79 Incidence Peaks and the Role of Influenza this study we were also unable to split NT2 and IH for the correlational analyses with preceding influenza season severity because of limited sample sizes. Given that both diagnoses contributed comparably to the observed 2010 and 2013 incidence peaks, this could suggest a similar contribution to the observed type A H1N1 and H3N2 influenza severity relationships. For individuals with NT2 and IH, it might have been more challenging to accurately identify the onset of EDS, which could have potentially influenced our findings. Our study unveils compelling new insights into the epidemiological dynamics of NT1, NT2, and IH across European countries, highlighting distinct incidence peaks in 2010 and 2013. Both hypersomnolence groups exhibited a significantly positive relationship with preceding type A H1N1 influenza season severity, with NT1 additionally associated with influenza type B Victoria. We propose influenza type B Victoria as a potential new candidate for triggering NT1, especially considering its frequent and relatively severe impact on children. Our results also provide clues that suggest an immune-related aetiology of NT2 and IH, and hereby offer highly anticipated insights for future investigations aiming to unravel the pathophysiologies of these enigmatic sleep disorders. Authorship contribution statement Conception and design of the study: ZZ, JKG, RF, RK, GJL. Acquisition of data: ZZ, JKG, RF, YD, CLAB, GM, GP, FP, JS, MP, SO, RPA, AMS, KS, RRV, RH, AW, PY, BH, MM, EF, JM, TP, FC, GJL. Analysis of data: ZZ, JKG, RF, GJL, RK. Interpretation of results: ZZ, JKG, RF, RK, GJL. Manuscript writing and revisions: ZZ, JKG, RF, YD, CLAB, GM, GP, FP, JS, MP, SO, RPA, AMS, KS, RRV, RH, AW, PY, BH, MM, EF, JM, TP, FC, ML, CRB, GJL. Disclosure statement Financial disclosure: nothing relevant to disclose. Non-financial disclosure: nothing relevant to disclose. Preprint repositories This study has been made available as preprint on MedRxiv: https://doi.org/10.1101/2024.04.19.24304365 3
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