Onset Rapid Eye Movement Periods Research Articles

Exploring sleep characteristics in Chinese patients with narcolepsy: insights from the nocturnal sleep onset rapid eye movement period (nSOREMP).

This study aims to investigate the unique characteristics and clinical significance of the nocturnal sleep onset rapid eye movement period (nSOREMP) in the Chinese population with narcolepsy, enhancing our understanding and management of the disorder globally. This retrospective analysis investigated narcolepsy in Chinese patients from six hospitals, using International Classification of Sleep Disorders. A parallel retrospective analysis of the Chinese Clinical Sleep Database (CCSD) focused on polysomnography (PSG) records was conducted to evaluate nSOREMP prevalence in other sleep disorders. The study found a 2.51% nSOREMP prevalence in other sleep disorders of CCSD. Significant differences in age, N2 and rapid eye movement (REM) percentages, REM latency, and various indexes were noted among narcolepsy with/without nSOREMP, and other sleep disorders with nSOREMP of CCSD. nSOREMP prevalence in NT1 was 33.33% and in NT2, 28.30%. Noteworthy disparities in NT1 included N2 percentages, REM latency, and SOREMPs in Multiple Sleep Latency Test (MSLT). In NT2, differences were significant in age, sleep latency, N2 and REM latencies, arousal index, mean sleep latency in MSLT, and MSLT SOREMPs. This study highlights the distinct characteristics of nSOREMP in the Chinese population. Patients exhibiting symptoms suggestive of the onset of narcolepsy are advised to undergo an MSLT, irrespective of the occurrence of SOREMP during nocturnal PSG.

A narcolepsy detection paradigm: automated nocturnal detection and notification of sleep onset rapid eye movement periods

A narcolepsy detection paradigm: automated nocturnal detection and notification of sleep onset rapid eye movement periods

Sleep Stage Transition of Sleep Onset Rapid Eye Movement Periods Suggesting REM Dysregulation in Narcolepsy

Objectives: Narcolepsy diagnosis is often complicated, using relatively simple criteria that rely on sleep onset rapid eye movement periods (SOREMP) and average sleep latency in the multiple sleep latency test (MSLT). Therefore, the main goal of this study was to gain a new perspective on narcolepsy diagnosis and explore the role of rapid eye movement (REM) dysregulation by examining the progression of sleep stage transitions leading to SOREMP.Methods: From 2008 to 2022, 109 patients diagnosed with narcolepsy who underwent polysomnography and MSLT were included. Comprehensive data on clinical features, polysomnography, and MSLT findings were collected. For the MSLT, we not only considered SOREMP and mean sleep latency but also the sleep stage transition preceding SOREMP, the presence of N3, and the average SOREMP duration.Results: Among the 109 patients enrolled in the study, 59 were diagnosed with narcolepsy type 1 (NT1) and 50 with narcolepsy type 2 (NT2). We observed a high frequency of transitions in the MSLT of waking to REM (W-R) in patients with NT1. Moreover, the occurrence of W-R was associated with a higher number of SOREMPs. The temporal distribution of the MSLT results revealed a significant correlation; W-R occurrences were more frequent during the third nap.Conclusions: W-R occurrence was frequent in patients with NT1, indicating more pronounced REM dysregulation than in patients with NT2.

A series of 7 cases of patients with narcolepsy with hypocretin deficiency without the HLA DQB1*06:02 allele.

