqüentes, são pertinentes à posição esquisoparanóide, medo de rejeição e abandono e desejo de proteção e contato. Revelou também dificuldades em relação aos vínculos interpessoais, com mecanismos de fuga e evitação principalmente nas situações grupais e de três pessoas. / Narcolepsy is a chronic brain disorder characterized by excessive daytime sleepiness and sleep attacks. It affects up to one in a thousand people. Rapid eye movement (REM) sleep phenomena such as cataplexy, sleep paralysis and hypnagogic hallucinations can also occur. The condition impinges on every aspect of life, and can make it difficult for sufferers to keep their jobs as well as personal relationships. There can be accident risks caused by the excessive sleepiness and cataplexy. It is believed to be caused by an interplay between genetic and environmental factors. The risk to first-degree relatives is estimated at 1-2%. Patients with narcolepsy have recently been shown to be deficient in hypocretin, also called orexin, in the cerebrospinal fluid and have a reduction in hipocretin cells in the lateral hypothalamus. The present study characterizes a sample of 23 patients suffering from narcolepsy, of which 15 female and 8 male patients, 44 years-old in average. They had their adaptive efficiency evaluated by R. Simon\'s Adaptive and Operationalised Diagnostic Scale (AODS). Major sleep disorders and their effects on patient\'s life quality were surveyed by Giglio\'s Sleep Questionnaire. Intensity of sleepiness was evaluated through Epworth Sleepiness Scale. Mind functioning dynamics was assessed by Phillips on Test (ORT) obeying psychoanalytic theoretical presuppositions. Up to the moment, results show that: 1) narcolepsy is associated to serious damage to adaptive efficiency, with moderate and severe inefficient adaptation, prevailing in most patients; 2) severe excessive daytime sleepiness, sleep attacks and fractioned nocturnal sleep are frequent in most of patients even when medicated with stimulants; 3) the analysis through ORT showed that these patients presented responses that for most of the time, impede their progress Paranoid-schizoid position defense mechanisms were frequent, with fears of being rejected and abandoned. The Object Relations Test revealed interpersonal links impairment, mainly in group and triangular situations.

No description available.

Les mouvements périodiques des jambes sont de courts mouvements involontaires qui surviennent de façon périodique au cours du sommeil ou de l’éveil. Ils sont présents dans certains troubles du sommeil, mais également chez des sujets sans plainte reliée au sommeil. Le premier objectif de cette thèse visait une meilleure description de la prévalence de ces mouvements. Nous avons montré que chez les sujets sans plainte de sommeil, la prévalence des mouvements périodiques des jambes en sommeil augmentait de façon importante à partir d’environ 40 ans, tandis que l’index des mouvements périodiques des jambes à l’éveil évoluait avec l’âge selon une courbe en U. Chez les sujets atteints de narcolepsie, on retrouvait davantage de mouvements périodiques des jambes que chez les sujets témoins, mais leur patron d’évolution avec l’âge était similaire. Le deuxième objectif de cette thèse visait l’étude des mouvements périodiques des jambes en relation avec le système nerveux autonome cardiovasculaire. Nous avons non seulement confirmé la présence d’une tachycardie suivie d’une bradycardie lors des mouvements périodiques des jambes durant le sommeil chez les patients atteints du syndrome d’impatiences musculaires à l’éveil et chez les sujets sans plainte de sommeil, mais nous avons également décrit ces mêmes changements de la fréquence cardiaque, quoiqu’avec une plus faible amplitude, chez les sujets atteints de narcolepsie. Finalement, nous avons montré pour la première fois que les mouvements périodiques des jambes en sommeil des sujets atteints du syndrome d’impatiences musculaires à l’éveil et des sujets sans plainte de sommeil étaient aussi associés à des augmentations importantes et significatives de la pression artérielle. / Periodic leg movements are short involuntary movements occurring periodically during sleep or wakefulness. They occur in some sleep disorders, but also in healthy subjects not complaining of sleep problems. The first objective of this thesis was to provide a better description of the prevalence of these movements. In healthy non-complaining subjects, the prevalence of periodic leg movements during sleep increased dramatically from about age 40, whereas the age-related evolution of periodic leg movements during wakefulness followed a U curve. In narcoleptic patients there were more periodic leg movements than in control subjects, but their evolution with age showed the same pattern. The second objective of this thesis was to study periodic leg movements in relationship with cardiovascular autonomic nervous system. We not only confirmed that periodic leg movements during sleep were associated with a tachycardia followed by a bradycardia in restless legs syndrome patients and in healthy non-complaining subjects, but that these heart rate changes were also present in narcoleptic patients, albeit of a lower amplitude. Finally, we showed for the first time that periodic leg movements during sleep in restless legs syndrome patients and in healthy non-complaining subjects were also associated with significant and important rises of blood pressure.

