119 Potential Immunological Triggers for Central Disorders of Hypersomnolence infections were reported most (7/28, 25.0% of total sample), followed by EBV (6/28, 21.4%), other non-respiratory infections (3/28, 10.7%) and flu (1/28, 3.6%). Reported other respiratory infections included pharyngitis (N = 2), allergic bronchitis (N = 1), pneumonia (N = 1), cmv (N = 1), scarlet fever with secondary pyelonephritis (N = 1) and (unspecified) pulmonary infection (N = 1). Nonrespiratory infections included appendicitis (N = 2) and otitis (N = 1). Rapid onset of narcolepsy type 2 or idiopathic hypersomnia within one year of the infection was seen in 8/17 (47.1%) of all people who had reported an infection and was most common for EBV (4/6, 66.7%), followed by other respiratory infections (4/7, 57.1%). Influenza vaccination history Influenza vaccination was reported in 3/34 (8.8%) people with narcolepsy type 2 or idiopathic hypersomnia with a known influenza vaccination history, of whom all were vaccinated in other years (not 2009-2010) or yearly without specification of the exact years (100.0%). Onset of narcolepsy type 2 or idiopathic hypersomnia within one month after an immunological event The monthly timing of the immunological event and onset of narcolepsy type 2 or idiopathic hypersomnia were not known in all individuals. Still, the latency between the immunological event and narcolepsy type 2 or idiopathic hypersomnia onset was regularly shorter than one year. There were four individuals with narcolepsy type 2 or idiopathic hypersomnia who developed EDS symptoms within one month of the infection. These infections included EBV (N = 2), pharyngitis (N = 1), and scarlet fever with secondary pyelonephritis (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 around symptom onset of narcolepsy type 2 or idiopathic hypersomnia that were not part of the semi-structured clinical interview and therefore sporadically reported in the medical records were brain trauma (N = 1), sarcoidosis (1), morbus Scheuermann with chronic pain (1) and childbirth (1). 4
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