We report data collected from 2 reference European sleep centers on a series of patients with narcolepsy with hypocretin-1 deficiency and absence of the human leukocyte antigens (HLA) DQB1*06:02 allele. Clinical data, HLA DQ markers, and cerebrospinal fluid assessments were collected retrospectively from Caucasian patients with a diagnosis of narcolepsy type 1 with cerebrospinal fluid hypocretin-1 deficiency (< 110 pg/ml) and absence of the HLA DQB1*06:02 allele, with follow-up with at least 1 visit within the last 4 years, consecutively admitted to 2 European sleep centers (Lugano, Switzerland and Montpellier, France). Seven patients (3 of 29 patients in Lugano and 4 of 328 in Montpellier) were diagnosed with narcolepsy with hypocretin-1 deficiency and absence of HLA DQB1*06:02 (ie, 2% of patients with narcolepsy type 1). Regarding the HLA-DQB1 genotyping, 4 cases were positive for HLA DQB1*03:01, 1 for DQB1*03:02, and 3 for DQB1*02:01. Three patients had atypical cataplexy and 1 had no cataplexy. Only 2 patients had both a mean sleep latency of less than 8 minutes and more than 2 sleep onset rapid eye movement periods on the Multiple Sleep Latency Test, indicative of a less severe condition. Although rare, this series of 7 cases confirms that hypocretin-deficient narcolepsy should not be excluded in the absence of HLA DQB1*06:02, especially if patients are carriers of other high-risk HLA-DQB1 alleles (DQB1*03:01, *03:02, *02:01). These data support the hypothesis that narcolepsy type 1 is a wider disease spectrum linked to the loss of hypocretin peptide. Miano S, Barateau L, De Pieri M, etal. A series of 7 cases of patients with narcolepsy with hypocretin deficiency without the HLA DQB1*06:02 allele. J Clin Sleep Med. 2023;19(12):2053-2057.

How reliable is a simplified MSLT nap termination protocol?

ObjectiveAccording to current practical guidelines, naps of the Mean Sleep Latency Test (MSLT) must be terminated 15 min after sleep onset, which requires ad hoc scoring. For clinical convenience, some sleep clinics use a simplified protocol with fixed nap lengths of 20min. Its diagnostic accuracy remains unknown. MethodsA subset of MSLT naps of 56 narcolepsy type 1 (NT1), 98 Parkinson's disease (PD), 117 sleep disordered breathing (SDB), 22 insufficient sleep syndrome (ISS) patients, and 24 patients with idiopathic hypersomnia (IH), originally performed according to the simplified protocol, were retrospectively adjusted to standard protocol (nap termination 15min after sleep onset or after 20min when no sleep occurs). This was feasible in 60% of MSLT naps; in this subset, we compared sensitivity and specificity of both MSLT protocols for identification of patients with and without NT1. ResultsSensitivity of classical MSLT criteria for NT1, i.e. mean sleep latency ≤8.0min and ≥2 sleep onset rapid eye movement periods (SOREMPs), did not differ between protocols (95%). Specificity, however, was slightly lower (88.1% vs. 89.7%) in the simplified nap termination protocol, with 3 SDB patients and 1 ISS patient having false-positive MSLT findings in the simplified but not in the standard protocol. ConclusionsThe use of a simplified MSLT protocol with fixed nap duration had no impact on MSLT sensitivity for NT1, but the longer sleep periods in the simplified protocol increased the likelihood of REM sleep occurrence particularly in non-NT1 conditions, resulting in a slightly lower MSLT specificity compared to the standard protocol.

Different Course of Narcolepsy Diagnosed by Multiple Sleep Latency Test: A Single Center Experience

Background and Objective Several studies have raised questions about determining the diagnosis of the narcolepsy using multiple sleep latency test (MSLT). In this study, we investigated the diagnostic change in narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2) using MSLT with long-term interval.Methods In this retrospective study, the demographic characteristics, polysomnography (PSG), and MSLT parameters were compared at the baseline between the NT1 and NT 2 patients. Then, MSLT re-tests were conducted with a mean follow-up of 8.48 years in patients with NT 1 and 7.05 years with NT 2.Results Seventy-four patients (58 with NT1 and 16 with NT2) were investigated in this study. At the baseline, demographic data showed a larger body mass index value, more sleep paralysis, and hypnogogic hallucination in NT 1 compared to NT 2. Also, at baseline MSLT, shorter mean sleep latency and higher number of sleep onset rapid eye movement periods (SOREMPs) were observed in the NT 1 than those of the NT 2. On follow-up MSLT, 6.9% (n = 4) patients with NT1 and 50% (n = 8) patients with NT2 did not satisfy the previous diagnosis. Furthermore, in all the groups who had the change in repeated-MSLT, the groups with less than 2 SOREMPs observed to be accompanied by negative MSL at follow-up.Conclusions The result of MSLT was observed not to be stable in the diagnosis of NT 2 at the study. Therefore, it is recommended to repeat MSLT at regular intervals and do a prospective multi-site survey for the accurate confirmation of a diagnosis of central hypersomnia.

