The impact of narcolepsy symptoms and treatment on sex life - current evidence and reports

Karol Kasprzak; Agnieszka Dyzma-Kasprzak; Zuzanna Wingralek; Agnieszka Pukaluk-Lewinska

doi:10.12923/2353-8627/2024-0012

Authors

Karol Kasprzak Student Research Group at I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University, Lublin, Poland Author https://orcid.org/0000-0003-2698-184X
Agnieszka Dyzma-Kasprzak Student Research Group at I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University, Lublin, Poland Author https://orcid.org/0009-0003-8782-4116
Zuzanna Wingralek Student Research Group at I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University, Lublin, Poland Author https://orcid.org/0000-0003-3253-9345
Agnieszka Pukaluk-Lewinska University Public Hospital no. 1, Lublin, Poland Author https://orcid.org/0009-0007-1542-0525

DOI:

https://doi.org/10.12923/2353-8627/2024-0012

Keywords:

narcolepsy, sexual dysfunctions, medications in narcolepsy

Abstract

Introduction: Narcolepsy (NT) can manifest as excessive daytime sleepiness (EDS), cataplexy, hypnagogic (HHG) and hypnopompic (HHP) hallucinations, sleep paralysis, orgasmolepsy – all of which may affect patients' functioning. The aim of the study was to determine the impact of NT, specific sexual dysfunctions and drugs used in NT on sex life.

Materials and methods: A narrative review was conducted, using keywords: narcolepsy, sexual dysfunctions, medications in narcolepsy from repository inception to March 17, 2024 searching PubMed/MEDLINE, Google Scholar, Crossref, Cochrane databases. The quality of the reviewed articles was assessed using the Scale for the Assessment of Narrative Review Articles (SANRA).

Results: Sexual activity and satisfaction are reduced in up to 81.1% of patients. There are often multiple co-occurring autonomic dysregulations in patients, including the genitourinary system, causing sexual dysfunction (erectile dysfunction in 48% of men; vaginal lubrication in 81% of women). Orgasmolepsy negatively affects sexual and social relationships in more than 1⁄3 of respondents. Sleep paralysis can be accompanied by HHG, which often present the impression of sexual assault and harassment. They may cause anxiety, post-traumatic stress disorder (PTSD) features, depressed mood, in extreme cases leading to suicide attempts. Of the drugs used in NT, only methylphenidate can increase libido and reduce erectile dysfunction in NT.

Conclusions: Orgasmolepsy, sexual and autonomic dysfunction in NT significantly reduce patients' quality of sex life. Sleep paralysis with sexual HHG can reduce psychological well-being. A holistic intervention approach, using behavioural interventions, cognitive-behavioural therapy, education of the patient and their loved ones, is crucial in the treatment of sexual difficulties.

References

1. Nishino S, Mignot E. Narcolepsy and cataplexy. Handb Clin Neurol Ed PJ Vinken GW Bruyn. 31 December 2011;99:783-814. https://doi.org/10.1016/B978-0-444-52007-4.00007-2

2. Mahoney CE, Cogswell A, Koralnik IJ, Scammell TE. The neurobiological basis of narcolepsy. Nat Rev Neurosci. February 2019;20(2):83-93. https://doi.org/10.1038/s41583-018-0097-x

3. AASM | Clinical Resources | International Classification of Sleep Disorders [Internet]. American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. [cited 9 March 2024]. Available on: https://aasm.org/clinical-resources/international-classification-sleep-disorders/

4. Szûcs A, Mutti C, Papp A, Halász P, Parrino L. REM sleep, REM parasomnias, REM sleep behaviour disorder. Ideggyogyaszati Szle. 30 May 2022;75(5-06):171-82. https://doi.org/10.18071/ISZ.75.0171

5. Dauvilliers Y, Arnulf I, Mignot E. Narcolepsy with cataplexy. Lancet Lond Engl. 10 February 2007;369(9560):499-511. https://doi.org/10.1016/S0140-6736(07)60237-2

6. Ohayon MM. Prevalence of hallucinations and their pathological associations in the general population. Psychiatry Res. 27 December 2000;97(2-3):153-64. https://doi.org/10.1016/S0165-1781(00)00227-4

