103 Potential Immunological Triggers for Central Disorders of Hypersomnolence of the immunological event was seen in 16/28 (57.1%) of all people who reported an infection and was most common for EBV (8/10, 80.0%), followed by other respiratory infections (4/8, 50.0%), flu (1/2, 50.0%) and other non-respiratory infections (3/8, 37.5%). Vaccination history Influenza vaccination was reported in 9/57 (15.8%) people with narcolepsy type 2 or idiopathic hypersomnia with a known influenza vaccination history. H1N1 influenza vaccination in 2009–2010 was reported in 2/57 (3.5%) of the total sample and 2/9 of all reported influenza vaccinations (22.2%). Seven people received influenza vaccination in other years or yearly without specification of which exact years (12.3% of the total sample and 77.8% of all influenza vaccinations). Onset of narcolepsy type 2 or idiopathic hypersomnia within one month after an immunological event Eight individuals with narcolepsy type 2 or idiopathic hypersomnia developed EDS symptoms within one month of the infection. These reported infections included flu (N = 1), EBV (N = 3), fever of unknown origin (N = 1), pharyngitis (N = 1), scarlet fever with secondary pyelonephritis (N = 1), cholecystitis (N = 1). The exact timings were not known in the influenza vaccination group. Disease progression Substantial worsening of EDS complaints was reported by one person with idiopathic hypersomnia (who already had EDS) after pharyngitis. Other life events Other life events that occurred before symptom onset of narcolepsy type 2 or idiopathic hypersomnia that were not part of the semi-structured clinical interview were brain trauma (N = 2), sarcoidosis (1), morbus Scheuermann with chronic pain (1), childbirth (1) and anorexia nervosa (1). Cross-disorder comparisons Rate differences were compared between groups with odds ratios in Table 2 and Figure 3. A full overview of all between-group comparisons is in Appendix C. In summary, people with narcolepsy type 1 and those with type 2 or idiopathic hypersomnia reported a similar overall prevalence of an immunological event before symptom onset (Figure 3A) (odds ratio [95% confidence interval]: 0.79 [0.46–1.36], corrected p-value = 0.5073). The distribution of immunological 4
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