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Gool JK, Zhang Z, Fronczek R, Amesz P, Khatami R, Lammers GJ. Potential immunological triggers for narcolepsy and idiopathic hypersomnia: Real-world insights on infections and influenza vaccinations. Sleep Med 2024; 116:105-114. [PMID: 38442518 DOI: 10.1016/j.sleep.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE It is hypothesized that narcolepsy type 1 (NT1) develops in genetically susceptible people who encounter environmental triggers leading to immune-mediated hypocretin-1 deficiency. The pathophysiologies of narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) remain unknown. The main aim of this study was to collect all reported immunological events before onset of a central disorder of hypersomnolence. METHODS Medical records of 290 people with NT1, and 115 with NT2 or IH were retrospectively reviewed to extract infection and influenza vaccination history. Prevalence, distribution of immunological events, and time until hypersomnolence onset were compared between NT1 and the combined group of NT2 and IH. RESULTS Immunological events were frequently reported before hypersomnolence disorder onset across groups. Flu and H1N1 influenza vaccination were more common in NT1, and Epstein-Barr virus and other respiratory and non-respiratory infections in NT2 and IH. Distributions of events were comparable between NT2 and IH. Rapid symptom onset within one month of infection was frequent across groups, especially after flu infection in NT1. Hypersomnolence disorder progression after an immunological event was reported in ten individuals. CONCLUSIONS Our findings suggest a variety of immunological triggers potentially related to NT1, including H1N1 influenza infection or vaccination, infection with other flu types, and other respiratory and non-respiratory infections. Frequent reports of immunological events (other than those reported in NT1) immediately prior to the development of NT2 and IH support the specificity of triggers for NT1, and open important new research avenues into possible underlying immunological mechanisms in NT2 and IH.
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Affiliation(s)
- Jari K Gool
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Center, Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; Anatomy&Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Compulsivity, Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam, Netherlands.
| | - Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Klinik Barmelweid AG, Barmelweid, Aargau, Switzerland
| | - Rolf Fronczek
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Center, Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Pauline Amesz
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Center, Heemstede, Netherlands
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Klinik Barmelweid AG, Barmelweid, Aargau, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gert Jan Lammers
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Center, Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.
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2
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Khatami R, Qi M, Hügli G, Zhang Z. Cumulative brain desaturation: Time to consider brain derived parameters to measure daytime sleepiness in obstructive sleep apnea. Sleep Med 2024; 113:338-341. [PMID: 38103465 DOI: 10.1016/j.sleep.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE /Background: The change in cerebral hemodynamics induced by sleep apneas and hypopneas may contribute to the daytime sleepiness in patients with obstructive sleep apnea (OSA). However, previous studies failed to discovery their relationship. We propose and test a new parameter, the cumulative brain oxygen desaturation, which may contribute to OSA patient's daytime sleepiness. PATIENTS/METHODS 22 patients with severe OSA (apnea-hypopnea index (AHI) at diagnosis [mean ± standard deviation, std.]: 52.1 ± 21.6/h, median: 45.1/h, interquartile range: 34.4-60.2/h) were monitored by polysomnography during routine continuous positive airway pressure titration. The reductions of brain tissue oxygen saturation (StO2) in all respiratory events at baseline sleep were measured by frequency-domain near-infrared spectroscopy (NIRS). The cumulative brain desaturation was calculated as AHI times the mean StO2 desaturation (i.e., AHI×ΔStO2‾). Similarly, cumulative peripheral desaturation was also calculated, i.e., AHI×ΔSpO2‾ where ΔSpO2‾ was the mean reduction of peripheral arterial oxygen saturation (SpO2). The correlations between Epworth sleepiness scale (ESS) and AHI, ΔStO2‾, AHI×ΔStO2‾, and AHI×ΔSpO2‾ were tested, respectively. Linear regression was applied to predict ESS using AHI×ΔStO2‾ and AHI×ΔSpO2‾, with age and BMI as covariates. RESULTS ESS significantly correlates to the cumulative brain desaturation (Pearson's correlation coefficient: 0.68, p = 0.00056), not the other parameters. Regression analysis only finds significant association between ESS and the cumulative cerebral desaturation (p = 0.00195) but not the cumulative peripheral desaturation (p = 0.71). CONCLUSIONS The cumulative brain oxygen desaturation, which comprehensively combines total sleep time, the frequency of apnea and hypopnea events, and the severity of cerebral oxygen desaturation, is a new indicator for daytime sleepiness in severe OSA.
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Affiliation(s)
- Ramin Khatami
- Center for Sleep Medicine, Sleep Research, and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland; Barmelweid Academy, Clinic Barmelweid, Barmelweid, Switzerland; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ming Qi
- Center for Sleep Medicine, Sleep Research, and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland
| | - Gordana Hügli
- Center for Sleep Medicine, Sleep Research, and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland
| | - Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research, and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland; Barmelweid Academy, Clinic Barmelweid, Barmelweid, Switzerland.
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3
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Eglin M, Schmid JP, Ronel J, Khatami R, Leiggener C, Koenig HG, Hefti R. Impact of social support and religiosity/spirituality on recovery from acute cardiac events and heart surgery in a Swiss study. Int J Psychiatry Med 2023:912174231225801. [PMID: 38156371 DOI: 10.1177/00912174231225801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of social support and religiosity/spirituality (R/S) on the recovery from an acute cardiac event or cardiac surgery during cardiac rehabilitation (CR). METHODS The study has a prospective design. A convenience sample of 159 patients participating in a CR program were enrolled. Religiosity/spirituality, social support, anxiety, depression, health related quality of life (QoL) and exercise capacity (6-min walk test, cycle ergometer test) were assessed. RESULTS Social support was significantly associated with less anxiety (P < .01), less depression (P < .01), and better QoL (P < .05) on admission. After adjustment for age, gender, education level, and morbidity, social support remained significantly associated with less depression (P < .001). Religiosity/spirituality was significantly associated with less depression (P < .05), better QoL (P < .05), and better exercise capacity (P < .05) at admission. After adjustment for covariates, however, significance was lost. There were no significant associations of social support or R/S with the course of CR measured by change in QoL or exercise capacity. CONCLUSION Social support may be a protective factor against depression in the recovery from cardiac events or surgery. Neither social support nor R/S had a significant impact on the course of the 3-week CR program.
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Affiliation(s)
- Micha Eglin
- University of Basel, Faculty of Medicine, Basel, Switzerland
| | | | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Ramin Khatami
- Centre of Sleep Medicine and Sleep Research, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Christoph Leiggener
- University of Basel, Faculty of Medicine, Basel, Switzerland
- Department of Oral- and Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Harold G Koenig
- Departments of Medicine and Psychiatry, Duke University Health System, Durham, NC, USA
- Department of Medicine, Division of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - René Hefti
- University of Basel, Faculty of Medicine, Basel, Switzerland
- Research Institute for Spirituality and Health (RISH), Langenthal, Switzerland
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4
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Plazzi G, Pizza F, Lecendreux M, Gringras P, Barateau L, Bruni O, Franco P, Iranzo A, Jennum P, Khatami R, Knudsen-Heier S, Miano S, Nobili L, Partinen M, Reading P, Sonka K, Szakacs A, Zenti M, Kallweit U, Lammers GJ, Dauvilliers Y, Bassetti CLA. Letter to editor. J Sleep Res 2023:e14055. [PMID: 38050449 DOI: 10.1111/jsr.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Michel Lecendreux
- Pediatric Sleep Disorders Center, AP-HP, Robert Debre Hospital, Paris, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Paris, France
| | | | - Lucie Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Patricia Franco
- Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon & U1028, Lyon Neuroscience Research Center (CRNL), University Lyon 1, Lyon, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome Lyon, Lyon, France
| | - Alex Iranzo
- Neurology Service, Sleep Disorders Centre, Hospital Clínic Barcelona, Universitat de Barcelona. IDIBAPS, CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Copenhagen, Denmark
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stine Knudsen-Heier
- Norwegian Center for Neurodevelopmental Disorders and Hypersomnias - NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silvia Miano
- Neurocenter of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Sleep Medicine Unit, Civic Hospital, Lugano, Switzerland
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
- Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genova, Genoa, Italy
| | - Markku Partinen
- Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
- Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, Finland
| | - Paul Reading
- Department of Neurology, The James Cook University Hospital, Middlesbrough, UK
| | - Karel Sonka
- Department of Neurology and Center for Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Attila Szakacs
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden
| | - Massimo Zenti
- Associazione Italiana Narcolettici e Ipersonni, Florence, Italy
- European Narcolepsy Alliance for Patients, Bruxells, Belgium
| | - Ulf Kallweit
- Center for Narcolepsy and Hypersomnias, Professorship for Narcolepsy and Hypersomnolence Research, Department of Medicine, University Witten/Herdecke, Witten, Germany
- Center for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | - Gert J Lammers
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Center, Heemstede, Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Claudio L A Bassetti
- Medical Faculty, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital (Inselspital), Bern, Switzerland
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5
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Wenz ES, Schinkelshoek MS, Kallweit U, Fronczek R, Rezaei R, Khatami R, Lammers GJ, Bassetti CLA. Narcolepsy type 1 and Sydenham chorea - Report of 3 cases and review of the literature. Sleep Med 2023; 112:234-238. [PMID: 37925849 DOI: 10.1016/j.sleep.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES/BACKGROUND Narcolepsy type 1 (NT1) is an immune-mediated disorder characterized by excessive daytime sleepiness, cataplexy, low levels of hypocretin-1 in the cerebrospinal fluid, and a strong association with the HLA DQB1*06:02 allele. There is evidence for streptococcal infections as one pathogenic factor that may lead to NT1 as part of a multifactorial pathogenesis. Elevated titers of Antistreptolysin-O antibodies and increased inflammatory activity in response to streptococci antigens have been described in patients with NT1. Sydenham chorea (SC) results from a post-streptococcal autoimmune process targeting basal ganglia neurons. Despite this common trigger, SC has been interpreted as a misdiagnosis in a few described cases of patients who were first diagnosed with SC and later with NT1. Our goal was to analyze the association between SC and NT1. PATIENTS/METHODS We reviewed the literature and report three patients from three European sleep centers who were diagnosed with both SC and NT1 within a few months. RESULTS We describe the cases of one male (age 10) and two female (age 22 and 10) patients. CONCLUSIONS We argue that in those cases both diagnoses are justified, unlike reports of previous cases in which SC was considered a misdiagnosis in patients with NT1. It remains, however, unclear if the conditions occur independently or if there is an overlap disorder- an SC-like subtype of narcolepsy with a particular sequence of symptoms. Further studies need to clarify the causality of the relationship and the pathophysiology of the reported rare association.
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Affiliation(s)
- Elena S Wenz
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School of Health Sciences, University of Bern, Switzerland.
| | - Mink S Schinkelshoek
- Neurology Department, Leiden University Medical Center, Heemstede, the Netherlands
| | - Ulf Kallweit
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University Witten/Herdecke, Germany
| | - Rolf Fronczek
- Neurology Department, Leiden University Medical Center, Heemstede, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wakecenter, Heemstede, the Netherlands
| | - Rana Rezaei
- Center for Narcolepsy and Hypersomnias, Clinical Sleep and Neuroimmunology, Institute of Immunology, University Witten/Herdecke, Germany
| | - Ramin Khatami
- Center for Sleep Medicine and Epileptology, Klinik Barmelweid AG, Switzerland
| | - Gert Jan Lammers
- Neurology Department, Leiden University Medical Center, Heemstede, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wakecenter, Heemstede, the Netherlands
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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6
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Gorban C, Zhang Z, Mensen A, Khatami R. The Comparison of Early Hemodynamic Response to Single-Pulse Transcranial Magnetic Stimulation following Inhibitory or Excitatory Theta Burst Stimulation on Motor Cortex. Brain Sci 2023; 13:1609. [PMID: 38002568 PMCID: PMC10670137 DOI: 10.3390/brainsci13111609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
We present a new study design aiming to enhance the understanding of the mechanism by which continuous theta burst stimulation (cTBS) or intermittent theta burst stimulation (iTBS) paradigms elicit cortical modulation. Using near-infrared spectroscopy (NIRS), we compared the cortical hemodynamics of the previously inhibited (after cTBS) or excited (after iTBS) left primary motor cortex (M1) as elicited by single-pulse TMS (spTMS) in a cross-over design. Mean relative changes in hemodynamics within 6 s of the stimulus were compared using a two-sample t-test (p < 0.05) and linear mixed model between real and sham stimuli and between stimuli after cTBS and iTBS. Only spTMS after cTBS resulted in a significant increase (p = 0.04) in blood volume (BV) compared to baseline. There were no significant changes in other hemodynamic parameters (oxygenated/deoxygenated hemoglobin). spTMS after cTBS induced a larger increase in BV than spTMS after iTBS (p = 0.021) and sham stimulus after cTBS (p = 0.009). BV showed no significant difference between real and sham stimuli after iTBS (p = 0.37). The greater hemodynamic changes suggest increased vasomotor reactivity after cTBS compared to iTBS. In addition, cTBS could decrease lateral inhibition, allowing activation of surrounding areas after cTBS.