7. Billiard M. Narcolepsy. Clinical features and aetiology. Ann Clin Res. 1985;17(5):220-6.

8. Leu-Semenescu S, De Cock VC, Le Masson VD, Debs R, Lavault S, Roze E, i in. Hallucinations in narcolepsy with and without cataplexy: contrasts with Parkinson’s disease. Sleep Med. May 2011;12(5):497-504. https://doi.org/10.1016/j. sleep.2011.03.006

9. Matas M, Marriott A. The girl who cried wolf: Pseudologia phantastica and sexual abuse. Can J Psychiatry Rev Can Psychiatr. 1987;32(4):305-9. https://doi.org/10.1177/070674378703200412

10. Hays P. False but sincere accusations of sexual assault made by narcoleptic [correction of narcotic] patients,. Med Leg J. 1992;60 ( Pt 4):265-71. https://doi.org/10.1177/002581729206000405

11. Stefani A, Högl B. Nightmare Disorder and Isolated Sleep Paralysis. Neurotherapeutics. January 2021;18(1):100-6. https://doi.org/10.1007/s13311-020-00966-8

12. Schenck CH, Bassetti CL, Arnulf I, Mignot E. English Translations Of The First Clinical Reports On Narcolepsy And Cataplexy By Westphal And Gélineau In The Late 19th Century, With Commentary. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 15 April 2007;3(3):301-11. PMID: 17561602; PMCID: PMC2564780.

13. Mignot E. A hundred years of narcolepsy research. Arch Ital Biol. April 2001;139(3):207-20. https://doi.org/10.4449/aib. v139i3.500

14. Nishino S, Ripley B, Overeem S, Lammers GJ, Mignot E. Hypocretin (orexin) deficiency in human narcolepsy. Lancet Lond Engl. 1 January 2000;355(9197):39-40. https://doi.org/10.1016/S0140-6736(99)05582-8

15. Thannickal TC, Moore RY, Nienhuis R, Ramanathan L, Gulyani S, Aldrich M, i in. Reduced number of hypocretin neurons in human narcolepsy. Neuron. September 2000;27(3):469-74. https://doi.org/10.1016/S0896-6273(00)00058-1

16. Mignot E, Lammers GJ, Ripley B, Okun M, Nevsimalova S, Overeem S, i in. The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias. Arch Neurol. October 2002;59(10):1553-62. https://doi.org/10.1001/archneur.59.10.1553

17. Kanbayashi T, Inoue Y, Chiba S, Aizawa R, Saito Y, Tsukamoto H, i in. CSF hypocretin-1 (orexin-A) concentrations in narcolepsy with and without cataplexy and idiopathic hypersomnia. J Sleep Res. March 2002;11(1):91-3. https://doi.org/10.1046/j.1365-2869.2002.00284.x

18. Thannickal TC, Nienhuis R, Siegel JM. Localized loss of hypocretin (orexin) cells in narcolepsy without cataplexy. Sleep. August 2009;32(8):993-8. https://doi.org/10.1093/sleep/32.8.993

19. Sarkanen TO, Alakuijala APE, Dauvilliers YA, Partinen MM. Incidence of narcolepsy after H1N1 influenza and vaccinations: Systematic review and meta-analysis. Sleep Med Rev. April 2018;38:177-86. https://doi.org/10.1016/j.smrv.2017.06.006

20. Lind A, Ramelius A, Olsson T, Arnheim-Dahlström L, Lamb F, Khademi M, i in. A/H1N1 antibodies and TRIB2 autoantibodies in narcolepsy patients diagnosed in conjunction with the Pandemrix vaccination campaign in Sweden 2009-2010. J Autoimmun. May 2014;50:99-106. https://doi.org/10.1016/j. jaut.2014.01.031

21. Koepsell TD, Longstreth WT, Ton TGN. Medical exposures in youth and the frequency of narcolepsy with cataplexy: a population-based case-control study in genetically predisposed people. J Sleep Res. March 2010;19(1 Pt 1):80-6. https://doi.org/10.1111/j.1365-2869.2009.00756.x

