Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy
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AbstractObjectives: To determine the diagnostic values, longitudinal stability, and HLA association of the sleep stage transitions in narcolepsy. Methods: To compare the baseline differences in the sleep stage transition to REM sleep among 35 patients with type 1 narcolepsy, 39 patients with type 2 narcolepsy, 26 unaffected relatives, and 159 non-narcoleptic sleep patient controls, followed by a reassessment at a mean duration of 37.4 months. Results: The highest prevalence of altered transition from stage non-N2/N3 to stage R in multiple sleep latency test (MSLT) and nocturnal polysomnography (NPSG) was found in patients with type 1 narcolepsy (92.0% and 57.1%), followed by patients with type 2 narcolepsy (69.4% and 12.8%), unaffected relatives (46.2% and 0%), and controls (39.3% and 1.3%). Individual sleep variables had varied sensitivity and specifi city in diagnosing narcolepsy. By incorporating a combination of sleep variables, the decision tree analysis improved the sensitivity to 94.3% and 82.1% and enhanced specifi city to 82.4% and 83% for the diagnosis of type 1 and type 2 narcolepsy, respectively. There was a signifi cant association of DBQ1?0602 with the altered sleep stage transition (OR = 16.0, 95% CI: 1.7-149.8, p = 0.015). The persistence of the altered sleep stage transition in both MSLT and NPSG was high for both type 1 (90.5% and 64.7%) and type 2 narcolepsy (92.3% and 100%), respectively. Conclusions: Altered sleep stage transition is a signifi cant and stable marker of narcolepsy, which suggests a vulnerable wake-sleep dysregulation trait in narcolepsy. Altered sleep stage transition has a signifi cant diagnostic value in the differential diagnosis of hypersomnias, especially when combined with other diagnostic sleep variables in decision tree analysis.
All Author(s) ListLiu Y., Zhang J., Lam V., Ho C.K.W., Zhou J., Li S.X., Lam S.P., Yu M.W.M., Tang X., Wing Y.-K.
Journal nameJournal of Clinical Sleep Medicine
Detailed descriptionpii: jc-00000-15.
Volume Number11
Issue Number8
PublisherThe American Academy of Sleep Medicine
Place of PublicationUnited States
Pages885 - 894
LanguagesEnglish-United Kingdom
KeywordsBiomarker, Hypersomnia, Multiple sleep latency test, Narcolepsy, Sleep onset REM sleep period, Sleep stage transitions

Last updated on 2020-06-08 at 01:36