Quality of life changes and their predictors in young adult narcolepsy patients after treatment: A real-world cohort study.

BackgroundWe conducted a five-year prospective follow-up study to track the real-world quality of life of patients with narcolepsy after medication and analyzed predictors.MethodsThe study ultimately included 157 participants who completed 5-year follow-up, 111 had type 1 narcolepsy (NT1) and 46 had type 2 narcolepsy (NT2). Polysomnography, multiple sleep latency test, actigraphy and HLA-typing were conducted. The Short Form 36 Health Survey Questionnaire (SF-36), the Stanford Center for Narcolepsy Sleep Inventory, the Epworth Sleepiness Scale (ESS), the visual analog for hypersomnolence (VAS), and Conners' Continuous Performance Test were used. Descriptive statistics, repeated measures, and hierarchical linear models were applied for analysis.ResultsMost demographic and clinical data did not significantly differ between groups, but the NT1 group had significantly more overweight, more severe narcoleptic symptoms, more positive HLA typing, shorter mean sleep latency, and more sleep onset rapid eye movement periods. No significant change to the physical domains of SF-36 was found in the total group, but we observed significant changes in emotional role functioning and social function. The NT1 group showed significant improvements in physical role functioning, emotional role functioning, and social function. The NT2 group demonstrated significant improvements in emotional role functioning. At the baseline, the NT2 group had significantly better scores, but there was no significant group difference after treatment, except for physical and social function. ESS and VAS were significantly improved during follow-up. At the baseline, the NT1 group had significantly higher ESS and VAS scores, and continuously significantly higher ESS scores during follow-up. Narcolepsy types, HLA typing, age of onset, symptom severity, attention and vigilance were significantly correlated with SF-36.ConclusionSymptom control greatly associates with the quality of life in narcoleptic patients, and medication can play the most important role. Management targeting narcoleptic symptoms, attention impairment, and drug adherence should be provided.

Narcolepsy with intermediate cerebrospinal level of hypocretin-1

To describe the phenotype of narcolepsy with intermediate cerebrospinal fluid hypocretin-1 levels (CSF hcrt-1). From 1600 consecutive patients with narcolepsy from Bologna and Montpellier sleep centers, we selected patients with intermediate CSF hcrt-1 levels (110-200 pg/mL). Clinical, neurophysiological, and biological data were contrasted for the presence of cataplexy, human leukocyte haplotype (HLA)-DQB1*06:02, and median CSF hcrt-1 levels (149.34 pg/mL). Forty-five (55% males, aged 35 ± 17 years) patients (2.8% of all cases) were included. Thirty-three (73%) were HLA-DQB1*06:02, 29 (64%) reported cataplexy (21, 72.4% with typical features), and 5 (11%) had presumed secondary etiology. Cataplexy was associated with other core narcolepsy symptoms, increased sleep onset rapid eye movement periods, and nocturnal sleep disruption. Cataplexy and irrepressible daytime sleep were more frequent in HLA-DQB1*06:02 positive patients. Lower CSF hcrt-1 levels were associated with hallucinations. Narcolepsy with intermediate CSF hcrt-1 level is a rare condition with heterogeneous phenotype. HLA-DQB1*06:02 and lower CSF hcrt-1 were associated with typical narcolepsy features, calling for future research to distinguish incomplete from secondary narcolepsy forms.

Multiple Sleep Latency Test: when are 4 naps enough?