22. Seifinejad A, Ramosaj M, Shan L, Li S, Possovre ML, Pfister C, i in. Epigenetic silencing of selected hypothalamic neuropeptides in narcolepsy with cataplexy. Proc Natl Acad Sci U S A. 9 May 2023;120(19):e2220911120. https://doi.org/10.1073/pnas.2220911120

23. Scammell TE, Mochizuki T. Is Low Histamine a Fundamental Cause of Sleepiness in Narcolepsy and Idiopathic Hypersomnia? Sleep. 1 February 2009;32(2):133-4. https://doi.org/10.1093/sleep/32.2.133

24. Biobaku F, Hanna A, Matthews G, Dhindsa S, Dandona P. Narcolepsy, depression, and severe flushing in an obese man. Clin Case Rep. 10 August 2020;8(9):1824-6. https://doi.org/10.1002/ccr3.2873

25. Nishino S, Kanbayashi T. Symptomatic narcolepsy, cataplexy and hypersomnia, and their implications in the hypothalamic hypocretin/orexin system. Sleep Med Rev. August 2005;9(4):269-310. https://doi.org/10.1016/j.smrv.2005.03.004

26. Sleep Medicine Textbook | ESRS Sleep Book 2nd Edition [Internet]. [cited 17 March 2024]. Dostępne na: https://esrs.eu/sleep-medicine-textbook/

27. Ervik S, Abdelnoor M, Heier MS, Ramberg M, Strand G. Health-related quality of life in narcolepsy. Acta Neurol Scand. September 2006;114(3):198-204. https://doi.org/10.1111/j.1600-0404.2006.00594.x

28. Raggi A, Plazzi G, Ferri R. Health-Related Quality of Life in Patients With Narcolepsy: A Review of the Literature. J Nerv Ment Dis. February 2019;207(2):84-99. https://doi.org/10.1097/NMD.0000000000000918

29. David A, Constantino F, dos Santos JM, Paiva T. Health-related quality of life in Portuguese patients with narcolepsy. Sleep Med. March 2012;13(3):273-7. https://doi.org/10.1016/j.sleep.2011.06.021

30. Daniels E, King MA, Smith IE, Shneerson JM. Health-related quality of life in narcolepsy. J Sleep Res. March 2001;10(1):75-81. https://doi.org/10.1046/j.1365-2869.2001.00234.x

31. Ozaki A, Inoue Y, Hayashida K, Nakajima T, Honda M, Usui A, i in. Quality of life in patients with narcolepsy with cataplexy, narcolepsy without cataplexy, and idiopathic hypersomnia without long sleep time: comparison between patients on psychostimulants, drug-naïve patients and the general Japanese population. Sleep Med. February 2012;13(2):200-6. https://doi.org/10.1016/j.sleep.2011.07.014

32. Lee DM, Vanhoutte B, Nazroo J, Pendleton N. Sexual Health and Positive Subjective Well-Being in Partnered Older Men and Women. J Gerontol B Psychol Sci Soc Sci. July 2016;71(4):698-710. https://doi.org/10.1093/geronb/gbw018

33. Rosen RC, Bachmann GA. Sexual well-being, happiness, and satisfaction, in women: the case for a new conceptual paradigm. J Sex Marital Ther. 2008;34(4):291-7; discussion 298-307. https://doi.org/10.1080/00926230802096234

34. Hicham M, Abdellatif B, Nadia O, Hakima A. The effect of sexuality on the quality of life of elderly people in Morocco. Afr J Reprod Health. 31 August 2023;27(8):76-82. https://doi.org/10.29063/ajrh2023/v27i8.8

35. Peixoto MM, Lopes J. Quality of life and emotional well-being during COVID-19 as mediators in the relationship between sexual functioning and satisfaction in Portuguese women. Women Health. April 2022;62(4):358-68. https://doi.org/10.10 80/03630242.2022.2074609

36. Baethge C, Goldbeck-Wood S, Mertens S. SANRA – a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 26 March 2019;4(1):5. https://doi.org/10.1186/s41073¬019-0064-8

37. Rovere H, Rossini S, Reimão R. Quality of life in patients with narcolepsy: a WHOQOL-bref study. Arq Neuropsiquiatr. June 2008;66(2A):163-7. https://doi.org/10.1590/s0004¬282x2008000200004

