258 Chapter 9 Figure 3. Current diagnoses and centers of inclusion. (A) Current diagnosis with physician’s diagnostic certainty, visualized as pie charts per cluster. Central number in the pie charts corresponds to cluster identification. Clusters 1 through 4 are dominated by narcolepsy type 1 (NT1), whereas narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) are more common in clusters 5 through 7. (B) To check whether center of inclusion (or country) could have introduced bias in the clustering, distribution of the centers of inclusion is visualized as pie charts per cluster. This shows that there is no clear dominance of single centers in individual clusters and that individuals from one center are spread over multiple clusters. Discussion This work presents the largest study to date on central hypersomnolence disorders that includes >1,000 adolescents and adults and the full scope of central hypersomnolence disorder characteristics. Our results provide important data-driven insights into new clinical biomarkers to improve future diagnostic criteria, especially for individuals without cataplexy. The clustering
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