The Multiple Sleep Latency Test (MSLT) is central to the diagnosis of narcolepsy and idiopathic hypersomnia. This study is the first to assess the impact of a 5-nap protocol on meeting MSLT-derived diagnostic criteria in a general cohort referred for MSLT, without selection bias. Data for all MSLTs performed at 2 tertiary sleep units in Australia between May 2012 and May 2018 were retrospectively assessed for the impact of the fifth nap on mean sleep latency (MSL) and sleep onset rapid eye movement periods. There were 122 MSLTs included. The MSL was 8.7 ± 5.1 minutes after 4 naps, compared with 9.2 ± 5.2 minutes for 5 naps (P < .0001). In 8 cases, inclusion of the fifth nap changed the MSL to a value above the diagnostic threshold of 8 minutes. There were no instances in which the MSL moved to ≤ 8 minutes based on fifth nap data. A sleep onset rapid eye movement period occurred in the fifth nap in 9 patients and altered the interpretation in 2 cases. The fifth nap in an MSLT is associated with an increased MSL, although this difference is rarely clinically significant. In patients with borderline MSL or 1 sleep onset rapid eye movement period after 4 naps, a fifth nap can alter the outcome and should be performed. However, for many cases, a 4-nap MSLT protocol will suffice, potentially allowing resource savings without compromising diagnostic accuracy. We propose the adoption of a conditional 4-nap or 5-nap protocol based on specific criteria.

Vaccination against swine flu caused narcolepsy in several european countries

Narcolepsy is a rare sleeping disorder that gives sleep onset rapid eye movement periods and excessive daytime sleepiness. It is divided into two subgroups, narcolepsy type 1 where there also is orexin deficiency and cataplexy and narcolepsy type 2 that lack these features. Narcolepsy type 1 is assumed to be an autoimmune disease with destruction of orexinproducing cells. The pathology behind is unclear. There is a strong association to a class II HLA allele, HLADQB1*06:02 and the H1N1-virus and streptococcal infections has also been associated with narcolepsy. The severity of narcolepsy differs between patients from those who can manage their disease without medication to those who has a severe impact on their everyday life. There is a diagnostic delay between the onset of symptoms and time for diagnosis that in some cases can be more than a decade. The global mean prevalence is 30 per 100 000 inhabitants. The incidence in children in northern Europe has risen since 2010. An early study of the 2009 H1N1 influenza A pandemic indicated a high mortality and prompted efforts to rapidly come up with a vaccine. One of these was Pandemrix that was the most widely used in Europe and 61 % of the inhabitants in Sweden was vaccinated. Studies have shown an increased incidence of narcolepsy type 1 in European countries that had used Pandemrix, but no increased risk was seen in countries that had used other vaccines than Pandemrix.

К проблеме вакцинации против свиного гриппа и ее связи с нарколепсией в нескольких европейских странах

Narcolepsy is a rare sleeping disorder that gives sleep onset rapid eye movement periods and excessive daytime sleepiness. It is divided into two subgroups, narcolepsy type 1 where there also is orexin deficiency and cataplexy and narcolepsy type 2 that lack these features. Narcolepsy type 1 is assumed to be an autoimmune disease with destruction of orexinproducing cells. The pathology behind is unclear. There is a strong association to a class II HLA allele, HLADQB1*06:02 and the H1N1-virus and streptococcal infections has also been associated with narcolepsy. The severity of narcolepsy differs between patients from those who can manage their disease without medication to those who has a severe impact on their everyday life. There is a diagnostic delay between the onset of symptoms and time for diagnosis that in some cases can be more than a decade. The global mean prevalence is 30 per 100 000 inhabitants. The incidence in children in northern Europe has risen since 2010. An early study of the 2009 H1N1 influenza A pandemic indicated a high mortality and prompted efforts to rapidly come up with a vaccine. One of these was Pandemrix that was the most widely used in Europe and 61 % of the inhabitants in Sweden was vaccinated. Studies have shown an increased incidence of narcolepsy type 1 in European countries that had used Pandemrix, but no increased risk was seen in countries that had used other vaccines than Pandemrix.

