Page 103 - The autoimmune hypothesis of narcolepsy and its unexplored clinical features M.S. Schinkelshoek

state misperception. 4 patients did not sleep. Classical sleep misperception is common in NT1 and NT2 and even more so in IH, ISS and OSA (p < 0.001, Figure 6.1) with 25% of all nap opportunities in which sleep was recorded (n = 712), ranging from 7% in NT1 to 39% in OSA. Also reverse sleep state misperception is relatively common in NT1, IH, ISS and OSA with 26% of all nap opportunities in which no sleep was recorded (n = 113), ranging from 12% in OSA to 48% in ISS.
Figure 6.1. Sleep state misperception percentages in MSLT nap opportunities. This figure depicts the percentage of nap opportunities in which patients misperceived sleep per sleep disorder. Nap opportunities in which a patient did not report sleep when sleep was recorded (classical sleep state misperception) are shown in grey; nap opportunities in which a patient reported sleep when no sleep was recorded (reverse sleep state misperception) are shown in black. For classical sleep state misperception, percentages are based on nap opportunities in which sleep was recorded, whereas for reverse sleep state misperception, percentages are based on nap opportunities in which no sleep was recorded. Statistical significance of differences between NT1 and NT2 patients and IH, OSA and ISS patients is shown by the horizontal bars.
*** p<0.001; IH = idiopathic hypersomnia; ISS = insufficient sleep syndrome; NT1 = narcolepsy type 1; NT2 = narcolepsy type 2; OSA = obstructive sleep apnea.
Long sleep onset latency and only N1 stage sleep predict sleep state misperception
Mixed model analysis took into account other parameters that might have influenced this seemingly strong effect of the sleep diagnosis on classical sleep state misperception during the MSLT. In the mixed model, only nap opportunities were used in which sleep was recorded. A long sleep-onset latency (β = 0.114 ± 0.033; p < 0.001) and not reaching N2 stage sleep (β = - 0.708 ± 0.329; p = 0.043) were shown to be important predictors for sleep state
Daytime sleep state misperception
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