Page 98 - The autoimmune hypothesis of narcolepsy and its unexplored clinical features M.S. Schinkelshoek

Chapter 6
Abstract
Study objectives: Sleep state misperception is common in various sleep disorders, especially in chronic insomnia with a prevalence ranging between 9-50%. Most prior studies used nocturnal polysomnography for the identification of sleep state misperception during nighttime. Our objective was to assess sleep state misperception during daytime in people with sleep disorders with excessive daytime sleepiness.
Methods: In this prospective observational study, we assessed the occurrence of, and factors influencing sleep state misperception in consecutive patients undergoing a routine multiple sleep latency test in a tertiary sleep-wake centre included between 2014 and 2017. Mixed models were applied to assess the influence of patients’ clinical data on sleep state perception.
Results: People with narcolepsy type 1 (n=33) and type 2 (n=14), idiopathic hypersomnia (n=56), obstructive sleep apnea (n=31) and insufficient sleep syndrome (n=31) were included. The prevalence of both classical and reverse sleep state misperception did not differ between the sleep disorders (mean 25%, range 8-37%) after correction for sleep stage, sleep onset latency and age. Longer sleep onset latency and reaching only non-REM sleep stage 1 were significant predictors for classical sleep state misperception.
Conclusions: Sleep state misperception is common in people with narcolepsy type 1 and 2, idiopathic hypersomnia, obstructive sleep apnea and insufficient sleep syndrome. 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.
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