1232 Improvement in Excessive Daytime Sleepiness in Two Narcoleptic Patients on Oral Contraceptives

Abstract Introduction Narcolepsy is a chronic disorder characterized by excessive daytime sleepiness (EDS). We present two patients with narcolepsy with improvement in symptoms with the use of oral contraceptives. Report of Case Patient A is a 15-year-old female with a family history of narcolepsy who presents with excessive daytime sleepiness and cataplexic episodes (eye twitching, abnormal sensations of the face, drop attacks). Her pediatric daytime sleepiness scale score (PDSS) was 29. The polysomnography (PSG) did not record sleep disordered breathing. Multiple sleep latency test (MSLT) recorded 4 out 4 sleep onset rapid eye movement period (SOREMPS) and mean sleep onset latency (SOL) of 6.2 minutes. She was diagnosed with Narcolepsy Type 1 and started on stimulants as family was not interested in Xyrem. Over two years, her PDSS the doses of the stimulants were increased due to significant daytime sleepiness. Caregiver was not interested in Xyrem. Patient demonstrated increased sleepiness during menstrual cycles. She was treated with OCPs for menorrhagia. Her EDS improved, PDSS decreased from an average of 24.5 to 17.5 and the dose of the stimulants was decreased. Patient B is an 11-year-old female with excessive daytime sleepiness and fragmented sleep with multiple awakenings. She took frequent naps during the day. Her PDSS was 29. The PSG showed mild OSA and the MSLT recorded 3 out of 4 SOREMPS and SOL was less than 1 minute. She was diagnosed with Narcolepsy Type 2. During her treatment course, several medication regimens were trialed but were not effective including stimulants, Modafinil, and Armodafinil. Caregiver was not interested in Xyrem. At the age of 13 years, she started OCPs for dysmenorrhea. Her EDS improved and PDSS decreased from an average of 29 to 16.75. Conclusion We present two patients with narcolepsy who continued to have EDS in spite of treatment with wake promoting agents and daytime naps. Their EDS and PDSS improved after initiating OCP therapy Pubertal changes may have a significant influence on narcolepsy patients. The use of OCPs may be beneficial in conjunction to wake promoting agents.

Structural organization of dream experience during daytime sleep-onset rapid eye movement period sleep of patients with narcolepsy type 1.

To assess the frequency of dream experience (DE) developed during naps at Multiple Sleep Latency Test (MSLT) by patients with narcolepsy type 1 (NT1) and establish, using story-grammar analysis, the structural organization of DEs developed during naps with sleep onset rapid eye movement (REM) period (SOREMP) sleep compared with their DEs during early- and late-night REM sleep. Thirty drug-free cognitively intact adult NT1 patients were asked to report DE developed during each MSLT nap. Ten NT1 patients also spent voluntarily a supplementary night being awakened during the first-cycle and third-cycle REM sleep. Patients provided dream reports, white dreams, and no dreams, whose frequencies were matched in naps with SOREMP versus non-REM (NREM) sleep. All dream reports were then analyzed using story-grammar rules. DE was recalled in detail (dream report) by NT1 patients after 75% of naps with SOREMP sleep and after 25% of naps with NREM sleep. Dream reports were provided by 8 out of 10 NT1 patients after both awakenings from nighttime REM sleep. Story-grammar analysis of dream reports showed that SOREMP-DEs are organized as hierarchically ordered sequences of events (so-called dream-stories), which are longer and more complex in the first and fourth SOREMP naps and are comparable with nighttime REM-DEs. The similar structural organization of SOREMP-DEs with nighttime REM-DEs indicates that their underlying cognitive processes are highly, albeit not uniformly, effective during daytime SOREMP sleep. Given the peculiar neurophysiology of SOREMP sleep, investigating SOREMP-DEs may cast further light on the relationships between the neurophysiological and psychological processes involved in REM-dreaming.