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Affiliation(s)
- Corina Gorban
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
- Department of Neurology, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
| | - Armand Mensen
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, 5017 Barmelweid, Switzerland; (C.G.); (A.M.); (R.K.)
- Department of Neurology, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
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7
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Ollila HM, Sharon E, Lin L, Sinnott-Armstrong N, Ambati A, Yogeshwar SM, Hillary RP, Jolanki O, Faraco J, Einen M, Luo G, Zhang J, Han F, Yan H, Dong XS, Li J, Zhang J, Hong SC, Kim TW, Dauvilliers Y, Barateau L, Lammers GJ, Fronczek R, Mayer G, Santamaria J, Arnulf I, Knudsen-Heier S, Bredahl MKL, Thorsby PM, Plazzi G, Pizza F, Moresco M, Crowe C, Van den Eeden SK, Lecendreux M, Bourgin P, Kanbayashi T, Martínez-Orozco FJ, Peraita-Adrados R, Benetó A, Montplaisir J, Desautels A, Huang YS, Jennum P, Nevsimalova S, Kemlink D, Iranzo A, Overeem S, Wierzbicka A, Geisler P, Sonka K, Honda M, Högl B, Stefani A, Coelho FM, Mantovani V, Feketeova E, Wadelius M, Eriksson N, Smedje H, Hallberg P, Hesla PE, Rye D, Pelin Z, Ferini-Strambi L, Bassetti CL, Mathis J, Khatami R, Aran A, Nampoothiri S, Olsson T, Kockum I, Partinen M, Perola M, Kornum BR, Rueger S, Winkelmann J, Miyagawa T, Toyoda H, Khor SS, Shimada M, Tokunaga K, Rivas M, Pritchard JK, Risch N, Kutalik Z, O'Hara R, Hallmayer J, Ye CJ, Mignot EJ. Narcolepsy risk loci outline role of T cell autoimmunity and infectious triggers in narcolepsy. Nat Commun 2023; 14:2709. [PMID: 37188663 DOI: 10.1038/s41467-023-36120-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2023] [Indexed: 05/17/2023] Open
Abstract
Narcolepsy type 1 (NT1) is caused by a loss of hypocretin/orexin transmission. Risk factors include pandemic 2009 H1N1 influenza A infection and immunization with Pandemrix®. Here, we dissect disease mechanisms and interactions with environmental triggers in a multi-ethnic sample of 6,073 cases and 84,856 controls. We fine-mapped GWAS signals within HLA (DQ0602, DQB1*03:01 and DPB1*04:02) and discovered seven novel associations (CD207, NAB1, IKZF4-ERBB3, CTSC, DENND1B, SIRPG, PRF1). Significant signals at TRA and DQB1*06:02 loci were found in 245 vaccination-related cases, who also shared polygenic risk. T cell receptor associations in NT1 modulated TRAJ*24, TRAJ*28 and TRBV*4-2 chain-usage. Partitioned heritability and immune cell enrichment analyses found genetic signals to be driven by dendritic and helper T cells. Lastly comorbidity analysis using data from FinnGen, suggests shared effects between NT1 and other autoimmune diseases. NT1 genetic variants shape autoimmunity and response to environmental triggers, including influenza A infection and immunization with Pandemrix®.
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Affiliation(s)
- Hanna M Ollila
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Eilon Sharon
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Ling Lin
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Nasa Sinnott-Armstrong
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Aditya Ambati
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Selina M Yogeshwar
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Department of Neurology, Charité-Universitätsmedizin, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, 10117, Berlin, Germany
| | - Ryan P Hillary
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Otto Jolanki
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Juliette Faraco
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Mali Einen
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Guo Luo
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Jing Zhang
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Fang Han
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Han Yan
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Xiao Song Dong
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jing Li
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurology, The Peking University People's Hospital, Beijing, China
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Tae Won Kim
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Geert Mayer
- Hephata Klinik, Schimmelpfengstr. 6, 34613, Schwalmstadt, Germany
- Philipps Universität Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Joan Santamaria
- Neurology Service, Institut de Neurociències Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, 75013, Paris, France
| | - Stine Knudsen-Heier
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - May Kristin Lyamouri Bredahl
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Monica Moresco
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | | | - Michel Lecendreux
- Pediatric Sleep Center and National Reference Center for Narcolepsy and Idiopathic Hypersomnia Hospital Robert Debre, Paris, France
| | - Patrice Bourgin
- Department of Sleep Medicine, Strasbourg University Hospital, Strasbourg University, Strasbourg, France
| | - Takashi Kanbayashi
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Francisco J Martínez-Orozco
- Sleep Unit. Clinical Neurophysiology Service. San Carlos University Hospital. University Complutense of Madrid, Madrid, Spain
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit, Clinical Neurophysiology Service, Gregorio Marañón University General Hospital and Research Institute, University Complutense of Madrid (UCM), Madrid, Spain
| | | | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
| | - Sona Nevsimalova
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Alex Iranzo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Neurology, Barcelona, Spain
- Multidisciplinary Sleep Disorders Unit, Barcelona, Spain
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, P.O. Box 61, 5590 AB, Heeze, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Makoto Honda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Seiwa Hospital, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | | | - Vilma Mantovani
- Center for Applied Biomedical Research (CRBA), St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Mia Wadelius
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Niclas Eriksson
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - Hans Smedje
- Division of Child and Adolescent Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Pär Hallberg
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - David Rye
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zerrin Pelin
- Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Claudio L Bassetti
- Neurology Department, EOC, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Adi Aran
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Centre, Kerala, India
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Markus Perola
- University of Helsinki, Institute for Molecular Medicine, Finland (FIMM) and Diabetes and Obesity Research Program. University of Tartu, Estonian Genome Center, Tartu, Estonia
| | - Birgitte R Kornum
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Sina Rueger
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Taku Miyagawa
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Toyoda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Seik-Soon Khor
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mihoko Shimada
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manuel Rivas
- Department of Biomedical Data Science-Administration, Stanford University, Palo Alto, CA, USA
| | | | - Neil Risch
- Dept. Epidemiology and Biostatistics, UCSF, 513 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Zoltan Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland, Lausanne, 1010, Switzerland
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Chun Jimmie Ye
- Department of Epidemiology & Biostatistics, Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Emmanuel J Mignot
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA.
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Zhang Z, Dauvilliers Y, Plazzi G, Mayer G, Lammers G, Santamaria J, Gaig C, Partinen M, Overeem S, Rio-Villegas RD, Šonka K, Peraita-Adrados R, Heinzer R, Wierzbicka A, Högl B, Manconi M, Feketeova E, da Silva A, Bušková J, Bassetti C, Barateau L, Pizza F, Gool J, Fronczek R, Khatami R. Idling for decades: a European study on risk factors associated with long time to narcolepsy diagnosis. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gool J, Zhang Z, Oei M, Mathias S, Dauvilliers Y, Mayer G, Plazzi G, del Rio-Villegas R, Santamaria J, Šonka K, Partinen M, Overeem S, Peraita-Adrados R, Heinzer R, Martins da Silva A, Högl B, Wierzbicka A, Heidbreder A, Feketeova E, Manconi M, Bušková J, Canellas F, Bassetti C, Barateau L, Pizza F, Schmidt M, Fronczek R, Khatami R, Lammers G. Unsupervised clustering of central hypersomnolence disorders enables data-driven phenotyping: toward more reliable diagnostic criteria. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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van der Meer J, Ferrazzini L, Zhang Z, Khatami R, Schmidt M, Bassetti C. Gender Differences of Sleepiness in central hypersomnolence disorders. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zhang Z, Qi M, Hügli G, Khatami R. Can oxygen desaturation measured by wearable optical sensor at the arm be used to measure obstructive sleep apnea? Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gnarra O, van der Meer J, Warncke J, Wenz E, Fragolente L, Khatami R, Schindler K, Tzovara A, Schmidt M, Bassetti C. SPHYNCS: Longterm monitoring with Fitbit in patients with narcolepsy and its borderland. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gool JK, Zhang Z, Oei MSSL, Mathias S, Dauvilliers Y, Mayer G, Plazzi G, Del Rio-Villegas R, Cano JS, Šonka K, Partinen M, Overeem S, Peraita-Adrados R, Heinzer R, Martins da Silva A, Högl B, Wierzbicka A, Heidbreder A, Feketeova E, Manconi M, Bušková J, Canellas F, Bassetti CL, Barateau L, Pizza F, Schmidt MH, Fronczek R, Khatami R, Lammers GJ. Data-Driven Phenotyping of Central Disorders of Hypersomnolence With Unsupervised Clustering. Neurology 2022; 98:e2387-e2400. [PMID: 35437263 PMCID: PMC9202524 DOI: 10.1212/wnl.0000000000200519] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/28/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies fueled doubts as to whether all currently defined central disorders of hypersomnolence are stable entities, especially narcolepsy type 2 and idiopathic hypersomnia. New reliable biomarkers are needed, and the question arises of whether current diagnostic criteria of hypersomnolence disorders should be reassessed. The main aim of this data-driven observational study was to see whether data-driven algorithms would segregate narcolepsy type 1 and identify more reliable subgrouping of individuals without cataplexy with new clinical biomarkers. METHODS We used agglomerative hierarchical clustering, an unsupervised machine learning algorithm, to identify distinct hypersomnolence clusters in the large-scale European Narcolepsy Network database. We included 97 variables, covering all aspects of central hypersomnolence disorders such as symptoms, demographics, objective and subjective sleep measures, and laboratory biomarkers. We specifically focused on subgrouping of patients without cataplexy. The number of clusters was chosen to be the minimal number for which patients without cataplexy were put in distinct groups. RESULTS We included 1,078 unmedicated adolescents and adults. Seven clusters were identified, of which 4 clusters included predominantly individuals with cataplexy. The 2 most distinct clusters consisted of 158 and 157 patients, were dominated by those without cataplexy, and among other variables, significantly differed in presence of sleep drunkenness, subjective difficulty awakening, and weekend-week sleep length difference. Patients formally diagnosed as having narcolepsy type 2 and idiopathic hypersomnia were evenly mixed in these 2 clusters. DISCUSSION Using a data-driven approach in the largest study on central disorders of hypersomnolence to date, our study identified distinct patient subgroups within the central disorders of hypersomnolence population. Our results contest inclusion of sleep-onset REM periods in diagnostic criteria for people without cataplexy and provide promising new variables for reliable diagnostic categories that better resemble different patient phenotypes. Cluster-guided classification will result in a more solid hypersomnolence classification system that is less vulnerable to instability of single features.
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Affiliation(s)
- Jari K Gool
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy.
| | - Zhongxing Zhang
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Martijn S S L Oei
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Stephanie Mathias
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Yves Dauvilliers
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Geert Mayer
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Giuseppe Plazzi
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Rafael Del Rio-Villegas
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Joan Santamaria Cano
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Karel Šonka
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Markku Partinen
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Sebastiaan Overeem
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Rosa Peraita-Adrados
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Raphael Heinzer
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Antonio Martins da Silva
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Birgit Högl
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Aleksandra Wierzbicka
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Anna Heidbreder
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Eva Feketeova
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Mauro Manconi
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Jitka Bušková
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Francesca Canellas
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Claudio L Bassetti
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Lucie Barateau
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Fabio Pizza
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Markus H Schmidt
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Rolf Fronczek
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Ramin Khatami
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
| | - Gert Jan Lammers
- From the Sleep Wake Center SEIN Heemstede (J.K.G., R.F., G.J.L.), Stichting Epilepsie Instellingen Nederland, Heemstede; Department of Neurology and Clinical Neurophysiology (J.K.G., R.F., G.J.L.), Leiden University Medical Center; Department of Anatomy and Neurosciences (J.K.G., S.M.), Amsterdam UMC (Location VUmc), the Netherlands; Center for Sleep Medicine, Sleep Research and Epileptology (Z.Z., R.K.), Klinik Barmelweid AG, Barmelweid, Switzerland; Leiden Observatory (M.S.S.L.O.), Leiden University, the Netherlands; Sleep-Wake Disorders Unit (Y.D., L.B.), Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome (Y.D., L.B.); Institute for Neurosciences of Montpellier INM (Y.D., L.B.), Univ Montpellier, INSERM, France; Neurology Department (G.M.), Hephata Klinik, Schwalmstadt, Germany; Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio Emilia; IRCCS Istituto delle Scienze Neurologiche di Bologna (G.P, F.P.), Bologna, Italy; Neurophysiology and Sleep Disorders Unit (R.d.R.-V.), Hospital Vithas Nuestra Señora de América, Madrid; Neurology Service (J.S.C.), Institut de Neurociències Hospital Clínic, University of Barcelona, Spain; Neurology Department and Centre of Clinical Neurosciences (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Helsinki Sleep Clinic (M.P.), Vitalmed Research Center, Finland; Sleep Medicine Center Kempenhaeghe (S.O.), Heeze; Eindhoven University of Technology (S.O.), the Netherlands; Sleep and Epilepsy Unit-Clinical Neurophysiology Service (R.P.-A.), University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón; University Complutense of Madrid (R.P.-A.), Spain; Center for Investigation and Research in Sleep (R.H.), Lausanne University Hospital, Switzerland; Serviço de Neurofisiologia (A.M.d.S.), Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal; Neurology Department (B.H., A.H.), Sleep Disorders Clinic, Innsbruck Medical University, Austria; Department of Clinical Neurophysiology (A.W.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Sleep Medicine and Neuromuscular Disorders (A.H.), University of Münster, Germany; Neurology Department (E.F.), Medical Faculty of P.J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic; Neurology Department (M.M.), EOC, Ospedale Regionale di Lugano, Ticino, Switzerland; Department of Sleep Medicine (J.B.), National Institute of Mental Health, Klecany, Czech Republic; Fundacio d`Investigacio Sanitaria de les illes balears (F.C.), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Department of Neurology (C.L.B., M.H.S., R.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Biomedical and Neuromotor Sciences (F.P.), University of Bologna, Italy
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14
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Zhang Z, Khatami R. Can we trust the oxygen saturation measured by consumer smartwatches? Lancet Respir Med 2022; 10:e47-e48. [PMID: 35358426 DOI: 10.1016/s2213-2600(22)00103-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research, and Epileptology, Klinik Barmelweid, Barmelweid CH-5017, Switzerland.
