1395 Wake-Up Call: Narcolepsy Symptom Improvement After Bariatric Surgery in an Adolescent

Abstract Introduction Narcolepsy is closely associated with metabolic dysfunction, particularly obesity. Standard therapy focuses on improving sleep efficiency and reducing excessive daytime sleepiness (EDS). Bariatric surgery is a well-established intervention for obesity, but its effect on narcolepsy has not been reported. We present an adolescent with narcolepsy who demonstrated notable improvement following bariatric surgery. Report of case(s) A 9-year-old female presented with EDS. Apart from obesity, her history was unremarkable. Diagnostic testing—including actigraphy, polysomnography (PSG), multiple sleep latency testing (MSLT), and presence of cataplexy—confirmed narcolepsy type 1. Her EDS was refractory to multiple stimulants, including methylphenidate, amphetamine/dextroamphetamine, modafinil, armodafinil, and lisdexamfetamine. Within a year she developed mild obstructive sleep apnea (OSA) requiring PAP therapy, but symptoms persisted. At age 12, sodium oxybate led to substantial improvement and was later transitioned to mixed-salt oxybate to limit sodium intake. Despite this, binge eating and progressive weight gain continued, with BMI reaching 48. At age 14, she underwent bariatric surgery and lost over 40 pounds. Repeat PSG revealed only primary snoring, allowing PAP discontinuation while oxybate was continued. By age 16, oxybate was tapered due to mood concerns and pitolisant was initiated. Around this time, she regained more than 40 pounds. After 6 months, she discontinued pitolisant, reporting consolidated sleep and improved daytime alertness. Remarkably, she no longer required daily lisdexamfetamine and used only occasional methylphenidate as rescue therapy, despite regaining her prior weight. Conclusion Narcolepsy treatment is often complex, requiring multiple pharmacologic and supportive strategies. In this case, bariatric surgery was followed by weight loss, resolution of OSA, and meaningful reduction in narcolepsy symptoms. Even after weight regain, the patient maintained improved sleep quality and reduced EDS, raising the possibility that bariatric surgery exerts effects beyond weight reduction—potentially through altered sleep physiology, metabolic signaling, or other mechanisms. To our knowledge, no prior reports describe bariatric surgery as a modifier of narcolepsy outcomes. Further study is needed to clarify whether weight reduction or metabolic changes following surgery can contribute to improved disease control in narcolepsy. Support (if any)