Utility of the sleep stage sequence preceding sleep onset REM periods for the diagnosis of narcolepsy: a study in a Japanese cohort

BackgroundThe minimum narcolepsy criteria “mean sleep latency (MSL) ≤8 min and ≥2 sleep onset rapid eye movement (REM) periods (SOREMPs) on polysomnography (PSG) and the multiple sleep latency test (MSLT),” according to The International Classification of Sleep Disorders, Third Edition (ICSD-3), are not specific to narcolepsy. Recently, the characteristic sleep stage sequences preceding SOREMPs in narcolepsy have received attention, but their diagnostic utility remains unclear. MethodsWe retrospectively reviewed PSG/MSLT records and chart data for 102 Japanese patients with hypersomnia and at least one SOREMP. We examined the sporadic rates of two sleep stage sequences preceding the SOREMPs—wakefulness or stage 1 to REM (W/S1→R) and stage 2 to REM (S2→R)—comparing these between patient groups with narcolepsy type 1 (N = 28), narcolepsy type 2 (N = 19), and other hypersomnia (N = 55). We also examined the utility of three simple indices using the occurrence of W/S1→R SOREMPs for distinguishing between narcolepsy and other hypersomnia in patients who satisfied the minimum narcolepsy criteria. ResultsW/S1→R SOREMPs were significantly more frequent in narcolepsy than in other hypersomnia, and this tendency was also observed even in the patients who satisfied the minimum narcolepsy criteria. The three indices had moderate sensitivities and specificities for distinguishing between narcolepsy and other hypersomnia in patients satisfying the minimum narcolepsy criteria. ConclusionsThe W/S1→R pattern was observed significantly more frequently in narcolepsy than in other hypersomnia, suggesting it may help with differentiating narcolepsy from other hypersomnia in patients demonstrating the narcolepsy criteria, although its ability to do so may be modest.

Antidepressants for the treatment of narcolepsy: A prospective study of 148 patients in northern China

Narcolepsy is a life-long neurological disorder characterized by excessive daytime sleepiness (EDS) and cataplexy. At present, Sodium oxybate, modafinil, methylphenidate and other stimulants are recommended first-line therapies for narcolepsy but are difficult to obtain in China. One hundred forty-eight patients with narcolepsy were treated with antidepressants and administered the Epworth Sleepiness Scale (ESS) and the Maintenance of Wakefulness Test (MWT) before and after treatment from August 2012 to August 2017. The subjects were followed for 1–6 years after treatment. Improvement in sleepiness, cataplexy, cataplexy-like episodes, and antidepressant side effects were assessed. There were significant differences in the mean sleep latency (MSL) and sleep onset rapid eye movement periods (SOREMPs) in MWT and ESS scores, cataplexy and cataplexy-like episodes before and after treatment (p < 0.01). Venlafaxine demonstrated significantly greater improvements in MSL in the MWT (p < 0.01). Early awakenings and dry mouth were the most common adverse effects.

Diagnostic value of multiple sleep latency test in children with narcolepsy

Objective To explore the value of multiple sleep latency test (MSLT)in children with narcolepsy, and summarize the clinical features and characteristics of 30 patients. Methods Thirty narcolepsy patients who got treated in Department of Pediatric Neurology, Shengjing Hospital Affiliated to China Medical University were chosen as the experimental group and 38 healthy children were taken as the healthy control group from January 2014 to September 2016.The sleep latency and sleep onset rapid eye movement periods (SOREMPs)with polysomnography were analyzed in order to find the clinical features of narcolepsy and the follow-up for therapeutic effects was evaluated. Results The narcolepsy patients got their disease at an average age of (7.50±2.08)years old, mostly in 6 to 9 years old, the average course of disease was (17.15±1.81)months.Thirty narcolepsy patients got excessive daytime sleepiness, which also came as the first symptom to hospital, and the sleep latency was (2.83±1.36)min, with an average (1.33±1.09)times of SOREMPs, while the healthy control group got (10.40±4.11)min, and there was significant difference between them(P<0.05). Eight patients got limb weakness or cataplexy, 3 patients got sleep paralysis and 3 patients had hypnagogic hallucination.Twenty-three patients(76.7%)got treatment, 14 cases (46.7%)of them got relieved in less than 3 months, 5 cases (16.7%)in 3 to 6 months, and another 4 cases (13.3%)after 6 months, while the other 7 cases (23.3%)did not get systemic therapy, in which symptoms did not get improved. Conclusion Excessive daytime sleepiness acts as a major clinical symptom in children with narcolepsy, while hypnagogic hallucinations and sleep paralysis are relatively infrequent.The peak incidence was in school age, and MSLT can help make an earlier diagnosis. Key words: Narcolepsy; Multiple sleep latency test; Polysomnography; Child

