Page 101 - The autoimmune hypothesis of narcolepsy and its unexplored clinical features M.S. Schinkelshoek

Post-hoc analyses were performed to assess the differences between all separate groups. Differences in sleep stage sequences between sleep disorders with EDS were analyzed with Pearson’s chi-squared tests with post-hoc testing to compare sleep disorders one by one. To assess whether other factors that were unevenly distributed amongst patient groups, such as age and sleep onset latency and sleep stages during the nap, might explain sleep state misperception, mixed models were applied to assess the influence of patients’ clinical data on sleep state misperception. We included only the nap opportunities in which patients fell asleep and so focused on classical sleep state misperception only. Reverse sleep state misperception was insufficiently present in our dataset to be able to assess factors influencing this type of sleep state misperception. A linear mixed model with a random slope and a random intercept for each individual was fitted. The outcome was classical sleep state misperception. As main effects we added age, sleep disorder (NT1; NT2; IH;OSA; ISS), sleep onset latency, sleep stage reached and the presence of REM to the model. Differences in dream reporting between REM and NREM sleep were analyzed using Pearson’s chi-squared tests. P-values below 0.05 were deemed significant. Bonferroni corrections were executed when needed. All analyses were conducted using the IBM SPSS Statistics 25 software package.
Results
Patient characteristics
A total of 165 people with 825 nap opportunities were included. People with NT1 and NT2 had a shorter mean sleep latency, had more SOREMPs and reported dreaming more frequently than people with IH, OSA and ISS (Table 6.1). People with NT1 had a shorter REM latency than others who had a SOREMP during the MSLT (3.4 min ± 3.5 vs. 5.7 min ± 3.7; p = 0.001). Scores on the ESS differed significantly between sleep disorders, with people with NT1, NT2, IH and ISS scoring significantly higher than those with OSA (Table 6.2); median ESS of all sleep disorders were well above the cut-off value of 10. Information on polysomnography characteristics can be found in Supplementary table 6.1.
Daytime sleep state misperception
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