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research, and Epileptology, Klinik Barmelweid, Barmelweid CH-5017, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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15
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Zhang Z, Dauvilliers Y, Plazzi G, Mayer G, Lammers GJ, Santamaria J, Partinen M, Overeem S, Del Rio Villegas R, Sonka K, Peraita-Adrados R, Heinzer R, Wierzbicka A, Högl B, Manconi M, Feketeova E, da Silva AM, Bušková J, Bassetti CLA, Barateau L, Pizza F, Antelmi E, Gool JK, Fronczek R, Gaig C, Khatami R. Idling for Decades: A European Study on Risk Factors Associated with the Delay Before a Narcolepsy Diagnosis. Nat Sci Sleep 2022; 14:1031-1047. [PMID: 35669411 PMCID: PMC9166906 DOI: 10.2147/nss.s359980] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/03/2022] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Narcolepsy type-1 (NT1) is a rare chronic neurological sleep disorder with excessive daytime sleepiness (EDS) as usual first and cataplexy as pathognomonic symptom. Shortening the NT1 diagnostic delay is the key to reduce disease burden and related low quality of life. Here we investigated the changes of diagnostic delay over the diagnostic years (1990-2018) and the factors associated with the delay in Europe. PATIENTS AND METHODS We analyzed 580 NT1 patients (male: 325, female: 255) from 12 European countries using the European Narcolepsy Network database. We combined machine learning and linear mixed-effect regression to identify factors associated with the delay. RESULTS The mean age at EDS onset and diagnosis of our patients was 20.9±11.8 (mean ± standard deviation) and 30.5±14.9 years old, respectively. Their mean and median diagnostic delay was 9.7±11.5 and 5.3 (interquartile range: 1.7-13.2 years) years, respectively. We did not find significant differences in the diagnostic delay over years in either the whole dataset or in individual countries, although the delay showed significant differences in various countries. The number of patients with short (≤2-year) and long (≥13-year) diagnostic delay equally increased over decades, suggesting that subgroups of NT1 patients with variable disease progression may co-exist. Younger age at cataplexy onset, longer interval between EDS and cataplexy onsets, lower cataplexy frequency, shorter duration of irresistible daytime sleep, lower daytime REM sleep propensity, and being female are associated with longer diagnostic delay. CONCLUSION Our findings contrast the results of previous studies reporting shorter delay over time which is confounded by calendar year, because they characterized the changes in diagnostic delay over the symptom onset year. Our study indicates that new strategies such as increasing media attention/awareness and developing new biomarkers are needed to better detect EDS, cataplexy, and changes of nocturnal sleep in narcolepsy, in order to shorten the diagnostic interval.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Klinik Barmelweid AG, Barmelweid, Aargau, Switzerland
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany
| | - Gert Jan Lammers
- Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands.,Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joan Santamaria
- Neurology Service, Institut de Neurociències Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Rafael Del Rio Villegas
- Neurophysiology and Sleep Disorders Unit, Hospital Vithas Nuestra Señora de América, Madrid, Spain
| | - Karel Sonka
- Neurology Department and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit - Clinical Neurophysiology Service, University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón, University Complutense of Madrid, Madrid, Spain
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Birgit Högl
- Neurology Department, Sleep Disorders Clinic, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Manconi
- Neurology Department, EOC, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Antonio Martins da Silva
- Serviço de Neurofisiologia, Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jitka Bušková
- Department of Sleep Medicine, National Institute of Mental Health, Klecany, Czech Republic
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Sechenov First Moscow State University, Moscow, Russia
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Fabio Pizza
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Jari K Gool
- Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands.,Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rolf Fronczek
- Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands.,Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carles Gaig
- Neurology Service, Institut de Neurociències Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Klinik Barmelweid AG, Barmelweid, Aargau, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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16
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Zhang Z, Qi M, Hügli G, Khatami R. Quantitative Changes in Muscular and Capillary Oxygen Desaturation Measured by Optical Sensors during Continuous Positive Airway Pressure Titration for Obstructive Sleep Apnea. Biosensors 2021; 12:bios12010003. [PMID: 35049631 PMCID: PMC8774245 DOI: 10.3390/bios12010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/24/2021] [Accepted: 12/19/2021] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder, and continuous positive airway pressure (CPAP) is the most effective treatment. Poor adherence is one of the major challenges in CPAP therapy. The recent boom of wearable optical sensors measuring oxygen saturation makes at-home multiple-night CPAP titrations possible, which may essentially improve the adherence of CPAP therapy by optimizing its pressure in a real-life setting economically. We tested whether the oxygen desaturations (ODs) measured in the arm muscle (arm_OD) by gold-standard frequency-domain multi-distance near-infrared spectroscopy (FDMD-NIRS) change quantitatively with titrated CPAP pressures in OSA patients together with polysomnography. We found that the arm_OD (2.08 ± 1.23%, mean ± standard deviation) was significantly smaller (p-value < 0.0001) than the fingertip OD (finger_OD) (4.46 ± 2.37%) measured by a polysomnography pulse oximeter. Linear mixed-effects models suggested that CPAP pressure was a significant predictor for finger_OD but not for arm_OD. Since FDMD-NIRS measures a mixture of arterial and venous OD, whereas a fingertip pulse oximeter measures arterial OD, our results of no association between arm_OD and finger_OD indicate that the arm_OD mainly represented venous desaturation. Arm_OD measured by optical sensors used for wearables may not be a suitable indicator of the CPAP titration effectiveness.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
- Barmelweid Academy, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
- Correspondence:
| | - Ming Qi
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
| | - Gordana Hügli
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland; (M.Q.); (G.H.); (R.K.)
- Barmelweid Academy, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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17
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Zhang Z, Qi M, Hügli G, Khatami R. Predictors of changes in cerebral perfusion and oxygenation during obstructive sleep apnea. Sci Rep 2021; 11:23510. [PMID: 34873232 PMCID: PMC8648752 DOI: 10.1038/s41598-021-02829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. Severe OSAS defined as apnea-hypopnea index (AHI) ≥ 30/h is a risk factor for developing cerebro-cardiovascular diseases. The mechanisms of how repetitive sleep apneas/hypopneas damage cerebral hemodynamics are still not well understood. In this study, changes in blood volume (BV) and oxygen saturation (StO2) in the left forehead of 29 newly diagnosed severe OSAS patients were measured by frequency-domain near-infrared spectroscopy during an incremental continuous positive airway pressure (CPAP) titration protocol together with polysomnography. The coefficients of variation of BV (CV-BV) and the decreases of StO2 (de-StO2) of more than 2000 respiratory events were predicted using linear mixed-effect models, respectively. We found that longer events and apneas rather than hypopneas induce larger changes in CV-BV and stronger cerebral desaturation. Respiratory events occurring during higher baseline StO2 before their onsets, during rapid-eye-movement sleep and those associated with higher heart rate induce smaller changes in CV-BV and de-StO2. The stepwise increased CPAP pressures can attenuate these changes. These results suggest that in severe OSAS the length and the type of respiratory event rather than widely used AHI may be better parameters to indicate the severity of cerebral hemodynamic changes.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017, Barmelweid, Switzerland. .,Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland.
| | - Ming Qi
- grid.452327.50000 0004 0519 8976Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
| | - Gordana Hügli
- grid.452327.50000 0004 0519 8976Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland
| | - Ramin Khatami
- grid.452327.50000 0004 0519 8976Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, 5017 Barmelweid, Switzerland ,grid.452327.50000 0004 0519 8976Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland ,grid.411656.10000 0004 0479 0855Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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18
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Zhang Z, Qi M, Hügli G, Khatami R. The Challenges and Pitfalls of Detecting Sleep Hypopnea Using a Wearable Optical Sensor: Comparative Study. J Med Internet Res 2021; 23:e24171. [PMID: 34326039 PMCID: PMC8367170 DOI: 10.2196/24171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/26/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is the most prevalent respiratory sleep disorder occurring in 9% to 38% of the general population. About 90% of patients with suspected OSA remain undiagnosed due to the lack of sleep laboratories or specialists and the high cost of gold-standard in-lab polysomnography diagnosis, leading to a decreased quality of life and increased health care burden in cardio- and cerebrovascular diseases. Wearable sleep trackers like smartwatches and armbands are booming, creating a hope for cost-efficient at-home OSA diagnosis and assessment of treatment (eg, continuous positive airway pressure [CPAP] therapy) effectiveness. However, such wearables are currently still not available and cannot be used to detect sleep hypopnea. Sleep hypopnea is defined by ≥30% drop in breathing and an at least 3% drop in peripheral capillary oxygen saturation (Spo2) measured at the fingertip. Whether the conventional measures of oxygen desaturation (OD) at the fingertip and at the arm or wrist are identical is essentially unknown. Objective We aimed to compare event-by-event arm OD (arm_OD) with fingertip OD (finger_OD) in sleep hypopneas during both naïve sleep and CPAP therapy. Methods Thirty patients with OSA underwent an incremental, stepwise CPAP titration protocol during all-night in-lab video-polysomnography monitoring (ie, 1-h baseline sleep without CPAP followed by stepwise increments of 1 cmH2O pressure per hour starting from 5 to 8 cmH2O depending on the individual). Arm_OD of the left biceps muscle and finger_OD of the left index fingertip in sleep hypopneas were simultaneously measured by frequency-domain near-infrared spectroscopy and video-polysomnography photoplethysmography, respectively. Bland-Altman plots were used to illustrate the agreements between arm_OD and finger_OD during baseline sleep and under CPAP. We used t tests to determine whether these measurements significantly differed. Results In total, 534 obstructive apneas and 2185 hypopneas were recorded. Of the 2185 hypopneas, 668 (30.57%) were collected during baseline sleep and 1517 (69.43%), during CPAP sleep. The mean difference between finger_OD and arm_OD was 2.86% (95% CI 2.67%-3.06%, t667=28.28; P<.001; 95% limits of agreement [LoA] –2.27%, 8.00%) during baseline sleep and 1.83% (95% CI 1.72%-1.94%, t1516=31.99; P<.001; 95% LoA –2.54%, 6.19%) during CPAP. Using the standard criterion of 3% saturation drop, arm_OD only recognized 16.32% (109/668) and 14.90% (226/1517) of hypopneas at baseline and during CPAP, respectively. Conclusions arm_OD is 2% to 3% lower than standard finger_OD in sleep hypopnea, probably because the measured arm_OD originates physiologically from arterioles, venules, and capillaries; thus, the venous blood adversely affects its value. Our findings demonstrate that the standard criterion of ≥3% OD drop at the arm or wrist is not suitable to define hypopnea because it could provide large false-negative results in diagnosing OSA and assessing CPAP treatment effectiveness.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland.,Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Ming Qi
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland
| | - Gordana Hügli
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Barmelweid, Switzerland.,Barmelweid Academy, Clinic Barmelweid AG, Barmelweid, Switzerland.,Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
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19
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Bassetti CLA, Kallweit U, Vignatelli L, Plazzi G, Lecendreux M, Baldin E, Dolenc-Groselj L, Jennum P, Khatami R, Manconi M, Mayer G, Partinen M, Pollmächer T, Reading P, Santamaria J, Sonka K, Dauvilliers Y, Lammers GJ. European guideline and expert statements on the management of narcolepsy in adults and children. J Sleep Res 2021; 30:e13387. [PMID: 34173288 DOI: 10.1111/jsr.13387] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children. METHODS The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. RESULTS A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. CONCLUSION The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.