38. Szűcs A, Janszky J, Holló A, Migléczi G, Halász P. Misleading hallucinations in unrecognized narcolepsy. Acta Psychiatr Scand. 2003;108(4):314-7. https://doi.org/10.1034/j.1600¬0447.2003.00114.x

39. Poryazova R, Khatami R, Werth E, Bassetti CL. Weak with sex: sexual intercourse as a trigger for cataplexy. J Sex Med. August 2009;6(8):2271-7. https://doi.org/10.1111/j.1743¬6109.2009.01328.x

40. Davidson RD, Biddle K, Nassan M, Scammell TE, Zhou ES. The impact of narcolepsy on social relationships in young adults. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 1 December 2022;18(12):2751-61. DOI: https://doi.org/10.5664/jcsm.10212

41. Karacan I, Gokcebay N, Hirshkowitz M, Ozmen M, Ozmen E, Williams RL. Sexual Dysfunction in Men with Narcolepsy. Loss Grief Care. 10 June 1992;5(3-4):81-90.

42. Kapella MC, Berger BE, Vern BA, Vispute S, Prasad B, Carley DW. Health-Related Stigma as a Determinant of Functioning in Young Adults with Narcolepsy. PLOS ONE. 21 April 2015;10(4):e0122478. https://doi.org/10.1371/journal.pone.0122478

43. Alaia SL. Life Effects of Narcolepsy: Measures of Negative Impact, Social Support, and Psychological Well-Being. W: Psychosocial Aspects of Narcolepsy. Routledge; 1992.

44. Ito E, Inoue Y. [The International Classification of Sleep Disorders, third edition. American Academy of Sleep Medicine. Includes bibliographies and index]. Nihon Rinsho Jpn J Clin Med. June 2015;73(6):916-23.

45. Grimaldi D, Silvani A, Benarroch EE, Cortelli P. Orexin/hypocretin system and autonomic control: new insights and clinical correlations. Neurology. 21 January 2014;82(3):271-8. https://doi.org/10.1212/WNL.0000000000000045

46. Wang Y, Sun Q, Tang Q, Zhang Y, Tang M, Wang D, i in. Progress of autonomic disturbances in narcolepsy type 1. Front Neurol. 6 March 2023;14:1107632. https://doi.org/10.3389/fneur.2023.1107632

47. Plazzi G, Moghadam KK, Maggi LS, Donadio V, Vetrugno R, Liguori R, i in. Autonomic disturbances in narcolepsy. Sleep Med Rev. June 2011;15(3):187-96. https://doi.org/10.1016/j. smrv.2010.05.002

48. Donadio V, Liguori R, Vandi S, Pizza F, Dauvilliers Y, Leta V, i in. Lower wake resting sympathetic and cardiovascular activities in narcolepsy with cataplexy. Neurology. 16 September 2014;83(12):1080-6. https://doi.org/10.1212/WNL.0000000000000793

49. Dauvilliers Y, Jaussent I, Krams B, Scholz S, Lado S, Levy P, i in. Non-dipping blood pressure profile in narcolepsy with cataplexy. PloS One. 2012;7(6):e38977. https://doi.org/10.1371/journal.pone.0038977

50. Barateau L, Chenini S, Evangelista E, Jaussent I, Lopez R, Dauvilliers Y. Clinical autonomic dysfunction in narcolepsy type 1. Sleep. 24 December 2019;42(12):zsz187. https://doi.org/10.1093/sleep/zsz187

51. Joshi D, Singh SK. The neuropeptide orexin A -search for its possible role in regulation of steroidogenesis in adult mice testes. Andrology. May 2018;6(3):465-77. https://doi.org/10.1111/andr.12475

52. Kok SW, Roelfsema F, Overeem S, Lammers GJ, Frölich M, Meinders AE, i in. Pulsatile LH release is diminished, whereas FSH secretion is normal, in hypocretin-deficient narcoleptic men. Am J Physiol Endocrinol Metab. October 2004;287(4):E630-636. https://doi.org/10.1152/ajpendo.00060.2004

53. Bassetti CLA, Adamantidis A, Burdakov D, Han F, Gay S, Kallweit U, i in. Narcolepsy -clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol. September 2019;15(9):519-39. https://doi.org/10.1038/s41582-019-0226-9

54. Rothfeld J. Affektiver Tonus- und Bewußtseinsverlust beim Lachen und Orgasmus (Gelo- und Orgasmolepsia). Z Für Gesamte Neurol Psychiatr. 1 December 1928;115(1):516-30.

