Decreased sleep stage transition pattern complexity in narcolepsy type 1

•Narcolepsy type 1 might exhibit distinctive sleep stage sequence organization and complexity.•The sleep stage transition pattern in type 1 narcolepsy is different from other hypersomnolences.•R-to-N2 transition probability <0.15 has high sensitivity and specificity for narcolepsy type 1. To anal...

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Published in:	Clinical neurophysiology Vol. 127; no. 8; pp. 2812 - 2819
Main Authors:	Ferri, Raffaele, Pizza, Fabio, Vandi, Stefano, Iloti, Martina, Plazzi, Giuseppe
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01.08.2016
Subjects:	Adolescent Adult Brain - physiopathology Disorders of Excessive Somnolence - physiopathology Entropy rate Female Humans Hypersomnolence, Idiopathic - physiopathology Idiopathic hypersomnia Male Markov process Middle Aged Narcolepsy - physiopathology Narcolepsy type 1 Narcolepsy type 2 Neurology Polysomnography Sleep stage transitions Sleep Stages - physiology Subjective hypersomnolence Young Adult Markov process Idiopathic hypersomnia CDH H0 H1 NT1 MSLT Sleep stage transitions NT2 TPM SOREMP Narcolepsy type 1 Subjective hypersomnolence Entropy rate Narcolepsy type 2 IH sHS narcolepsy type 1 sleep onset REM period zero-memory Markov model entropy rate narcolepsy type 2 multiple sleep latency test subjective hypersomnolence central disorder of hypersomnolence transition probability matrix idiopathic hypersomnia first-order Markov model entropy rate
ISSN:	1388-2457, 1872-8952, 1872-8952
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Abstract	•Narcolepsy type 1 might exhibit distinctive sleep stage sequence organization and complexity.•The sleep stage transition pattern in type 1 narcolepsy is different from other hypersomnolences.•R-to-N2 transition probability <0.15 has high sensitivity and specificity for narcolepsy type 1. To analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1) might exhibit distinctive sleep stage sequence organization and complexity. Seventy-nine NT1 patients, 22 narcolepsy type 2 (NT2), 22 idiopathic hypersomnia (IH), and 52 patients with subjective hypersomnolence (sHS) were recruited and their nocturnal sleep was polysomnographically recorded and scored. Group between-stage transition probability matrices were obtained and compared. Patients with NT1 differed significantly from all the other patient groups, the latter, in turn, were not different between each other. The individual probability of the R-to-N2 transition was found to be the parameter showing the difference of highest significance between the groups (lowest in NT1) and classified patients with or without NT1 with an accuracy of 78.9% (sensitivity 78.5% and specificity 79.2%), by applying a cut-off value of 0.15. The main result of this study is that the structure of the sleep stage transition pattern of hypocretin-deficient NT1 patients is significantly different from that of other forms of CDH and sHS, with normal hypocretin levels. The lower probability of R-to-N2 transition occurrence in NT1 appears to be a reliable polysomnographic feature with potential application at the individual level, for supportive diagnostic purposes.
AbstractList	•Narcolepsy type 1 might exhibit distinctive sleep stage sequence organization and complexity.•The sleep stage transition pattern in type 1 narcolepsy is different from other hypersomnolences.•R-to-N2 transition probability <0.15 has high sensitivity and specificity for narcolepsy type 1. To analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1) might exhibit distinctive sleep stage sequence organization and complexity. Seventy-nine NT1 patients, 22 narcolepsy type 2 (NT2), 22 idiopathic hypersomnia (IH), and 52 patients with subjective hypersomnolence (sHS) were recruited and their nocturnal sleep was polysomnographically recorded and scored. Group between-stage transition probability matrices were obtained and compared. Patients with NT1 differed significantly from all the other patient groups, the latter, in turn, were not different between each other. The individual probability of the R-to-N2 transition was found to be the parameter showing the difference of highest significance between the groups (lowest in NT1) and classified patients with or without NT1 with an accuracy of 78.9% (sensitivity 78.5% and specificity 79.2%), by applying a cut-off value of 0.15. The main result of this study is that the structure of the sleep stage transition pattern of hypocretin-deficient NT1 patients is significantly different from that of other forms of CDH and sHS, with normal hypocretin levels. The lower probability of R-to-N2 transition occurrence in NT1 appears to be a reliable polysomnographic feature with potential application at the individual level, for supportive diagnostic purposes. To analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1) might exhibit distinctive sleep stage sequence organization and complexity. Seventy-nine NT1 patients, 22 narcolepsy type 2 (NT2), 22 idiopathic hypersomnia (IH), and 52 patients with subjective hypersomnolence (sHS) were recruited and their nocturnal sleep was polysomnographically recorded and scored. Group between-stage transition probability matrices were obtained and compared. Patients with NT1 differed significantly from all the other patient groups, the latter, in turn, were not different between each other. The individual probability of the R-to-N2 transition was found to be the parameter showing the difference of highest significance between the groups (lowest in NT1) and classified patients with or without NT1 with an accuracy of 78.9% (sensitivity 78.5% and specificity 79.2%), by applying a cut-off value of 0.15. The