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Affiliation(s)
- Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ulf Kallweit
- Center for Narcolepsy/Hypersomnias, Clin. Sleep and Neuroimmunology, Institute of Immunology, University Witten/Herdecke, Witten, Germany
| | - Luca Vignatelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | - Elisa Baldin
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Leja Dolenc-Groselj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Center of Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid, Barmelweid, Switzerland
| | - Mauro Manconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep Center, Faculty of Biomedical Sciences, Neurocenter of Southern Switzerland, Università della Svizzera Italiana, Lugano, Switzerland
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany.,Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Markku Partinen
- Department of Clinial Neurosciences, Clinicum, Helsinki Sleep Clinic, Vitalmed Research Center, Terveystalo Biobank and Clinical Research, University of Helsinki, Helsinki, Finland
| | | | - Paul Reading
- Department of Neurology, James Cook University Hospital, Middlesbrough, UK
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, INM INSERM, Montpellier, France
| | - Gert J Lammers
- Sleep Wake Centre SEIN, Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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20
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Bassetti CLA, Kallweit U, Vignatelli L, Plazzi G, Lecendreux M, Baldin E, Dolenc-Groselj L, Jennum P, Khatami R, Manconi M, Mayer G, Partinen M, Pollmächer T, Reading P, Santamaria J, Sonka K, Dauvilliers Y, Lammers GJ. European guideline and expert statements on the management of narcolepsy in adults and children. Eur J Neurol 2021; 28:2815-2830. [PMID: 34173695 DOI: 10.1111/ene.14888] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIM Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children. METHODS The European Academy of Neurology (EAN), European Sleep Research Society (ESRS) and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. RESULTS A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong), methylphenidate, amphetamine derivates (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) excessive daytime sleepiness in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivates (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. CONCLUSION The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.
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Affiliation(s)
- Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ulf Kallweit
- Center for Narcolepsy/Hypersomnias, Clin. Sleep and Neuroimmunology, Institute of Immunology, University Witten/Herdecke, Witten, Germany
| | - Luca Vignatelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | - Elisa Baldin
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Leja Dolenc-Groselj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Center of Sleep Medicine, Sleep Research and Epileptology. Clinic Barmelweid, Barmelweid, Switzerland
| | - Mauro Manconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep Center, Faculty of Biomedical Sciences, Neurocenter of Southern Switzerland, Università della Svizzera Italiana, Lugano, Switzerland
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany.,Department of Neurology, Philipps-Universität Marburg, Marburg, Germany
| | - Markku Partinen
- Department of Clinial Neurosciences, Clinicum, Helsinki Sleep Clinic, Vitalmed Research Center, Terveystalo Biobank and Clinical Research, University of Helsinki, Helsinki, Finland
| | | | - Paul Reading
- Department of Neurology, James Cook University Hospital, Middlesbrough, UK
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, INM INSERM, Montpellier, France
| | - Gert J Lammers
- Sleep Wake Centre SEIN, Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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21
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Zhang Z, Gool JK, Fronczek R, Dauvilliers Y, Bassetti CLA, Mayer G, Plazzi G, Pizza F, Santamaria J, Partinen M, Overeem S, Peraita-Adrados R, da Silva AM, Sonka K, Del Rio-Villegas R, Heinzer R, Wierzbicka A, Young P, Högl B, Manconi M, Feketeova E, Mathis J, Paiva T, Canellas F, Lecendreux M, Baumann CR, Lammers GJ, Khatami R. New 2013 incidence peak in childhood narcolepsy: more than vaccination? Sleep 2021; 44:5903541. [PMID: 32909046 DOI: 10.1093/sleep/zsaa172] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Increased incidence rates of narcolepsy type-1 (NT1) have been reported worldwide after the 2009-2010 H1N1 influenza pandemic (pH1N1). While some European countries found an association between the NT1 incidence increase and the H1N1 vaccination Pandemrix, reports from Asian countries suggested the H1N1 virus itself to be linked to the increased NT1 incidence. Using robust data-driven modeling approaches, that is, locally estimated scatterplot smoothing methods, we analyzed the number of de novo NT1 cases (n = 508) in the last two decades using the European Narcolepsy Network database. We confirmed the peak of NT1 incidence in 2010, that is, 2.54-fold (95% confidence interval [CI]: [2.11, 3.19]) increase in NT1 onset following 2009-2010 pH1N1. This peak in 2010 was found in both childhood NT1 (2.75-fold increase, 95% CI: [1.95, 4.69]) and adulthood NT1 (2.43-fold increase, 95% CI: [2.05, 2.97]). In addition, we identified a new peak in 2013 that is age-specific for children/adolescents (i.e. 2.09-fold increase, 95% CI: [1.52, 3.32]). Most of these children/adolescents were HLA DQB1*06:02 positive and showed a subacute disease onset consistent with an immune-mediated type of narcolepsy. The new 2013 incidence peak is likely not related to Pandemrix as it was not used after 2010. Our results suggest that the increased NT1 incidence after 2009-2010 pH1N1 is not unique and our study provides an opportunity to develop new hypotheses, for example, considering other (influenza) viruses or epidemiological events to further investigate the pathophysiology of immune-mediated narcolepsy.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Jari K Gool
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.,Department of Anatomy and Neurosciences, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands
| | - Rolf Fronczek
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Yves Dauvilliers
- Centre de Reference Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Neurology, Sechenov University, Moscow, Russian Federation
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Joan Santamaria
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit-Clinical Neurophysiology Service, University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón, University Complutense of Madrid, Madrid, Spain
| | - Antonio Martins da Silva
- Serviço de Neurofisiologia, Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Karel Sonka
- Neurology Department and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Rafael Del Rio-Villegas
- Unidad de Neurofisiología y Trastornos del Sueño, Hospital Vithas Internacional Madrid, Madrid, Spain
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Birgit Högl
- Neurology Department, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Teresa Paiva
- Institute of Molecular Medicine Portugal, Medical Faculty Lisbon University, Lisbon, Portugal
| | - Francesca Canellas
- Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | | | - Gert Jan Lammers
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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22
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Ferini-Strambi L, Auer R, Bjorvatn B, Castronovo V, Franco O, Gabutti L, Galbiati A, Hajak G, Khatami R, Kitajima T, McEvoy D, Nissen C, Perlis M, Pevernagie DA, Randerath W, Riemann D, Rizzo G, Van Someren E, Vgontzas A, Barazzoni F, Bassetti C. Insomnia disorder: clinical and research challenges for the 21st century. Eur J Neurol 2021; 28:2156-2167. [PMID: 33619858 DOI: 10.1111/ene.14784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Insomnia is a common and debilitating disorder that is frequently associated with important consequences for physical health and well-being. METHODS An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field of insomnia and identified future priorities. RESULTS The association of trajectories of insomnia with subsequent quality of life, health and mortality should be investigated in large populations. Prospective health economics studies by separating the costs driven specifically by insomnia and costs attributable to its long-term effects are needed. Ignoring the heterogeneity of insomnia patients leads to inadequate diagnosis and inefficient treatment. Individualized interventions should be promoted. More data are needed on both the impact of sleep on overnight effects, such as emotion regulation, and the potential compensatory effort to counteract diurnal impairments. Another gap is the definition of neurocognitive deficits in insomnia patients compared to normal subjects after chronic sleep loss. There are also a number of key gaps related to insomnia treatment. Expert guidelines indicate cognitive-behavioural therapy for insomnia as first-line treatment. They neglect, however, the reality of major healthcare providers. The role of combined therapy, cognitive-behavioural therapy for insomnia plus pharmacological treatment, should be evaluated more extensively. CONCLUSION Whilst insomnia disorder might affect large proportions of the population, there are a number of significant gaps in the epidemiological/clinical/research studies carried out to date. In particular, the identification of different insomnia phenotypes could allow more cost-effective and efficient therapies.
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Affiliation(s)
- Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy.,Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Vincenza Castronovo
- Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Oscar Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Luca Gabutti
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
| | - Andrea Galbiati
- "Vita-Salute" San Raffaele University, Milan, Italy.,Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Goeran Hajak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Ramin Khatami
- Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid, Barmelweid Academy, Barmelweid, Switzerland
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Perlis
- Department of Psychiatry, Behavioral Sleep Medicine Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dirk A Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | | | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Alexandros Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | | | - Claudio Bassetti
- Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Sechenov University, Moscow, Russia
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23
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Dietmann A, Wenz E, van der Meer J, Ringli M, Warncke JD, Edwards E, Schmidt MH, Bernasconi CA, Nirkko A, Strub M, Miano S, Manconi M, Acker J, von Manitius S, Baumann CR, Valko PO, Yilmaz B, Brunner AD, Tzovara A, Zhang Z, Largiadèr CR, Tafti M, Latorre D, Sallusto F, Khatami R, Bassetti CLA. The Swiss Primary Hypersomnolence and Narcolepsy Cohort study (SPHYNCS): Study protocol for a prospective, multicentre cohort observational study. J Sleep Res 2021; 30:e13296. [PMID: 33813771 PMCID: PMC8519114 DOI: 10.1111/jsr.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022]
Abstract
Narcolepsy type 1 (NT1) is a disorder with well‐established markers and a suspected autoimmune aetiology. Conversely, the narcoleptic borderland (NBL) disorders, including narcolepsy type 2, idiopathic hypersomnia, insufficient sleep syndrome and hypersomnia associated with a psychiatric disorder, lack well‐defined markers and remain controversial in terms of aetiology, diagnosis and management. The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a comprehensive multicentre cohort study, which will investigate the clinical picture, pathophysiology and long‐term course of NT1 and the NBL. The primary aim is to validate new and reappraise well‐known markers for the characterization of the NBL, facilitating the diagnostic process. Seven Swiss sleep centres, belonging to the Swiss Narcolepsy Network (SNaNe), joined the study and will prospectively enrol over 500 patients with recent onset of excessive daytime sleepiness (EDS), hypersomnia or a suspected central disorder of hypersomnolence (CDH) during a 3‐year recruitment phase. Healthy controls and patients with EDS due to severe sleep‐disordered breathing, improving after therapy, will represent two control groups of over 50 patients each. Clinical and electrophysiological (polysomnography, multiple sleep latency test, maintenance of wakefulness test) information, and information on psychomotor vigilance and a sustained attention to response task, actigraphy and wearable devices (long‐term monitoring), and responses to questionnaires will be collected at baseline and after 6, 12, 24 and 36 months. Potential disease markers will be searched for in blood, cerebrospinal fluid and stool. Analyses will include quantitative hypocretin measurements, proteomics/peptidomics, and immunological, genetic and microbiota studies. SPHYNCS will increase our understanding of CDH and the relationship between NT1 and the NBL. The identification of new disease markers is expected to lead to better and earlier diagnosis, better prognosis and personalized management of CDH.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Elena Wenz
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Julia van der Meer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maya Ringli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan D Warncke
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ellen Edwards
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Corrado A Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | | | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Jens Acker
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
| | | | | | - Philip O Valko
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Bahtiyar Yilmaz
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.,Maurice Müller Laboratories, Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Andreas-David Brunner
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Athina Tzovara
- Institute of Computer Science, University of Bern, Bern, Switzerland.,Department of Neurology, Sleep Wake Epilepsy Center, NeuroTec, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Zhongxing Zhang
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Carlo R Largiadèr
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mehdi Tafti
- Department of Biomedical Science, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Federica Sallusto
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland.,Institute for Research in Biomedicine, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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24
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Nobili L, de Weerd A, Rubboli G, Beniczky S, Derry C, Eriksson S, Halasz P, Högl B, Santamaria J, Khatami R, Ryvlin P, Rémi J, Tinuper P, Bassetti C, Manni R, Koutroumanidis M, Vignatelli L. Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: A European Academy of Neurology, European Sleep Research Society and International League against Epilepsy-Europe consensus review. J Sleep Res 2020; 29:e13184. [PMID: 32959468 DOI: 10.1111/jsr.13184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Some epilepsy syndromes (sleep-related epilepsies [SRE]) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. PURPOSES To define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2). METHODS The project was conducted under the auspices of the European Academy of Neurology (EAN), the European Sleep Research Society (ESRS) and the International League against Epilepsy (ILAE) Europe. The framework of the document entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For literature search a step-wise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library. RESULTS Scenario 1: despite a low quality of evidence, recommendations on anamnestic evaluation, tools for capturing the event at home or in the laboratory are provided for specific SRE. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizures control. CONCLUSIONS Definitive procedures for evaluating patients with SRE are lacking. We provide advice that could be of help for standardising and improving the diagnostic approach of specific SRE. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation-Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sofia Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK
| | - Peter Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Multidisciplinary Sleep Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Ramin Khatami
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Barmelweid Academy, Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid, Barmelweid, Switzerland
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Claudio Bassetti
- Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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Nobili L, de Weerd A, Rubboli G, Beniczky S, Derry C, Eriksson S, Halasz P, Högl B, Santamaria J, Khatami R, Ryvlin P, Rémi J, Tinuper P, Bassetti C, Manni R, Koutroumanidis M, Vignatelli L. Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: an EAN, ESRS and ILAE-Europe consensus review. Eur J Neurol 2020; 28:15-32. [PMID: 32959446 DOI: 10.1111/ene.14468] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/01/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Some epilepsy syndromes (sleep-related epilepsies, SREs) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. Our purpose was to define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2). METHODS The project was conducted under the auspices of the European Academy of Neurology, the European Sleep Research Society and the International League Against Epilepsy Europe. The framework entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For the literature search a stepwise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library. RESULTS Scenario 1: Despite a low quality of evidence, recommendations on anamnestic evaluation and tools for capturing the event at home or in the laboratory are provided for specific SREs. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizure control. CONCLUSIONS Definitive procedures for evaluating patients with SRE are lacking. Advice is provided that could be of help for standardizing and improving the diagnostic approach of specific SREs. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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Affiliation(s)
- L Nobili
- Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Italy
| | - A de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, The Netherlands
| | - G Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - S Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - S Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK
| | - P Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - B Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Santamaria
- Multidisciplinary Sleep Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - R Khatami
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Barmelweid Academy, Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid AG, Barmelweid, Switzerland
| | - P Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - J Rémi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - P Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - C Bassetti
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - R Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - M Koutroumanidis
- Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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26
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Dietmann A, Horn MP, Schinkelshoek MS, Fronczek R, Salmen A, Bargiotas P, Lammers GJ, Khatami R, Bassetti CLA. Conventional autoantibodies against brain antigens are not routinely detectable in serum and CSF of narcolepsy type 1 and 2 patients. Sleep Med 2020; 75:188-191. [PMID: 32858359 DOI: 10.1016/j.sleep.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/15/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022]
Abstract
Narcolepsy with cataplexy (NT1) is a chronic hypothalamic disorder with a presumed immune-mediated etiology leading to a loss of hypocretin neurons. Previous studies reported conflicting results in terms of presence of auto-antibodies involved in narcolepsy pathophysiology. A total of 86 patients with primary/idiopathic narcolepsy (74 NT1, 12 NT2) and 23 control patients with excessive daytime sleepiness due to other causes were tested for the presence of a wide range of anti-neuronal antibodies in both serum and cerebrospinal fluid (CSF). Anti-neuronal antibodies were rarely found in patients with narcolepsy (n = 2) and in controls (n = 1). Our results are in line with previous reports. We can therefore support the current evidence, that conventional anti-neuronal antibodies are not routinely detected during the workup of NT1 and other CDH patients.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - Michael P Horn
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mink S Schinkelshoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Sleep-wake Centre SEIN, Heemstede, the Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Sleep-wake Centre SEIN, Heemstede, the Netherlands
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Panagiotis Bargiotas
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Gert J Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Sleep-wake Centre SEIN, Heemstede, the Netherlands
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Center for Sleep Medicine and Sleep Research, Clinic Barmelweid, Barmelweid, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
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Lammers GJ, Bassetti CL, Dolenc-Groselj L, Jennum PJ, Kallweit U, Khatami R, Lecendreux M, Manconi M, Mayer G, Partinen M, Plazzi G, Reading PJ, Santamaria J, Sonka K, Dauvilliers Y. Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. Sleep Med Rev 2020; 52:101306. [DOI: 10.1016/j.smrv.2020.101306] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
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28
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Zhang Z, Qi M, Hügli G, Khatami R. THE CHANGES IN CEREBRAL AND MUSCULAR HEMODYNAMICS INDUCED BY SLEEP APNEA/HYPOPNEA EVENTS SHOW DISTINCT PATTERNS UNDER CPAP TITRATION. Chest 2019. [DOI: 10.1016/j.chest.2019.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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29
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Zhang Z, Qi M, Hügli G, Khatami R. THE AMPLITUDE OF CHANGES IN CEREBRAL HEMODYNAMICS DEPENDS ON THE CPAP PRESSURES AND THE LENGTHS OF THE APNEA/HYPOPNEA EVENTS IN CPAP TITRATION. Chest 2019. [DOI: 10.1016/j.chest.2019.04.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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Zhang Z, Cajochen C, Khatami R. Social Jetlag and Chronotypes in the Chinese Population: Analysis of Data Recorded by Wearable Devices. J Med Internet Res 2019; 21:e13482. [PMID: 31199292 PMCID: PMC6595939 DOI: 10.2196/13482] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 01/20/2023] Open
Abstract
Background Chronotype is the propensity for a person to sleep at a particular time during 24 hours. It is largely regulated by the circadian clock but constrained by work obligations to a specific sleep schedule. The discrepancy between biological and social time can be described as social jetlag (SJL), which is highly prevalent in modern society and associated with health problems. SJL and chronotypes have been widely studied in Western countries but have never been described in China. Objective We characterized the chronotypes and SJL in mainland China objectively by analyzing a database of Chinese sleep-wake pattern recorded by up-to-date wearable devices. Methods We analyzed 71,176 anonymous Chinese people who were continuously recorded by wearable devices for at least one week between April and July in 2017. Chronotypes were assessed (N=49,573) by the adjusted mid-point of sleep on free days (MSFsc). Early, intermediate, and late chronotypes were defined by arbitrary cut-offs of MSFsc <3 hours, between 3-5 hours, and >5 hours. In all subjects, SJL was calculated as the difference between mid-points of sleep on free days and work days. The correlations between SJL and age/body mass index/MSFsc were assessed by Pearson correlation. Random forest was used to characterize which factors (ie, age, body mass index, sex, nocturnal and daytime sleep durations, and exercise) mostly contribute to SJL and MSFsc. Results The mean total sleep duration of this Chinese sample is about 7 hours, with females sleeping on average 17 minutes longer than males. People taking longer naps sleep less during the night, but they have longer total 24-hour sleep durations. MSFsc follows a normal distribution, and the percentages of early, intermediate, and late chronotypes are approximately 26.76% (13,266/49,573), 58.59% (29,045/49,573), and 14.64% (7257/49,573). Adolescents are later types compared to adults. Age is the most important predictor of MSFsc suggested by our random forest model (relative feature importance: 0.772). No gender differences are found in chronotypes. We found that SJL follows a normal distribution and 17.07% (12,151/71,176) of Chinese have SJL longer than 1 hour. Nearly a third (22,442/71,176, 31.53%) of Chinese have SJL<0. The results showed that 53.72% (7127/13,266), 25.46% (7396/29,045), and 12.71% (922/7257) of the early, intermediate, and late chronotypes have SJL<0, respectively. SJL correlates with MSFsc (r=0.54, P<.001) but not with body mass index (r=0.004, P=.30). Random forest model suggests that age, nocturnal sleep, and daytime nap durations are the features contributing to SJL (their relative feature importance is 0.441, 0.349, and 0.204, respectively). Conclusions Our data suggest a higher proportion of early compared to late chronotypes in Chinese. Chinese have less SJL than the results reported in European populations, and more than half of the early chronotypes have negative SJL. In the Chinese population, SJL is not associated with body mass index. People of later chronotypes and long sleepers suffer more from SJL.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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31
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Khan S, Nobili L, Khatami R, Loddenkemper T, Cajochen C, Dijk DJ, Eriksson SH. Circadian rhythm and epilepsy. Lancet Neurol 2018; 17:1098-1108. [PMID: 30366868 DOI: 10.1016/s1474-4422(18)30335-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/18/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
Abstract
Advances in diagnostic technology, including chronic intracranial EEG recordings, have confirmed the clinical observation of different temporal patterns of epileptic activity and seizure occurrence over a 24-h period. The rhythmic patterns in epileptic activity and seizure occurrence are probably related to vigilance states and circadian variation in excitatory and inhibitory balance. Core circadian genes BMAL1 and CLOCK, which code for transcription factors, have been shown to influence excitability and seizure threshold. Despite uncertainties about the relative contribution of vigilance states versus circadian rhythmicity, including circadian factors such as seizure timing improves sensitivity of seizure prediction algorithms in individual patients. Improved prediction of seizure occurrence opens the possibility for personalised antiepileptic drug-dosing regimens timed to particular phases of the circadian cycle to improve seizure control and to reduce side-effects and risks associated with seizures. Further studies are needed to clarify the pathways through which rhythmic patterns of epileptic activity are generated, because this might also inform future treatment options.
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Affiliation(s)
- Sofia Khan
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK; Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Lino Nobili
- Centre of Sleep Medicine, Centre for Epilepsy Surgery C Munari, Niguarda Hospital, Milan, Italy; Child Neuropsychiatry Unit, IRCCS Giannina Gaslini Pediatric Institute, DINOGMI, University of Genoa, Italy
| | - Ramin Khatami
- Centre for Sleep Research, Sleep Medicine and Epileptology, Klinik Barmelweid AG, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sofia H Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK.
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32
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Latorre D, Kallweit U, Armentani E, Foglierini M, Mele F, Cassotta A, Jovic S, Jarrossay D, Mathis J, Zellini F, Becher B, Lanzavecchia A, Khatami R, Manconi M, Tafti M, Bassetti CL, Sallusto F. T cells in patients with narcolepsy target self-antigens of hypocretin neurons. Nature 2018; 562:63-68. [PMID: 30232458 DOI: 10.1038/s41586-018-0540-1] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/10/2018] [Indexed: 11/09/2022]
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33
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Zhang Z, Mayer G, Dauvilliers Y, Plazzi G, Pizza F, Fronczek R, Santamaria J, Partinen M, Overeem S, Peraita-Adrados R, da Silva AM, Sonka K, Rio-Villegas RD, Heinzer R, Wierzbicka A, Young P, Högl B, Bassetti CL, Manconi M, Feketeova E, Mathis J, Paiva T, Canellas F, Lecendreux M, Baumann CR, Barateau L, Pesenti C, Antelmi E, Gaig C, Iranzo A, Lillo-Triguero L, Medrano-Martínez P, Haba-Rubio J, Gorban C, Luca G, Lammers GJ, Khatami R. Exploring the clinical features of narcolepsy type 1 versus narcolepsy type 2 from European Narcolepsy Network database with machine learning. Sci Rep 2018; 8:10628. [PMID: 30006563 PMCID: PMC6045630 DOI: 10.1038/s41598-018-28840-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/20/2018] [Indexed: 12/16/2022] Open
Abstract
Narcolepsy is a rare life-long disease that exists in two forms, narcolepsy type-1 (NT1) or type-2 (NT2), but only NT1 is accepted as clearly defined entity. Both types of narcolepsies belong to the group of central hypersomnias (CH), a spectrum of poorly defined diseases with excessive daytime sleepiness as a core feature. Due to the considerable overlap of symptoms and the rarity of the diseases, it is difficult to identify distinct phenotypes of CH. Machine learning (ML) can help to identify phenotypes as it learns to recognize clinical features invisible for humans. Here we apply ML to data from the huge European Narcolepsy Network (EU-NN) that contains hundreds of mixed features of narcolepsy making it difficult to analyze with classical statistics. Stochastic gradient boosting, a supervised learning model with built-in feature selection, results in high performances in testing set. While cataplexy features are recognized as the most influential predictors, machine find additional features, e.g. mean rapid-eye-movement sleep latency of multiple sleep latency test contributes to classify NT1 and NT2 as confirmed by classical statistical analysis. Our results suggest ML can identify features of CH on machine scale from complex databases, thus providing 'ideas' and promising candidates for future diagnostic classifications.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Klinik Barmelweid AG, Barmelweid, Switzerland
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany
| | - Yves Dauvilliers
- Centre de Reference Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, Montpellier, France
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, ASL di Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, ASL di Bologna, Bologna, Italy
| | - Rolf Fronczek
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Joan Santamaria
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit, Clinical Neurophysiology Department, Gregorio Marañón University Hospital, Complutense University of Madrid (UCM), Madrid, Spain
| | - Antonio Martins da Silva
- Serviço de Neurofisiologia, Hospital Santo António/Centro Hospitalar do Porto and Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Karel Sonka
- Neurology Department and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Rafael Del Rio-Villegas
- Unidad de Neurofisiología y Trastornos del Sueño. Hospital Vithas Internacional Madrid, Madrid, Spain
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Birgit Högl
- Neurology Department, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Teresa Paiva
- Institute of Molecular Medicine Portugal, Medical Faculty Lisbon University, Lisbon, Portugal
| | - Francesca Canellas
- Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | | | - Lucie Barateau
- Centre de Reference Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, Montpellier, France
| | - Carole Pesenti
- Centre de Reference Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, Montpellier, France
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, ASL di Bologna, Bologna, Italy
| | - Carles Gaig
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Laura Lillo-Triguero
- Sleep and Epilepsy Unit, Clinical Neurophysiology Department, Gregorio Marañón University Hospital, Complutense University of Madrid (UCM), Madrid, Spain
| | - Pablo Medrano-Martínez
- Sleep and Epilepsy Unit, Clinical Neurophysiology Department, Gregorio Marañón University Hospital, Complutense University of Madrid (UCM), Madrid, Spain
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Corina Gorban
- Center for Sleep Medicine, Sleep Research and Epileptology, Klinik Barmelweid AG, Barmelweid, Switzerland
| | - Gianina Luca
- Centre Neuchatelois de Psychiatrie, Neuchatel, Switzerland
| | - Gert Jan Lammers
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Klinik Barmelweid AG, Barmelweid, Switzerland. .,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
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34
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Edelmann C, Ghiassi R, Vogt DR, Partridge MR, Khatami R, Leuppi JD, Miedinger D. A pictorial Sleepiness and Sleep Apnoea Scale to recognize individuals with high risk for obstructive sleep apnea syndrome. Nat Sci Sleep 2017; 9:253-265. [PMID: 29123432 PMCID: PMC5661851 DOI: 10.2147/nss.s139936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the validity of a new pictorial form of a screening test for obstructive sleep apnea syndrome (OSAS) - the pictorial Sleepiness and Sleep Apnoea Scale (pSSAS). Validation was performed in a sample of patients admitted to sleep clinics in the UK and Switzerland. PATIENTS AND METHODS All study participants were investigated with objective sleep tests such as full-night-attended polysomnography or polygraphy. The pSSAS was validated by taking into account the individual result of the sleep study, sleep-related questionnaires and objective parameters such as body mass index (BMI) or neck circumference. Different scoring schemes of the pSSAS were evaluated, and an internal validation was undertaken. RESULTS The full data set consisted of 431 individuals (234 patients from the UK, 197 patients from Switzerland). The pSSAS showed good predictive performance for OSAS with an area under the curve between 0.77 and 0.81 depending on which scoring scheme was used. The subscores of the pSSAS had a moderate-to-strong correlation with widely used screening questionnaires for OSAS or excessive daytime sleepiness as well as with BMI and neck circumference. CONCLUSION The pSSAS can be used to select patients with a high probability of having OSAS. Due to its simple pictorial design with short questions, it might be suitable for screening in populations with low health literacy and in non-native English or German speakers.
