Effect of Low Sodium Oxybate (LXB) on Autonomic Symptom Burden in Idiopathic Hypersomnia Patients With Postural Tachycardia Syndrome

• Low sodium oxybate (LXB) (Drug): Participants will continue take low sodium oxybate (LXB) for two weeks after completing an open-label titration and dose optimization period of low sodium oxybate (LXB).
• Placebo (Drug): Participants will take placebo for two weeks after completing an open-label titration and dose optimization period of low sodium oxybate (LXB).

Primary outcomes

• Overall COMPASS-31 Score as a measure of direct comparison between the two conditions across the two-week randomized withdrawal period. [At the end of the two-week randomized withdrawal period]: The Composite Autonomic Symptom Severity Scale-31 (COMPASS-31) is an overall assessment of autonomic symptom severity. The scale measures neurodegenerative system symptoms through 31 patient-reported questions. Assessment is through six weighted domains: orthostatic intolerance \[10 points\]; vasomotor \[6 points\]; secretomotor \[7 points\]; gastrointestinal \[28 points\]; bladder \[9 points\] and pupillomotor \[15 points\]. Weighted scores are summed. A higher score indicates worse autonomic dysfunction.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

1. Age ≥ 18 years
2. English speaking and capable of signing the informed consent form and comply with the protocol requirements
3. Diagnosis of IH based on ICSD-3 criteria
4. Diagnosis of POTS based on the 2011 Consensus Criteria
5. Oxybate naïve. Participants on daytime alerting medications at baseline can remain on these medications for the duration of the study, provided doses remain stable for the duration of the study. This rule also applies to medications prescribed for the treatment of POTS. All medications known to affect cardiovascular function will be held for the appropriate time periods prior to active stand testing so as not to influence results.
6. COMPASS 31 ≥ 40 at the screening visit
7. Agree to use contraceptives consistent with local regulations regarding the methods of contraception for those participating in clinical trials

Exclusion Criteria:

1. Hypersomnia due to another medical, behavioral, sleep, or psychiatric disorder
2. Evidence of untreated or inadequately treated sleep disordered breathing, defined as AHI ≥ 10
3. History of bipolar or psychotic disorders, major depressive episode, or current suicidal risk
4. Pregnant or lactating or intends to become pregnant during the study
5. History of or currently being treated for clinically significant ongoing cardiac arrythmia, heart failure, myocarditis, pulmonary embolism requiring anticoagulation, pulmonary fibrosis or other pulmonary diagnosis that in the investigator's opinion may contribute to symptoms of POTS
6. Clinically significant uncontrolled active or chronic bacterial, viral, or fungal infection or positive SARS-CoV-2 PCR test at screening
7. A medical condition that could confound the results of the study or put the participant at undue risk in the investigator's judgment
8. Intends to have surgery or procedures requiring anesthesia or conscious sedation during the study
9. Currently participating in another interventional clinical study
10. Unwilling to remain on a stable regimen of medications during the study
11. Use of or planned use of intravenous saline infusions during the study

• Mitchell Miglis, MD, Principal investigator, Stanford University