main result of this study is that the structure of the sleep stage transition pattern of hypocretin-deficient NT1 patients is significantly different from that of other forms of CDH and sHS, with normal hypocretin levels. The lower probability of R-to-N2 transition occurrence in NT1 appears to be a reliable polysomnographic feature with potential application at the individual level, for supportive diagnostic purposes. Highlights • Narcolepsy type 1 might exhibit distinctive sleep stage sequence organization and complexity. • The sleep stage transition pattern in type 1 narcolepsy is different from other hypersomnolences. • R-to-N2 transition probability <0.15 has high sensitivity and specificity for narcolepsy type 1. To analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1) might exhibit distinctive sleep stage sequence organization and complexity.OBJECTIVETo analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1) might exhibit distinctive sleep stage sequence organization and complexity.Seventy-nine NT1 patients, 22 narcolepsy type 2 (NT2), 22 idiopathic hypersomnia (IH), and 52 patients with subjective hypersomnolence (sHS) were recruited and their nocturnal sleep was polysomnographically recorded and scored. Group between-stage transition probability matrices were obtained and compared.METHODSSeventy-nine NT1 patients, 22 narcolepsy type 2 (NT2), 22 idiopathic hypersomnia (IH), and 52 patients with subjective hypersomnolence (sHS) were recruited and their nocturnal sleep was polysomnographically recorded and scored. Group between-stage transition probability matrices were obtained and compared.Patients with NT1 differed significantly from all the other patient groups, the latter, in turn, were not different between each other. The individual probability of the R-to-N2 transition was found to be the parameter showing the difference of highest significance between the groups (lowest in NT1) and classified patients with or without NT1 with an accuracy of 78.9% (sensitivity 78.5% and specificity 79.2%), by applying a cut-off value of 0.15.RESULTSPatients with NT1 differed significantly from all the other patient groups, the latter, in turn, were not different between each other. The individual probability of the R-to-N2 transition was found to be the parameter showing the difference of highest significance between the groups (lowest in NT1) and classified patients with or without NT1 with an accuracy of 78.9% (sensitivity 78.5% and specificity 79.2%), by applying a cut-off value of 0.15.The main result of this study is that the structure of the sleep stage transition pattern of hypocretin-deficient NT1 patients is significantly different from that of other forms of CDH and sHS, with normal hypocretin levels.CONCLUSIONSThe main result of this study is that the structure of the sleep stage transition pattern of hypocretin-deficient NT1 patients is significantly different from that of other forms of CDH and sHS, with normal hypocretin levels.The lower probability of R-to-N2 transition occurrence in NT1 appears to be a reliable polysomnographic feature with potential application at the individual level, for supportive diagnostic purposes.SIGNIFICANCEThe lower probability of R-to-N2 transition occurrence in NT1 appears to be a reliable polysomnographic feature with potential application at the individual level, for supportive diagnostic purposes.
Author	Plazzi, Giuseppe Pizza, Fabio Vandi, Stefano Iloti, Martina Ferri, Raffaele
Author_xml	– sequence: 1 givenname: Raffaele surname: Ferri fullname: Ferri, Raffaele email: rferri@oasi.en.it organization: Department of Neurology I.C., IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy – sequence: 2 givenname: Fabio surname: Pizza fullname: Pizza, Fabio organization: Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy – sequence: 3 givenname: Stefano surname: Vandi fullname: Vandi, Stefano organization: Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy – sequence: 4 givenname: Martina surname: Iloti fullname: Iloti, Martina organization: Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy – sequence: 5 givenname: Giuseppe surname: Plazzi fullname: Plazzi, Giuseppe organization: Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Keywords	Markov process Idiopathic hypersomnia CDH H0 H1 NT1 MSLT Sleep stage transitions NT2 TPM SOREMP Narcolepsy type 1 Subjective hypersomnolence Entropy rate Narcolepsy type 2 IH sHS narcolepsy type 1 sleep onset REM period zero-memory Markov model entropy rate narcolepsy type 2 multiple sleep latency test subjective hypersomnolence central disorder of hypersomnolence transition probability matrix idiopathic hypersomnia first-order Markov model entropy rate
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Snippet	•Narcolepsy type 1 might exhibit distinctive sleep stage sequence organization and complexity.•The sleep stage transition pattern in type 1 narcolepsy is... Highlights • Narcolepsy type 1 might exhibit distinctive sleep stage sequence organization and complexity. • The sleep stage transition pattern in type 1... To analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1)...
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SubjectTerms	Adolescent Adult Brain - physiopathology Disorders of Excessive Somnolence - physiopathology Entropy rate Female Humans Hypersomnolence, Idiopathic - physiopathology Idiopathic hypersomnia Male Markov process Middle Aged Narcolepsy - physiopathology Narcolepsy type 1 Narcolepsy type 2 Neurology Polysomnography Sleep stage transitions Sleep Stages - physiology Subjective hypersomnolence Young Adult
Title	Decreased sleep stage transition pattern complexity in narcolepsy type 1
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