250 Chapter 9 and there was one smaller cluster (7) mixing 43 people with and without cataplexy. The variable categories night-time sleep, difficulties in waking up, cataplexy, hypnagogic hallucinations, sleep paralysis, sleepiness, and biomarkers were most often different between clusters. Appendix F gives a full overview of raw variable values per cluster. Differentiating variables From the significances barcodes (Figure 2), it is noticeable that the first four clusters were different mainly in noncataplectic symptoms and represented different narcolepsy with cataplexy subtypes. Cluster 1 included the most severe phenotype with frequent presence of disturbed nocturnal sleep (72%), sleep attacks (94%), cataplexy attacks (97%) that were most often complete with many potential triggers, hypnagogic hallucinations (90%), and sleep paralysis (82%). Cluster 2 was the largest but least affected cluster in which hypnagogic hallucinations (22%) and sleep paralysis (5%) were notably absent. In contrast to the other clusters of people with cataplexy, those in cluster 3 reported more difficulty in waking up (77%) with frequent presence of sleep drunkenness (83%), fatigue complaints (88%), and not feeling refreshed after sleep (36% not refreshed, 36% not always refreshed). This cluster was composed predominantly of male participants (74%). Cluster 4 mainly consisted of female participants (99%) with present (but infrequent) hypnagogic hallucinations (61%) and sleep paralysis (73%). Clusters 1 through 4 all had frequent MSLT sleeponset REM periods (SOREMPs), HLA-DQB1*0602 positivity, and low mean hypocretin-1 levels.
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