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Affiliation(s)
| | - Ramesh Ghiassi
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Deborah R Vogt
- Clinical Trial Unit, University of Basel, University Hospital Basel, Basel
| | | | | | - Jörg D Leuppi
- Medical Faculty, University of Basel, Basel, Switzerland.,University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - David Miedinger
- Medical Faculty, University of Basel, Basel, Switzerland.,University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland
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35
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Abassi F, Mirzaii-Dizgah I, Manifar S, Kazemian A, Khatami R, Nazari-Sharbayani F. Saliva 8-hydroxy-2’-deoxyguanosine changes following radiotherapy in patients with head and neck cancer. Dental Cadmos 2016. [DOI: 10.19256/d.cadmos.08.2016.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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36
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Zhang Z, Schneider M, Laures M, Qi M, Khatami R. The Comparisons of Cerebral Hemodynamics Induced by Obstructive Sleep Apnea with Arousal and Periodic Limb Movement with Arousal: A Pilot NIRS Study. Front Neurosci 2016; 10:403. [PMID: 27630539 PMCID: PMC5005379 DOI: 10.3389/fnins.2016.00403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/18/2016] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSA) and restless legs syndrome (RLS) with periodic limb movement during sleep (PLMS) are two sleep disorders characterized by repetitive respiratory or movement events associated with cortical arousals. We compared the cerebral hemodynamic changes linked to periodic apneas/hypopneas with arousals (AHA) in four OSA-patients with periodic limb movements (PLMA) with arousals in four patients with RLS-PLMS using near-infrared spectroscopy (NIRS). AHA induced homogenous pattern of periodic fluctuations in oxygenated (HbO2) and deoxygenated (HHb) hemoglobin, i.e., the decrease of HbO2 was accompanied by an increase of HHb during the respiratory event and resolved to reverse pattern when cortical arousal started. Blood volume (BV) showed the same pattern as HHb but with relative smaller amplitude in most of the AHA events.These changing patterns were significant as Wilcoxon signed-rank tests gave p < 0.001 when comparing the area under the curve of these hemodynamic parameters to zero. By contrast, in PLMA limb movements induced periodic increments in HbO2 and BV (Wilcoxon signed-rank tests, p < 0.001), but HHb changed more heterogeneously even during the events coming from the same patient. Heart rate (HR) also showed different patterns between AHA and PLMA. It significantly decreased during the respiratory event (Wilcoxon signed-rank test, p < 0.001) and then increased after the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001); while in PLMA HR first increased preceding the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001) and then decreased. The results of this preliminary study show that both AHA and PLMA induce changes in cerebral hemodynamics. The occurrence of cortical arousal is accompanied by increased HR in both events, but by different BV changes (i.e., decreased/increased BV in AHA/PLMA, respectively). HR changes may partially account for the increased cerebral hemodynamics during PLMA; whereas in AHA probable vasodilatation mediated by hypoxia/hypercapnia is more crucial for the post-arousal hemodynamics. The differences between changes of cerebral hemodynamics and HR may indicate different pathological mechanisms behind these two sleep disorder events.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine and Sleep Research, Clinic BarmelweidBarmelweid, Switzerland; Bern Network for Epilepsy, Sleep and Consciousness (BENESCO), Department of Neurology, University Hospital Bern, University of BernBern, Switzerland
| | - Maja Schneider
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid Barmelweid, Switzerland
| | - Marco Laures
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid Barmelweid, Switzerland
| | - Ming Qi
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid Barmelweid, Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine and Sleep Research, Clinic BarmelweidBarmelweid, Switzerland; Bern Network for Epilepsy, Sleep and Consciousness (BENESCO), Department of Neurology, University Hospital Bern, University of BernBern, Switzerland
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37
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Tafti M, Lammers GJ, Dauvilliers Y, Overeem S, Mayer G, Nowak J, Pfister C, Dubois V, Eliaou JF, Eberhard HP, Liblau R, Wierzbicka A, Geisler P, Bassetti CL, Mathis J, Lecendreux M, Khatami R, Heinzer R, Haba-Rubio J, Feketeova E, Baumann CR, Kutalik Z, Tiercy JM. Narcolepsy-Associated HLA Class I Alleles Implicate Cell-Mediated Cytotoxicity. Sleep 2016; 39:581-7. [PMID: 26518595 DOI: 10.5665/sleep.5532] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/11/2015] [Indexed: 02/01/2023] Open
Abstract
STUDY OBJECTIVES Narcolepsy with cataplexy is tightly associated with the HLA class II allele DQB1*06:02. Evidence indicates a complex contribution of HLA class II genes to narcolepsy susceptibility with a recent independent association with HLA-DPB1. The cause of narcolepsy is supposed be an autoimmune attack against hypocretin-producing neurons. Despite the strong association with HLA class II, there is no evidence for CD4+ T-cell-mediated mechanism in narcolepsy. Since neurons express class I and not class II molecules, the final effector immune cells involved might include class I-restricted CD8+ T-cells. METHODS HLA class I (A, B, and C) and II (DQB1) genotypes were analyzed in 944 European narcolepsy with cataplexy patients and in 4,043 control subjects matched by country of origin. All patients and controls were DQB1*06:02 positive and class I associations were conditioned on DQB1 alleles. RESULTS HLA-A*11:01 (OR = 1.49 [1.18-1.87] P = 7.0*10(-4)), C*04:01 (OR = 1.34 [1.10-1.63] P = 3.23*10(-3)), and B*35:01 (OR = 1.46 [1.13-1.89] P = 3.64*10(-3)) were associated with susceptibility to narcolepsy. Analysis of polymorphic class I amino-acids revealed even stronger associations with key antigen-binding residues HLA-A-Tyr(9) (OR = 1.32 [1.15-1.52] P = 6.95*10(-5)) and HLA-C-Ser(11) (OR = 1.34 [1.15-1.57] P = 2.43*10(-4)). CONCLUSIONS Our findings provide a genetic basis for increased susceptibility to infectious factors or an immune cytotoxic mechanism in narcolepsy, potentially targeting hypocretin neurons.
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Affiliation(s)
- Mehdi Tafti
- Center for Integrative Genomics (CIG) University of Lausanne, Lausanne, Switzerland.,Center for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Gert J Lammers
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.,Sleep-Wake Center of the Stichting Epilepsie Instellingen Netherland, Heemstede, the Netherlands
| | - Yves Dauvilliers
- INSERM-1061, Montpellier, France.,National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Department of Neurology, Gui-de-Chauliac Hospital, Montpellier, France
| | | | - Geert Mayer
- Hephata-Clinic for Neurology, Schwalmstadt-Treysa, Germany
| | - Jacek Nowak
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Corinne Pfister
- Center for Integrative Genomics (CIG) University of Lausanne, Lausanne, Switzerland
| | - Valérie Dubois
- HLA Laboratory, Etablissement Français du Sang, Lyon, France
| | - Jean-François Eliaou
- Department of Immunology, CHRU of Montpellier, University of Montpellier, France
| | | | - Roland Liblau
- INSERM-UMR1043, CNRS-U5282, Université de Toulouse, Centre de Physiopathologie Toulouse Purpan (CPTP), Toulouse, France
| | - Aleksandra Wierzbicka
- Institute of Psychiatry and Neurology, Department of Clinical Neurophysiology and Sleep Disorders Center, Warsaw, Poland
| | - Peter Geisler
- Sleep Disorders and Research Center, Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Michel Lecendreux
- Pediatric Sleep Center, National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Department of Child and Adolescent Psychopathology, Robert Debré Hospital, Paris VII University, Paris, France
| | | | - Raphaël Heinzer
- Center for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Eva Feketeova
- Department of Neurology, Faculty of Medicine, Safarikiensis University and Louis Pasteur Faculty Hospital Kosice, Kosice, Slovakia
| | | | - Zoltán Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne 1010, Switzerland
| | - Jean-Marie Tiercy
- National Reference Laboratory for Histocompatibility, Transplantation Immunology Unit, Department of Genetics and Laboratory Medicine, University Hospital Geneva, Geneva, Switzerland
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Kretzschmar U, Werth E, Sturzenegger C, Khatami R, Bassetti CL, Baumann CR. Which diagnostic findings in disorders with excessive daytime sleepiness are really helpful? A retrospective study. J Sleep Res 2016; 25:307-13. [PMID: 26864219 DOI: 10.1111/jsr.12383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/13/2015] [Indexed: 11/29/2022]
Abstract
Due to extensive clinical and electrophysiological overlaps, the correct diagnosis of disorders with excessive daytime sleepiness is often challenging. The aim of this study was to provide diagnostic measures that help discriminating such disorders, and to identify parameters, which don't. In this single-center study, we retrospectively identified consecutive treatment-naïve patients who suffered from excessive daytime sleepiness, and analyzed clinical and electrophysiological measures in those patients in whom a doubtless final diagnosis could be made. Of 588 patients, 287 reported subjective excessive daytime sleepiness. Obstructive sleep apnea is the only disorder that could be identified by polysomnography alone. The diagnosis of insufficient sleep syndrome relies on actigraphy as patients underestimate their sleep need and the disorder shares several clinical and electrophysiological properties with both narcolepsy type 1 and idiopathic hypersomnia. Sleep stage sequencing on MSLT appears helpful to discriminate between insufficient sleep syndrome and narcolepsy. Sleep inertia is a strong indicator for idiopathic hypersomnia. There are no distinctive electrophysiological findings for the diagnosis of restless legs syndrome. Altogether, EDS disorders are common in neurological sleep laboratories, but usually cannot be diagnosed based on PSG and MSLT findings alone. The diagnostic value of actigraphy recordings can hardly be overestimated.