55. Pellitteri G, Dolso P, Valente M, Gigli GL. Orgasmolepsy in Narcolepsy Type 1 Responsive to Pitolisant: A Case Report. Nat Sci Sleep. 31 December 2020;12:1237-40. https://doi.org/10.2147/NSS.S286358

56. Georgiadis JR, Kortekaas R, Kuipers R, Nieuwenburg A, Pruim J, Reinders AATS, i in. Regional cerebral blood flow changes associated with clitorally induced orgasm in healthy women. Eur J Neurosci. December 2006;24(11):3305-16 https://doi.org/10.1111/j.1460-9568.2006.05206.x

57. Georgiadis JR, Reinders AATS, Van der Graaf FHCE, Paans AMJ, Kortekaas R. Brain activation during human male ejaculation revisited. Neuroreport. 16 April 2007;18(6):553-7. https://doi.org/10.1097/WNR.0b013e3280b10bfe

58. Clément P, Pozzato C, Heidbreder C, Alexandre L, Giuliano F, Melotto S. Delay of ejaculation induced by SB-277011, a selective dopamine D3 receptor antagonist, in the rat. J Sex Med. April 2009;6(4):980-8. https://doi.org/10.1111/j.1743¬6109.2008.01173.x

59. Marcus JN, Aschkenasi CJ, Lee CE, Chemelli RM, Saper CB, Yanagisawa M, i in. Differential expression of orexin receptors 1 and 2 in the rat brain. J Comp Neurol. 18 June 2001;435(1):6-25. https://doi.org/10.1002/cne.1190

60. Narita M, Nagumo Y, Miyatake M, Ikegami D, Kurahashi K, Suzuki T. Implication of protein kinase C in the orexin-induced elevation of extracellular dopamine levels and its rewarding effect. Eur J Neurosci. March 2007;25(5):1537-45. https://doi.org/10.1111/j.1460-9568.2007.05403.x

61. Muschamp JW, Dominguez JM, Sato SM, Shen RY, Hull EM. A role for hypocretin (orexin) in male sexual behavior. J Neurosci Off J Soc Neurosci. 14 March 2007;27(11):2837-45. https://doi.org/10.1523/JNEUROSCI.4121-06.2007

62. Wamsley E, Donjacour CEHM, Scammell TE, Lammers GJ, Stickgold R. Delusional Confusion of Dreaming and Reality in Narcolepsy. Sleep. 1 February 2014;37(2):419-22. https://doi.org/10.5665/sleep.3428

63. Cheyne JA, Girard TA. Paranoid delusions and threatening hallucinations: a prospective study of sleep paralysis experiences. Conscious Cogn. December 2007;16(4):959-74. https://doi.org/10.1016/j.concog.2007.01.002

64. Nielsen T. Felt presence: paranoid delusion or hallucinatory social imagery? Conscious Cogn. December 2007;16(4):975-83; discussion 984-991. https://doi.org/10.1016/j.concog.2007.02.002

65. Solomonova E, Nielsen T, Stenstrom P, Simard V, Frantova E, Donderi D. Sensed presence as a correlate of sleep paralysis distress, social anxiety and waking state social imagery. Conscious Cogn. March 2008;17(1):49-63. https://doi.org/10.1016/j.concog.2007.04.007

66. Sharpless BA, Barber JP. Lifetime Prevalence Rates of Sleep Paralysis: A Systematic Review. Sleep Med Rev. October 2011;15(5):311-5. https://doi.org/10.1016/j.smrv.2011.01.007

67. Fosse R. REM mentation in narcoleptics and normals: an empirical test of two neurocognitive theories. Conscious Cogn. December 2000;9(4):488-509. https://doi.org/10.1006/ccog.2000.0466

68. Mazzetti M, Bellucci C, Mattarozzi K, Plazzi G, Tuozzi G, Cipolli C. REM-dreams recall in patients with narcolepsy-cataplexy. Brain Res Bull. 15 January 2010;81(1):133-40. https://doi.org/10.1016/j.brainresbull.2009.10.021

69. Tjokrodipo L, Sneep A, Michielsen P. A case of incubus phenomenon. Eur Psychiatry. April 2021;64(S1):S818-S818. https://doi.org/10.1192/j.eurpsy.2021.2162.

