Narcolepsy Mortality Debate: Researchers Defend 25-Year VA Cohort Study

A methodological dispute over whether narcolepsy shortens lives has escalated in the Journal of Clinical Sleep Medicine, where researchers have defended a 25-year Veterans Health Administration mortality study. The original analysis, led by Amir Sharafkhaneh of Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, reported that patients with clinically identified narcolepsy had higher mortality and greater healthcare use than matched sleep-clinic patients. Critics named Mehri and Finsterer argued the conclusions were too reliant on retrospective cohort methods, citing limitations such as bias. In an open-access reply, the authors defend using electronic health record data because rare diseases make prospective, long-duration cohorts difficult. They also distinguish recall bias—less relevant in EHR records—from selection bias and confounding, which they acknowledge as concerns.