97 Potential Immunological Triggers for Central Disorders of Hypersomnolence of influenza vaccination. The third branch separated based on the latency between the reported event and the onset of the hypersomnolence disorder (third leaf). This was grouped into hypersomnolence disorder start within or over one year after the reported immunological event, with occurrences within one year regarded as rapid onset. The precise timing of the immunological event and onset of the hypersomnolence disorder were not known in all individuals. If known, the latency between the event and hypersomnolence disorder onset was often much shorter than one year. We therefore separately also reported prevalences of latencies within one month for each immunological event type. For people with narcolepsy type 1, we additionally described whether the progression between the onset of the EDS and cataplexy was within or over one year, with further subdivision per immunological event type. Statistical analyses were performed on demographics and diagnostic criteria comparing narcolepsy type 1, narcolepsy type 2 and idiopathic hypersomnia. Shapiro–Wilk normality tests were first used to test the distributions of the numerical variables in each subgroup, and one-way ANOVA or Kruskal-Wallis tests were used to compare the variables among the three subgroups depending on whether the data were normally distributed. The distribution of different immunological event types, prevalence of reported infections and influenza vaccinations were compared between people with narcolepsy type 1 and the non-hypocretin-1 diagnoses combined using ChiSquare tests, with subsequent analyses on the individual event types. Fisher’s exact tests were used for group comparisons with fewer than five observations per outcome option. We estimated odds ratios and effect sizes. P-values were reported after multiple comparisons correction using the Benjamini–Hochberg procedure to decrease the false discovery rate to 0.05. Results We included 194 out of 290 people with narcolepsy type 1, 18 out of 28 people with narcolepsy type 2 and 54 out of 87 people with idiopathic hypersomnia based on the availability of onset of hypersomnolence complaints and data on infections and/or influenza vaccination. Clinical characteristics of the populations with known infection and/or influenza vaccination history are presented in Table 1. Typical clinical profiles for narcolepsy type 1, narcolepsy type 2 and idiopathic hypersomnia were seen. 4
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