70. McNally RJ, Clancy SA. Sleep Paralysis, Sexual Abuse, and Space Alien Abduction. Transcult Psychiatry. 2005;42(1):113-22. https://doi.org/10.1177/1363461505050715

71. Espinoza Lopez DA, Alfaro EC, Booth VA. 60. Hallucinations with sexual context as manifestation of narcolepsy without cataplexy. Case report. Clin Neurophysiol. 1 September 2016;127(9):e316. https://doi.org/10.1016/j.clinph.2016.05.335

72. van Berlo W, Ensink B. Problems with sexuality after sexual assault. Annu Rev Sex Res. 2000;11:235-57.

73. Moszczynski A, Coelho F. Sexual hypnagogic hallucinations and narcolepsy with cataplexy: A case report. Sleep Sci. 1 January 2011;4:110-2.

74. Teixeira VG, Faccenda JF, Douglas NJ. Functional status in patients with narcolepsy. Sleep Med. September 2004;5(5):477-83. https://doi.org/10.1016/j.sleep.2004.07.001

75. Ballon JS, Feifel D. A systematic review of modafinil: Potential clinical uses and mechanisms of action. J Clin Psychiatry. April 2006;67(4):554-66. https://doi.org/10.4088/jcp.v67n0406

76. Qu WM, Huang ZL, Xu XH, Matsumoto N, Urade Y. Dopaminergic D1 and D2 receptors are essential for the arousal effect of modafinil. J Neurosci Off J Soc Neurosci. 20 August 2008;28(34):8462-9. https://doi.org/10.1523/JNEUROSCI.1819-08.2008

77. Modafinil - referral | European Medicines Agency [Internet]. [cited 9 March 2024]. Available on: https://www.ema.europa.eu/en/medicines/human/referrals/modafinil

78. Nazlı ŞB, Sevindik M. Use of Methylphenidate in Coexisting Major Depression, Loss of Libido and Erectile Dysfunction. Alpha Psychiatry. January 2021;22(1):70. https://doi.org/10.5455/apd.112405

79. Franceschini C, Pizza F, Antelmi E, Folli MC, Plazzi G. Narcolepsy treatment: pharmacological and behavioural strategies in adults and children. Sleep Breath. 1 June 2020;24(2):615-27. https://doi.org/10.1007/s11325-019-01894-4

80. Bierer G, Banashek LR, Wen E. Narcolepsy with Cataplexy: Treatment Tailored to the Patient. 2013;17.

81. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001;62 Suppl 3:10-21.

82. Nishino S. Narcolepsy: pathophysiology and pharmacology. J Clin Psychiatry. 2007;68 Suppl 13:9-15.

83. Wakix | European Medicines Agency [Internet]. [cited 9 march 2024]. Available on: https://www.ema.europa.eu/en/medicines/human/EPAR/wakix

84. Guevarra JT, Hiensch R, Varga AW, Rapoport DM. Pitolisant to Treat Excessive Daytime Sleepiness and Cataplexy in Adults with Narcolepsy: Rationale and Clinical Utility. Nat Sci Sleep. 12 October 2020;12:709-19. https://doi.org/10.2147/NSS.S264140

85. Bernasconi R, Mathivet P, Bischoff S, Marescaux C. Gamma¬hydroxybutyric acid: an endogenous neuromodulator with abuse potential? Trends Pharmacol Sci. April 1999;20(4):135-41. https://doi.org/10.1016/s0165-6147(99)01341-3

86. Gulia KK, Mallick HN, Kumar VM. Orexin A (hypocretin-1) application at the medial preoptic area potentiates male sexual behavior in rats. Neuroscience. 2003;116(4):921-3. https://doi.org/10.1016/s0306-4522(02)00877-1

The impact of narcolepsy symptoms and treatment on sex life - current evidence and reports

Authors

DOI:

Keywords:

Abstract

References

Downloads

Published

Issue

Section

License