Page 106 - The autoimmune hypothesis of narcolepsy and its unexplored clinical features M.S. Schinkelshoek

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Chapter 6
Discussion
Sleep state misperception during the short nap opportunities of an MSLT was frequently seen in people with NT1, NT2, IH, OSA and ISS. Classical sleep state misperception was more common than reverse sleep state misperception, mostly due to the fact that in most nap opportunities sleep was recorded. People with NT1 and NT2 patients misperceived their sleep less than those with IH, OSA and ISS. Multifactorial modelling on nap opportunities in which sleep was recorded, showed that this decreased prevalence of classical sleep state misperception in people with NT1 and NT2 is at least partly due to the fact that they were, on average, younger, had a shorter sleep latency and reached deeper sleep during a nap than those with IH, OSA and ISS. Despite this, a slightly lower percentage of classical sleep state misperception in people with NT1 and NT2 persists, albeit not significant after correction for other factors of influence in a linear mixed model, that could not be explained by the other factors in the model. The fact that sleep state misperception was almost absent in naps with dream reporting (data not shown) and the higher percentage of dream reporting in NT1 and NT2 supports the hypothesis that more intense emotions upon dream perception (Fosse et al., 2002) in people with NT1 and NT2 might explain part of the difference.
The increasing percentage of classical sleep state misperception with age, is in contrast with a study in people with chronic insomnia, where those with sleep state misperception were significantly younger than those without sleep state misperception (Moon et al., 2015). Other studies on sleep state misperception in chronic insomnia find no factors influencing sleep state perception, apart from those dictated by the sleep disorder itself (e.g. total sleep time (Dittoni et al., 2013, Moon et al., 2015)).
The significant percentage of nap opportunities in which people with different sleep disorders misperceived their sleep is in line with previous studies that describe significant poor sleep state perception in a variety of patient groups, such as chronic insomnia (up to 73% sleep state misperception), epilepsy, OSA and even healthy controls (Nam et al., 2016, Goulart et al., 2014, Ng and Bianchi, 2014, Mercer et al., 2002). All studies focused on classical sleep state misperception.
A SOREMP in a nap was not a significant predictor of sleep state misperception in our model. A reason could be the low number of SOREMPs in people with