Page 109 - The autoimmune hypothesis of narcolepsy and its unexplored clinical features M.S. Schinkelshoek

2017). However, several earlier studies reported these sleep stage sequences in the naps of the MSLT to be highly narcolepsy-specific (Drakatos et al., 2016, Drakatos et al., 2013), while we also observed these transitions in the scarce naps with SOREMPs of people with IH, OSA and ISS.
As the study was performed in a tertiary sleep-wake centre, the makeup of the population is different than would be expected in a secondary sleep-wake centre. The relatively small amount of people with narcolepsy in this study, for example compared with people with idiopathic hypersomnia, is explained by the fact that many people with narcolepsy that are admitted to our tertiary centre have already undergone an MSLT in the referring sleep-wake centre and/or already on medication that cannot be interrupted. Repeating our approach in a secondary sleep-wake centre is therefore warranted to assess the generalizability of our findings.
The fact that research on daytime sleep state misperception is scarce (Bishop et al., 1998) led to a limitation in comparing our results with those of others. Most studies focus specifically on nocturnal sleep state misperception in which different definitions are used to describe the condition. Data is generated using nighttime PSG, while we use daytime data to describe and assess sleep state misperception. To be able to validate our findings, comparisons with other, more extensive, patient groups measured during daytime nap opportunities is needed. These cohort studies could also focus on reverse sleep state misperception. This type of sleep state misperception was scarce in this study and could therefore not be further analyzed using mixed models.
Conclusion
Both classical and reverse sleep state misperception during the short naps of an MSLT is common in NT1, NT2, IH, OSA and ISS. Classical sleep state misperception is more frequent in patients with longer sleep onset latencies who only reach non-REM sleep stage 1 during a nap. The fact that classical sleep state misperception is common in NT1, NT2, IH, OSA and ISS is relevant for patients and sleep physicians when assessing disease severity and fitness to drive and making treatment decisions in sleep disorders with EDS. Notably, dreaming was frequently reported even when REM sleep did not occur.
Daytime sleep state misperception
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