Page 104 - The autoimmune hypothesis of narcolepsy and its unexplored clinical features M.S. Schinkelshoek

Chapter 6
misperception during MSLT. Even though the diagnosis NT1 and age were predictors that were not statistically significant, the magnitude of their effect suggests there may be a clinically significant influence of these parameters on sleep state misperception (Table 6.3).
Table 6.3. Linear mixed model of sleep misperception. The linear mixed model of sleep misperception is fitted with a random slope and random intercept per individual for naps in which sleep was recorded. A positive value for B indicates a higher probability of sleep misperception. P-values are based on the parameters in the model. For specific categories within the parameters, such as sleep stage, the confidence interval for the coefficient of each category relative to the other categories is shown.
Parameter
Age (per year)
Sleep onset latency (per min) Sleep stage reached
N1 N2 N3
SOREMP Diagnosis category
NT1 NT2 IH OSA ISS
B
0.014 0.114
0 -0.708 -0.204 -0.735
0 0.455 1.043 1.112 1.289
95% confidence interval
p-value
0.143 <0.001 0.043
0.169 0.273
0.302
Nap (#)
Lower boundary
-0.005 0.050
-1.352 -1.141 -1.784
-0.734 -0.066 -0.113 0.097
-0.901 -0.828 -0.717 -1.217
Upper boundary
0.032 0.177
-0.063 0.733 0.313
1.643 2.152 2.336 2.480
0.193 0.374 0.435 0.019
10
2 -0.354 3 -0.227 4 -0.141 5 -0.599
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EDS = excessive daytime sleepiness; IH = idiopathic hypersomnia; ISS = insufficient sleep syndrome; NT1 = narcolepsy type 1; NT2 = narcolepsy type 2; OSA = obstructive sleep apnea; SOREMP = sleep-onset REM period.
Dream perception is partly dissociated from REM sleep
In 29.3% of naps in which patients had only NREM sleep, patients reported to have dreamed (Table 6.4). The distribution of these findings was different between sleep disorders: when a SOREMP was absent during the nap, people with NT1 and NT2 reported having dreamed more often than those with IH, OSA and ISS. Patient reported not to have dreamed in 25.8% of naps with a SOREMP. Interestingly, in 9 nap opportunities patients (1 NT1, 2 IH, 3 OSA, 3 ISS) reported having dreamed, even though no sleep was recorded.