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Affiliation(s)
- Ute Kretzschmar
- University Hospital, Zurich, Switzerland.,Schulthess Clinic, Zurich, Switzerland
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39
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Khatami R, Luca G, Baumann CR, Bassetti CL, Bruni O, Canellas F, Dauvilliers Y, Del Rio-Villegas R, Feketeova E, Ferri R, Geisler P, Högl B, Jennum P, Kornum BR, Lecendreux M, Martins-da-Silva A, Mathis J, Mayer G, Paiva T, Partinen M, Peraita-Adrados R, Plazzi G, Santamaria J, Sonka K, Riha R, Tafti M, Wierzbicka A, Young P, Lammers GJ, Overeem S. The European Narcolepsy Network (EU-NN) database. J Sleep Res 2016; 25:356-64. [DOI: 10.1111/jsr.12374] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/07/2015] [Indexed: 12/15/2022]
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40
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Mensen A, Poryazova R, Huegli G, Baumann CR, Schwartz S, Khatami R. The Roles of Dopamine and Hypocretin in Reward: A Electroencephalographic Study. PLoS One 2015; 10:e0142432. [PMID: 26599765 PMCID: PMC4658140 DOI: 10.1371/journal.pone.0142432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/21/2015] [Indexed: 11/19/2022] Open
Abstract
The proper functioning of the mesolimbic reward system is largely dependent on the neurotransmitter dopamine. Recent evidence suggests that the hypocretin system has significant projections to this reward system. We examined the distinct effects of reduced dopamine or reduced hypocretin levels on reward activity in patients with Parkinson’s disease, dopamine deficient, as well as patients with narcolepsy-cataplexy, hypocretin depleted, and healthy controls. Participants performed a simple game-like task while high-density electroencephalography was recorded. Topography and timing of event-related potentials for both reward cue, and reward feedback was examined across the entire dataset. While response to reward cue was similar in all groups, two distinct time points were found to distinguish patients and controls for reward feedback. Around 160ms both patient groups had reduced ERP amplitude compared to controls. Later at 250ms, both patient groups also showed a clear event-related potential (ERP), which was absent in controls. The initial differences show that both patient groups show a similar, blunted response to reward delivery. The second potential corresponds to the classic feedback-related negativity (FRN) potential which relies on dopamine activity and reflects reward prediction-error signaling. In particular the mismatch between predicted reward and reward subsequently received was significantly higher in PD compared to NC, independent of reward magnitude and valence. The intermediate FRN response in NC highlights the contribution of hypocretin in reward processing, yet also shows that this is not as detrimental to the reward system as in Parkinson’s. Furthermore, the inability to generate accurate predictions in NC may explain why hypocretin deficiency mediates cataplexy triggered by both positive and negative emotions.
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Affiliation(s)
- Armand Mensen
- Department of Sleep Medicine, Clinic Barmelweid, 5017 Aargau, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, 8006 Zurich, Switzerland
| | - Gordana Huegli
- Department of Sleep Medicine, Clinic Barmelweid, 5017 Aargau, Switzerland
| | | | - Sophie Schwartz
- Department of Neuroscience, University of Geneva, 1211 Geneva, Switzerland
| | - Ramin Khatami
- Department of Sleep Medicine, Clinic Barmelweid, 5017 Aargau, Switzerland
- * E-mail:
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41
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Bassetti CL, Ferini-Strambi L, Brown S, Adamantidis A, Benedetti F, Bruni O, Cajochen C, Dolenc-Groselj L, Ferri R, Gais S, Huber R, Khatami R, Lammers GJ, Luppi PH, Manconi M, Nissen C, Nobili L, Peigneux P, Pollmächer T, Randerath W, Riemann D, Santamaria J, Schindler K, Tafti M, Van Someren E, Wetter TC. Neurology and psychiatry: waking up to opportunities of sleep. : State of the art and clinical/research priorities for the next decade. Eur J Neurol 2015; 22:1337-54. [DOI: 10.1111/ene.12781] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/05/2015] [Indexed: 12/22/2022]
Affiliation(s)
- C. L. Bassetti
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - L. Ferini-Strambi
- Division of Neuroscience; Sleep Disorders Centre; Università Vita-Salute San Raffaele; Milan Italy
| | - S. Brown
- Institute of Pharmacology and Toxicology; University of Zürich; Zürich Switzerland
| | - A. Adamantidis
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - F. Benedetti
- Department of Clinical Neurosciences; Scientific Institute and University Vita-Salute San Raffaele; Milan Italy
| | - O. Bruni
- Department of Developmental and Social Psychology; Sapienza University; Rome Italy
| | - C. Cajochen
- Psychiatric University Clinic; Basel Switzerland
| | - L. Dolenc-Groselj
- Division of Neurology; Institute of Clinical Neurophysiology; University Medical Centre Ljubljana; Ljubljana Slovenia
| | - R. Ferri
- Department of Neurology; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
| | - S. Gais
- Medical Psychology and Behavioural Neurobiology; Eberhard Karls Universität Tübingen; Tübingen Germany
| | - R. Huber
- Department of Paediatrics; Children's University Hospital; Zurich Switzerland
| | - R. Khatami
- Sleep Centre; Klinik Barmelweid AG; Barmelweid Switzerland
| | - G. J. Lammers
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden The Netherlands
- Sleep Wake Centre SEIN; Stichting Epilepsie Instellingen Nederland; Heemstede The Netherlands
| | - P. H. Luppi
- UMR 5292 CNRS/U1028 INSERM; Centre de Recherche en Neurosciences de Lyon (CRNL); Team “Physiopathologie des réseaux neuronaux responsables du cycle veille-sommeil”; Université Claude Bernard Lyon I; Lyon France
| | - M. Manconi
- Sleep and Epilepsy Centre; Neurocentre of Southern Switzerland; Civic Hospital (EOC) of Lugano; Lugano Switzerland
| | - C. Nissen
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Centre for Mental Disorders; Freiburg University Medical Centre; Freiburg Germany
| | - L. Nobili
- Centre of Epilepsy Surgery ‘C. Munari’; Niguarda Hospital; Milan Italy
| | - P. Peigneux
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit; CRCN - Centre de Recherches Cognition et Neurosciences and UNI - ULB Neurosciences Institute; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - T. Pollmächer
- Center of Mental Health; Klinikum Ingolstadt; Ingolstadt Germany
| | - W. Randerath
- Institut für Pneumologie; Krankenhaus Bethanien gGmbH; Universität Witten/Herdecke; Solingen Germany
| | - D. Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Centre for Mental Disorders; Freiburg University Medical Centre; Freiburg Germany
| | - J. Santamaria
- Neurology Service; Hospital Clínic of Barcelona; Institut d'Investigació Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Barcelona Spain
| | - K. Schindler
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - M. Tafti
- Centre for Integrative Genomics; University of Lausanne; Lausanne Switzerland
- Centre for Investigation and Research in Sleep; Vaud University Hospital; Lausanne Switzerland
| | - E. Van Someren
- Department of Sleep and Cognition; Netherlands Institute for Neuroscience; Amsterdam The Netherlands
- Departments of Integrative Neurophysiology and Medical Psychology; Center for Neurogenomics and Cognitive Research (CNCR); VU University and Medical Center; Amsterdam The Netherlands
| | - T. C. Wetter
- Department of Psychiatry and Psychotherapy; University of Regensburg; Regensburg Germany
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Zhang Z, Khatami R. A Biphasic Change of Regional Blood Volume in the Frontal Cortex during Non-Rapid Eye Movement Sleep: A Near-Infrared Spectroscopy Study. Sleep 2015; 38:1211-7. [PMID: 25761983 DOI: 10.5665/sleep.4894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 01/16/2015] [Indexed: 12/29/2022] Open
Abstract
STUDY OBJECTIVES Current knowledge on hemodynamics in sleep is limited because available techniques do not allow continuous recordings and mainly focus on cerebral blood flow while neglecting other important parameters, such as blood volume (BV) and vasomotor activity. DESIGN Observational study. PARTICIPANTS AND SETTINGS Continuous measures of hemodynamics over the left forehead and biceps were performed using near-infrared spectroscopy (NIRS) during nocturnal polysomnography in 16 healthy participants in sleep laboratory. MEASUREMENTS AND RESULTS Temporal dynamics and mean values of cerebral and muscular oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (HHb), and BV during different sleep stages were compared. A biphasic change of cerebral BV was observed which contrasted a monotonic increase of muscular BV during non-rapid eye movement sleep. A significant decrement in cerebral HbO2 and BV accompanied by an increase of HHb was recorded at sleep onset (Phase I). Prior to slow wave sleep (SWS) HbO2 and BV turned to increase whereas HHb began to decrease in subsequent Phase II suggested increased brain perfusion during SWS. The cerebral HbO2 slope correlated to BV slope in Phase I and II, but it only correlated to HHb slope in Phase II. The occurrence time of inflection points correlated to SWS latencies. CONCLUSION Initial decrease of brain perfusion with decreased blood volume (BV) and oxygenated hemoglobin (HbO2) together with increasing muscular BV fit thermoregulation process at sleep onset. The uncorrelated and correlated slopes of HbO2 and deoxygenated hemoglobin indicate different mechanisms underlying the biphasic hemodynamic process in light sleep and slow wave sleep (SWS). In SWS, changes in vasomotor activity (i.e., increased vasodilatation) may mediate increasing cerebral and muscular BV.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid, Barmelweid, Switzerland.,Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid, Barmelweid, Switzerland.,Department of Neurology, University Hospital Bern, Bern, Switzerland.,ZIHP, Zurich Center for Integrative Human Physiology, Zürich, Switzerland
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Abstract
Neurological sleep disorders are common in the general population and may have a strong impact on quality of life. General practitioners play a key role in recognizing and managing sleep disorders in the general population. They should therefore be familiar with the most important neurological sleep disorders. This review provides a comprehensive overview of the most prevalent and important neurological sleep disorders, including Restless legs syndrome (with and without periodic limb movements in sleep), narcolepsy, NREM- and REM-sleep parasomnias and the complex relationship between sleep and epilepsies. Although narcolepsy is considered as a rare disease, recent discoveries in narcolepsy research provided insight in the function of brain circuitries involved in sleep wake regulation. REM sleep behavioral parasomnia (RBD) is increasingly recognized to represent an early manifestation of neurodegenerative disorders, in particular evolving synucleinopathies. Early diagnosis may thus open new perspectives for developing novel treatment options by targeting neuroprotective substances.
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Affiliation(s)
- Ramin Khatami
- Klinik für Schlafmedizin und Schlafforschung, Klinik Barmelweid AG, Schweiz
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44
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Poryazova R, Huber R, Khatami R, Werth E, Brugger P, Barath K, Baumann CR, Bassetti CL. Topographic sleep EEG changes in the acute and chronic stage of hemispheric stroke. J Sleep Res 2014; 24:54-65. [DOI: 10.1111/jsr.12208] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/28/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Rositsa Poryazova
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | - Reto Huber
- University Children's Hospital Zurich; Zurich Switzerland
| | - Ramin Khatami
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
- Sleep Centre; Clinic Barmelweid; Barmelweid Switzerland
| | - Esther Werth
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | - Peter Brugger
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | - Krizstina Barath
- Department of Neuroradiology; University Hospital Zurich; Zurich Switzerland
| | | | - Claudio L. Bassetti
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
- Department of Neurology; Inselspital; Bern Switzerland
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45
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Zhang Z, Khatami R. Predominant endothelial vasomotor activity during human sleep: a near-infrared spectroscopy study. Eur J Neurosci 2014; 40:3396-404. [DOI: 10.1111/ejn.12702] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine and Sleep Research; Clinic Barmelweid; 5017 Barmelweid Switzerland
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | - Ramin Khatami
- Center for Sleep Medicine and Sleep Research; Clinic Barmelweid; 5017 Barmelweid Switzerland
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
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46
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Mensen A, Gorban C, Niklaus M, Kuske E, Khatami R. The effects of theta-burst stimulation on sleep and vigilance in humans. Front Hum Neurosci 2014; 8:420. [PMID: 24971057 PMCID: PMC4054091 DOI: 10.3389/fnhum.2014.00420] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/25/2014] [Indexed: 11/22/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (TMS) has become a popular tool to modulate neuronal networks and associated brain functions in both clinical and basic research. Yet few studies have examined the potential effects of cortical stimulation on general levels of vigilance. In this exploratory study, we used theta-burst protocols, both continuous (cTBS) and intermittent (iTBS) patterns, to examine whether inhibition or excitation of the left dorso-lateral prefrontal cortex (dlPFC) was able to induce reliable and acute changes to vigilance measures, compared to the left dorso-lateral associative visual cortex (dlAVC) as a control site in line with previous work. Partially sleep restricted participants underwent four separate sessions in a single day, in a between subjects design for TBS stimulation type and within subjects for locaton, each consisting of maintenance of wakefulness test (MWT), a sleep latency test, and a psychomotor vigilance task (PVT). TBS significantly affected measures of sleep consolidation, namely latency to sleep stage 2 and sleep efficiency, but had no effects on sleep drive or psychomotor vigilance levels for either TBS type or location. Contrary to our initial hypothesis of the dlAVC as a control site, stimulation to this region resulted in the largest differential effects between stimulation types. Moreover, the effect of TBS was found to be consistent throughout the day. These data may provide the basis for further investigation into therapeutic applications of TBS in sleep disorders.