Optimizing MSLT Specificity in Narcolepsy With Cataplexy.

Multiple sleep onset rapid eye movement (R) periods (SOREMPs) and a mean sleep latency of ≤8 minutes on the multiple sleep latency test (MSLT) are diagnostic criteria of narcolepsy (NC), but also occur in other conditions with increased sleep pressure, including insufficient sleep syndrome (ISS), sleep-disordered breathing (SDB), or Parkinson's disease (PD). These false positives are common, may create diagnostic uncertainty, and highlight the need for complementary MSLT measures with high specificity for NC. Detailed analysis of MSLT findings in 56 NC, 83 PD, 89 SDB, and 23 ISS patients, using receiver operating characteristic curves. A positive MSLT (mean sleep latency ≤ 8.0 minutes and ≥2 SOREMPs) was found in 53 NC (95%), 1 PD (1%), 8 SDB (9%), and 12 ISS patients (52%). MSLT-based differentiation between NC and non-NC patients was best when applying a mean R latency of ≤5 minutes (sensitivity/specificity/positive predictive value [PPV]: 49%/95%/96%) or a mean percentage of sleep stage R ≥ 40% (sensitivity/specificity/PPV: 60%/100%/100%) as cutoffs. When analyzing all 252 naps with SOREMPs in isolation, the combination of both R latency of ≤5 minutes and R percentage of ≥50% yielded a sensitivity/specificity/PPV of 50%/99%/99%. In addition, a sleep stage sequence with R occurring prior to N2 was more common in NC than in non-NC (71% vs. 32%, p < .001), and in combination with R percentage of ≥50% yielded a sensitivity/specificity/PPV of 53%/96%/97%. A better characterization of R sleep by latency, duration, and sleep stage sequence facilitates detection of false positives and, hence, contributes to a higher MSLT specificity in NC.

Sleepless Night and Day, the Plight of Progressive Supranuclear Palsy.

To elucidate the unique sleep and waking characteristics in progressive supranuclear palsy (PSP), a neurodegenerative disease associated with motor deficits and dementia that largely affects the brainstem and thalamic regions. A total of 20 PSP and 16 healthy older adult controls participated in this study. The participants underwent an overnight polysomnography and multiple sleep latency test (MSLT) the following day. Prior to the MSLT last trial, they were asked to complete the Stanford Sleepiness Scale. Data were assessed for measures of latency to sleep onset, sleep duration, waking, and sleep staging during the night. Mean sleep latency, a measure of daytime sleepiness, sleep onset rapid eye movement (REM) periods, and microsleeps were studied with the MSLT. Spectral analysis of wake electroencephalogram (EEG) was performed for 30-second periods at the start of each MSLT trial. PSP took significantly longer time to fall asleep (p < .001), slept less during the night (p ≤ .001), and had more wake after sleep onset than controls (p ≤ .001). PSP had less N2 sleep (p < .05) and N3 sleep (p < .05), and REM sleep (p < .001) than controls. During the MSLT, PSP took significantly longer to fall asleep (p < .001), did not have microsleeps when they remained awake throughout the assessment periods, but were subjectively sleepier than controls (p < .05). Gamma power was increased during wake EEG in PSP (p < .01). Sleep/waking regulation and REM sleep regulation are disrupted in PSP, leading to profound sleep deprivation without recuperation. Our findings suggest a diminished homeostatic sleep drive in PSP. This hyperaroused state is unique and is a severely disabling feature of PSP.

