Race, age, and other factors are linked to disparities in care for people with narcolepsy.
By Sree Roy
At SLEEP 2026, I felt a buzz in the narcolepsy arena, where pharmaceutical companies showcased drugs and drug candidates with the potential to be transformative. But my excitement was tempered by a concern: Are advancements in narcolepsy pharmacology reaching the diverse patient populations who could benefit from them?
According to new claims database analyses, the answer is no. Several SLEEP 2026 abstracts, conducted with support from Avadel (now owned by Alkermes plc), reveal troubling patterns of disparities in who has been receiving gold-standard treatments—and who hasn’t.
Co-investigator neurologist-sleep physician Brian Abaluck, MD, had noticed that “patients, by the time they came to me, depending on what their backgrounds were, seemed to have had very different evaluations and very different opportunities to receive care.” Separately, a co-investigator, pediatric pulmonary specialist Rakesh Bhattacharjee, MD, was troubled by the same observation.
Their team analyzed more than 30,000 patient records, dissecting a closed claims dataset based on variables such as age, race, and sex, to detail the populations who received gold-standard treatments in the year 2023 (the ones strongly recommended in the American Academy of Sleep Medicine guideline), and identifying trends in who got no pharmacologic treatment whatsoever for the symptom of excessive daytime sleepiness.
A consistent finding was that Black patients were less likely to receive gold-standard narcolepsy treatments—and more likely to receive no treatment at all. “Fewer Black patients receive any form of care for central disorders of hypersomnolence,” said Abaluck, senior medical director at Alkermes, adding that many factors likely contribute to this.
Also, their analyses suggest that the youngest and oldest patients—those under 17 and over 65—are the least treated groups overall. Does this stem from a tendency to dismiss sleepiness as “normal” or blame it on lifestyle at these ages? For children, an assumption can be, “this child stayed up too late last night,” Abaluck noted. These biases, conscious or not, can create barriers to diagnosis and therapy.
Also startling to me is the low use of oxybates, though this finding was not surprising to Abaluck. “I strongly feel that they are underutilized,” he told me. He attributed this to a combination of factors, including stigma and a learning curve that requires navigating a Risk Evaluation and Mitigation Strategy (REMS) program. “I think the REMS program can be intimidating,” Abaluck said. In his experience, after clinicians are educated on the program, it’s “quite navigable” and sometimes even less work than anticipated.
Perhaps the most disheartening finding was that a substantial proportion of patients with a narcolepsy diagnosis receive no treatment for their excessive daytime sleepiness whatsoever. “That is disappointing, and, I think, a reflection of our healthcare system more broadly: a diagnosis may occur, and then people may cycle in and out of having insurance,” Abaluck said. He urged clinicians to remember the immense burden these patients carry. “It’s hard enough to make an appointment with a doctor and to get in at the time that you want. But just imagine if you were struggling to stay awake throughout the day, how challenging that process would be.”
The path forward, Abaluck emphasized, is education. The sleep subspecialty, as a community, must raise awareness among peers and referring providers. The tools are only as good as the ability to deliver them equitably. “No matter how many developments occur in this space, if patients are not being given those options, they’re not going to benefit,” Abaluck observed. “It is incumbent upon providers to think through each patient.”
References
Bhattacharjee R, Platt A, Merius H, et al. 0703 Impact of economic status across race and ethnicity on narcolepsy treatment access: a claims database analysis. Sleep. 2026;49(suppl_1):A313.
Bhattacharjee R, Platt A, Martin C, et al. 0704 Impact of sex and race on treatment of narcolepsy: a claims database analysis. Sleep. 2026;49(suppl 1):A313-4.
Platt A, Bhattacharjee R, Lavender M, et al. 0705 Treatment access for narcolepsy across patient demographic characteristics: a claims database analysis. Sleep. 2026;49(suppl 1):A314.