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Affiliation(s)
- Armand Mensen
- Department of Sleep Medicine, Clinic Barmelweid Barmelweid, Switzerland
| | - Corina Gorban
- Department of Sleep Medicine, Clinic Barmelweid Barmelweid, Switzerland ; Department of Medicine, University of Zurich Zurich, Switzerland
| | - Marcel Niklaus
- Department of Sleep Medicine, Clinic Barmelweid Barmelweid, Switzerland
| | - Eva Kuske
- Department of Sleep Medicine, Clinic Barmelweid Barmelweid, Switzerland
| | - Ramin Khatami
- Department of Sleep Medicine, Clinic Barmelweid Barmelweid, Switzerland ; Department of Medicine, University of Zurich Zurich, Switzerland
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Mensen A, Poryazova R, Schwartz S, Khatami R. Humor as a reward mechanism: event-related potentials in the healthy and diseased brain. PLoS One 2014; 9:e85978. [PMID: 24489683 PMCID: PMC3906016 DOI: 10.1371/journal.pone.0085978] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/03/2013] [Indexed: 12/04/2022] Open
Abstract
Humor processing involves distinct processing stages including incongruity detection, emotional response, and engagement of mesolimbic reward regions. Dysfunctional reward processing and clinical symptoms in response to humor have been previously described in both hypocretin deficient narcolepsy-cataplexy (NC) and in idiopathic Parkinson disease (PD). For NC patients, humor is the strongest trigger for cataplexy, a transient loss of muscle tone, whereas dopamine-deficient PD-patients show blunted emotional responses to humor. To better understand the role of reward system and the various contributions of hypocretinergic and dopaminergic mechanisms to different stages of humor processing we examined the electrophysiological response to humorous and neutral pictures when given as reward feedback in PD, NC and healthy controls. Humor compared to neutral feedback demonstrated modulation of early ERP amplitudes likely corresponding to visual processing stages, with no group differences. At 270 ms post-feedback, conditions showed topographical and amplitudinal differences for frontal and left posterior electrodes, in that humor feedback was absent in PD patients but increased in NC patients. We suggest that this effect relates to a relatively early affective response, reminiscent of increased amygdala response reported in NC patients. Later ERP differences, corresponding to the late positive potential, revealed a lack of sustained activation in PD, likely due to altered dopamine regulation in reward structures in these patients. This research provides new insights into the temporal dynamics and underlying mechanisms of humor detection and appreciation in health and disease.
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Affiliation(s)
- Armand Mensen
- Department of Sleep Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Schwartz
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
| | - Ramin Khatami
- Department of Sleep Medicine, Clinic Barmelweid, Barmelweid, Switzerland
- * E-mail:
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Tafti M, Hor H, Dauvilliers Y, Lammers GJ, Overeem S, Mayer G, Javidi S, Iranzo A, Santamaria J, Peraita-Adrados R, Vicario JL, Arnulf I, Plazzi G, Bayard S, Poli F, Pizza F, Geisler P, Wierzbicka A, Bassetti CL, Mathis J, Lecendreux M, Donjacour CEHM, van der Heide A, Heinzer R, Haba-Rubio J, Feketeova E, Högl B, Frauscher B, Benetó A, Khatami R, Cañellas F, Pfister C, Scholz S, Billiard M, Baumann CR, Ercilla G, Verduijn W, Claas FHJ, Dubois V, Nowak J, Eberhard HP, Pradervand S, Hor CN, Testi M, Tiercy JM, Kutalik Z. DQB1 locus alone explains most of the risk and protection in narcolepsy with cataplexy in Europe. Sleep 2014; 37:19-25. [PMID: 24381371 DOI: 10.5665/sleep.3300] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY OBJECTIVE Prior research has identified five common genetic variants associated with narcolepsy with cataplexy in Caucasian patients. To replicate and/or extend these findings, we have tested HLA-DQB1, the previously identified 5 variants, and 10 other potential variants in a large European sample of narcolepsy with cataplexy subjects. DESIGN Retrospective case-control study. SETTING A recent study showed that over 76% of significant genome-wide association variants lie within DNase I hypersensitive sites (DHSs). From our previous GWAS, we identified 30 single nucleotide polymorphisms (SNPs) with P < 10(-4) mapping to DHSs. Ten SNPs tagging these sites, HLADQB1, and all previously reported SNPs significantly associated with narcolepsy were tested for replication. PATIENTS AND PARTICIPANTS For GWAS, 1,261 narcolepsy patients and 1,422 HLA-DQB1*06:02-matched controls were included. For HLA study, 1,218 patients and 3,541 controls were included. MEASUREMENTS AND RESULTS None of the top variants within DHSs were replicated. Out of the five previously reported SNPs, only rs2858884 within the HLA region (P < 2x10(-9)) and rs1154155 within the TRA locus (P < 2x10(-8)) replicated. DQB1 typing confirmed that DQB1*06:02 confers an extraordinary risk (odds ratio 251). Four protective alleles (DQB1*06:03, odds ratio 0.17, DQB1*05:01, odds ratio 0.56, DQB1*06:09 odds ratio 0.21, DQB1*02 odds ratio 0.76) were also identified. CONCLUSION An overwhelming portion of genetic risk for narcolepsy with cataplexy is found at DQB1 locus. Since DQB1*06:02 positive subjects are at 251-fold increase in risk for narcolepsy, and all recent cases of narcolepsy after H1N1 vaccination are positive for this allele, DQB1 genotyping may be relevant to public health policy.
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Affiliation(s)
- Mehdi Tafti
- Center for Integrative Genomics (CIG) University of Lausanne, Lausanne, Switzerland ; Center for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Hyun Hor
- Center for Integrative Genomics (CIG) University of Lausanne, Lausanne, Switzerland ; Center for Genomic Regulation (CRG), Barcelona, and Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Yves Dauvilliers
- INSERM-1061, Montpellier, France ; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Department of Neurology, Guide-Chauliac Hospital, Montpellier, France
| | - Gert J Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands ; Sleep-Wake Center SEIN, Heemstede, The Netherlands
| | | | - Geert Mayer
- Hephata-Clinic for Neurology, Schwalmstadt-Treysa, Germany
| | - Sirous Javidi
- Hephata-Clinic for Neurology, Schwalmstadt-Treysa, Germany
| | - Alex Iranzo
- Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Joan Santamaria
- Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit - Clinical Neurophysiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - José L Vicario
- Histocompatibility, Blood Center of the Community of Madrid, Madrid, Spain
| | - Isabelle Arnulf
- National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Sleep disorders unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Giuseppe Plazzi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna and IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna Italy
| | - Sophie Bayard
- INSERM-1061, Montpellier, France ; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Department of Neurology, Guide-Chauliac Hospital, Montpellier, France
| | - Francesca Poli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna and IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna Italy
| | - Fabio Pizza
- Department of Biomedical and NeuroMotor Sciences, University of Bologna and IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna Italy
| | - Peter Geisler
- Sleep Disorders and Research Center, Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Aleksandra Wierzbicka
- Institute of Psychiatry and Neurology, Department of Clinical Neurophysiology and Sleep Disorders Center, Warsaw, Poland
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Michel Lecendreux
- Pediatric Sleep Center, National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Robert Debré Hospital, Paris VII University, Paris, France
| | | | - Astrid van der Heide
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Eva Feketeova
- Department of Neurology, Faculty of Medicine, Safarikiensis University and Louis Pasteur Faculty Hospital Kosice, Kosice, Slovakia
| | - Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Antonio Benetó
- Unidad de Sueño, Servicio Neurofisiología Clínica, Hospital Universitario La Fe, Valencia, Spain
| | | | - Francesca Cañellas
- Servicio de Psiquiatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Corinne Pfister
- Center for Integrative Genomics (CIG) University of Lausanne, Lausanne, Switzerland
| | - Sabine Scholz
- National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Department of Neurology, Guide-Chauliac Hospital, Montpellier, France
| | - Michel Billiard
- National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia), Department of Neurology, Guide-Chauliac Hospital, Montpellier, France
| | | | | | - Willem Verduijn
- Department of Immunohaematology and Blood Trans-fusion, Leiden University Medical Centre, The Netherlands
| | - Frans H J Claas
- Department of Immunohaematology and Blood Trans-fusion, Leiden University Medical Centre, The Netherlands
| | - Valérie Dubois
- HLA Laboratory, Etablissement Français du Sang, Lyon, France
| | - Jacek Nowak
- Department of Immunogenetics, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Sylvain Pradervand
- Lausanne Genomic Technologies Facility, Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland ; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Charlotte N Hor
- Center for Genomic Regulation (CRG), Barcelona, and Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Manuela Testi
- Laboratory of Immunogenetics and Transplant Biology, IME Foundation-Mediterranean Institute of Hematology, Roma, Italy
| | - Jean-Marie Tiercy
- National Reference Laboratory for Histocompatibility, Transplantation Immunology Unit, Department of Genetics and Laboratory Medicine, University Hospital Geneva, Geneva, Switzerland
| | - Zoltán Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland ; Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland ; Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Poryazova R, Mensen A, Bislimi F, Huegli G, Baumann CR, Khatami R. Time perception in narcolepsy in comparison to patients with Parkinson's disease and healthy controls - an exploratory study. J Sleep Res 2013; 22:625-33. [PMID: 23879404 DOI: 10.1111/jsr.12069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/08/2013] [Indexed: 11/26/2022]
Abstract
The striatum and the prefrontal cortex play an important role in cognitive time processing, and time perception depends on sustained attention. Narcolepsy patients are unable to maintain sustained attention, due probably to deficient hypocretin signalling. Impaired time perception has been found in Parkinson's disease (PD) and attributed to a dysfunctional dopaminergic striatal pacemaker. We aimed to assess time perception in patients with narcolepsy and PD and to compare the outcome to healthy control participants. Seventeen narcolepsy patients, 12 PD patients and 15 healthy controls performed a short time production task, where they had to produce an interval of 1, 2 or 5 s. The accuracy of time production differed significantly according to task target duration, and there was a trend towards a group difference with narcolepsy patients tending to overproduce all target durations. Absolute variability was significantly different between groups, with narcolepsy patients showing higher absolute variability in comparison to controls and PD patients. The analysis of the temporal course of time estimation showed more pronounced overproduction of each target duration at the end of each trial in narcolepsy patients, whereas performance was more or less stable in controls and PD patients. Overproduction and higher variability of all time durations in narcolepsy indicate impaired short interval timing in the seconds range, while the scalar property of timing was preserved. The time-course of accuracy and variability of time production within sessions indicate an attention-related mechanism of impaired interval timing.
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50
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Luca G, Haba-Rubio J, Dauvilliers Y, Lammers GJ, Overeem S, Donjacour CE, Mayer G, Javidi S, Iranzo A, Santamaria J, Peraita-Adrados R, Hor H, Kutalik Z, Plazzi G, Poli F, Pizza F, Arnulf I, Lecendreux M, Bassetti C, Mathis J, Heinzer R, Jennum P, Knudsen S, Geisler P, Wierzbicka A, Feketeova E, Pfister C, Khatami R, Baumann C, Tafti M. Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study. J Sleep Res 2013; 22:482-95. [PMID: 23496005 DOI: 10.1111/jsr.12044] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Gianina Luca
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Yves Dauvilliers
- INSERM-1061; Montpellier France
- Department of Neurology; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Gui-de-Chauliac Hospital; Montpellier France
| | - Gert-Jan Lammers
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden the Netherlands
| | | | - Claire E. Donjacour
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Geert Mayer
- Hephata-Clinic for Neurology; Schwalmstadt-Treysa Germany
| | - Sirous Javidi
- Hephata-Clinic for Neurology; Schwalmstadt-Treysa Germany
| | - Alex Iranzo
- Neurology Service; Hospital Clinic; Barcelona Spain
| | | | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit - Clinical Neurophysiology Department; Gregorio Marañón University Hospital; Madrid Spain
| | - Hyun Hor
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - Zoltan Kutalik
- Department of Medical Genetics; University of Lausanne; Lausanne Switzerland
- Swiss Institute of Bioinformatics; Lausanne Switzerland
| | - Giuseppe Plazzi
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Francesca Poli
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Fabio Pizza
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Isabelle Arnulf
- National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Sleep Disorders Unit; Pitié-Salpêtrière Hospital; Paris France
| | - Michel Lecendreux
- Pediatric Sleep Center; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Robert-Debré Hospital; Paris France
| | - Claudio Bassetti
- Department of Neurology; Inselspital, Bern University Hospital and University of Bern; Bern Switzerland
| | - Johannes Mathis
- Department of Neurology; Inselspital, Bern University Hospital and University of Bern; Bern Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Poul Jennum
- Department of Clinical Neurophysiology; University of Copenhagen; Glostrup Denmark
| | - Stine Knudsen
- Department of Clinical Neurophysiology; University of Copenhagen; Glostrup Denmark
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy; Sleep Disorders and Research Center; University Hospital Regensburg; Regensburg Germany
| | - Aleksandra Wierzbicka
- Third Department of Psychiatry; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Eva Feketeova
- Department of Neurology; Faculty of Medicine; Safarikiensis University and Louis Pasteur Faculty Hospital Kosice; Kosice Slovakia
| | - Corinne Pfister
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - Ramin Khatami
- Sleep Medicine; Barmelweid Clinic; Barmelweid Switzerland
| | - Christian Baumann
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | - Mehdi Tafti
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
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