Circadian characteristics of spontaneous physical activity and body temperature in narcoleptic patients

Objective To assess circadian characteristics of spontaneous physical activity and deep body temperature in narcoleptic patients. Methods Fourteen narcoleptic patients and 14 healthy age- and sex-matched control subjects were enrolled. Nocturnal polysomnography (PSG) was recorded, followed by standard multiple sleep latency test (MSLT). Then all subjects were required to wear the actigraphy (actiwatch) at home with continuous monitoring of spontaneous physical activity for 1-2 weeks and complete the daily sleep record. All subjects' deep body temperatures were measured at 20 time points. Results In comparison with control subjects, PSG data suggested narcoleptic patients had significantly longer time in bed at night ( P = 0.008), decreased sleep efficiency ( P = 0.001), increased awakenings ( P = 0.000), extended wake time after sleep onset ( P = 0.000) and sleep onset rapid eye movement period (SOREMP, P = 0.002). MSLT data suggested decreased average sleep latency ( P = 0.000) and increased SOREMPs ( P = 0.000). Actigraphy data suggested increased nocturnal activity and nocturnal activity per hour ( P = 0.000, for all), decreased daytime activity and daytime activity per hour ( P = 0.000, for all) and increased nocturnal activity per hour/daytime activity per hour ( P = 0.000, for all). The deep body temperature in both groups showed significant circadian rhythms. The differences in mesor, amplitude and peak phase of deep body temperature between 2 groups had no statistical significance ( P = 0.177, 0.730, 0.488). Conclusions Narcoleptic patients are characterized by impaired circadian rhythm of sleep-wake and spontaneous physical activity. The limited effects on deep body temperature suggest the relative conservation of thermoregulation in narcolepsy. DOI: 10.3969/j.issn.1672-6731.2016.07.010

Nocturnal Sleep Dynamics Identify Narcolepsy Type 1

To evaluate the reliability of nocturnal sleep dynamics in the differential diagnosis of central disorders of hypersomnolence. Cross-sectional. Sleep laboratory. One hundred seventy-five patients with hypocretin-deficient narcolepsy type 1 (NT1, n = 79), narcolepsy type 2 (NT2, n = 22), idiopathic hypersomnia (IH, n = 22), and "subjective" hypersomnolence (sHS, n = 52). None. Polysomnographic (PSG) work-up included 48 h of continuous PSG recording. From nocturnal PSG conventional sleep macrostructure, occurrence of sleep onset rapid eye movement period (SOREMP), sleep stages distribution, and sleep stage transitions were calculated. Patient groups were compared, and receiver operating characteristic (ROC) curve analysis was used to test the diagnostic utility of nocturnal PSG data to identify NT1. Sleep macrostructure was substantially stable in the 2 nights of each diagnostic group. NT1 and NT2 patients had lower latency to rapid eye movement (REM) sleep, and NT1 patients showed the highest number of awakenings, sleep stage transitions, and more time spent in N1 sleep, as well as most SOREMPs at daytime PSG and at multiple sleep latency test (MSLT) than all other groups. ROC curve analysis showed that nocturnal SOREMP (area under the curve of 0.724 ± 0.041, P < 0.0001), percent of total sleep time spent in N1 (0.896 ± 0.023, P < 0.0001), and the wakefulness-sleep transition index (0.796 ± 0.034, P < 0.0001) had a good sensitivity and specificity profile to identify NT1 sleep, especially when used in combination (0.903 ± 0.023, P < 0.0001), similarly to SOREMP number at continuous daytime PSG (0.899 ± 0.026, P < 0.0001) and at MSLT (0.956 ± 0.015, P < 0.0001). Sleep macrostructure (i.e. SOREMP, N1 timing) including stage transitions reliably identifies hypocretin-deficient narcolepsy type 1 among central disorders of hypersomnolence.