Narcolepsia é uma doença neurológica crônica caracterizada por sonolência diurna excessiva e ataques de sono. Ocorre na população de uma para cada mil pessoas. Fenômenos de sono REM (rapid eye movement), cataplexia, paralisia do sono e alucinações hipnagógicas podem também ocorrer. Afeta todos os aspectos da vida e pode causar dificuldades para os pacientes em manter seus empregos, nos relacionamentos interpessoais e riscos de acidentes devido à sonolência excessiva e à cataplexia. Acredita-se que seja causada por um interjogo de fatores genéticos e ambientais. O risco para familiares de primeiro grau é estimado em de 1-2%. Recentemente foi demonstrado que os pacientes com narcolepsia têm uma deficiência de hipocretina também chamada de orexina na parte lateral do hipotálamo. O presente trabalho teve como objetivos: a) caracterizar os aspectos psicodinâmicos mais freqüentes da amostra; b) verificar a eficácia adaptativa do ego; c) verificar o equilíbrio e o funcionamento psíquico e relacionar com aspectos clínicos dos pacientes. A amostra foi de 23 pacientes portadores de narcolepsia, 15 mulheres e 8 homens, com média de idade de 44 anos. Eles foram avaliados através da Escala Diagnóstica Adaptativa Operacionalizada (EDAO), de R. Simon. O Questionário do Sono, de Giglio, foi utilizado para levantar os principais problemas no sono e as conseqüências na qualidade de vida dos pacientes. A Escala de Sonolência Epworth avaliou a intensidade da sonolência diurna. A dinâmica do funcionamento mental foi avaliada através do Teste das Relações Objetais de Phillipson (TRO), segundo os pressupostos teóricos da psicanálise. Os resultados mostraram que: 1) a narcolepsia está associada a sério prejuízo na eficácia adaptativa, com diagnóstico de Adaptação Ineficaz Moderada e Severa na maioria dos sujeitos; 2) sonolência severa excessiva diurna, ataques de sono e sono noturno fracionado; 3) a análise do funcionamento psíquico revelou que estes pacientes apresentam respostas, as quais, na maioria das vezes, impedem seu desenvolvimento. Os principais mecanismos de defesa, mais freqüentes, são pertinentes à posição esquisoparanóide, medo de rejeição e abandono e desejo de proteção e contato. Revelou também dificuldades em relação aos vínculos interpessoais, com mecanismos de fuga e evitação principalmente nas situações grupais e de três pessoas. / Narcolepsy is a chronic brain disorder characterized by excessive daytime sleepiness and sleep attacks. It affects up to one in a thousand people. Rapid eye movement (REM) sleep phenomena such as cataplexy, sleep paralysis and hypnagogic hallucinations can also occur. The condition impinges on every aspect of life, and can make it difficult for sufferers to keep their jobs as well as personal relationships. There can be accident risks caused by the excessive sleepiness and cataplexy. It is believed to be caused by an interplay between genetic and environmental factors. The risk to first-degree relatives is estimated at 1-2%. Patients with narcolepsy have recently been shown to be deficient in hypocretin, also called orexin, in the cerebrospinal fluid and have a reduction in hipocretin cells in the lateral hypothalamus. The present study characterizes a sample of 23 patients suffering from narcolepsy, of which 15 female and 8 male patients, 44 years-old in average. They had their adaptive efficiency evaluated by R. Simon\'s Adaptive and Operationalised Diagnostic Scale (AODS). Major sleep disorders and their effects on patient\'s life quality were surveyed by Giglio\'s Sleep Questionnaire. Intensity of sleepiness was evaluated through Epworth Sleepiness Scale. Mind functioning dynamics was assessed by Phillips on Test (ORT) obeying psychoanalytic theoretical presuppositions. Up to the moment, results show that: 1) narcolepsy is associated to serious damage to adaptive efficiency, with moderate and severe inefficient adaptation, prevailing in most patients; 2) severe excessive daytime sleepiness, sleep attacks and fractioned nocturnal sleep are frequent in most of patients even when medicated with stimulants; 3) the analysis through ORT showed that these patients presented responses that for most of the time, impede their progress Paranoid-schizoid position defense mechanisms were frequent, with fears of being rejected and abandoned. The Object Relations Test revealed interpersonal links impairment, mainly in group and triangular situations.