ArticleSleep2009
Elevated anti-streptococcal antibodies in patients with recent narcolepsy onset.
Article in Sleep, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 127 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
127 citing papers in PubMed, 3 syntheses or guidelines pooled it, 350 citations in OpenAlex.
- Month of birth and the risk of narcolepsy: a systematic review and meta-analysis.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2022Pooled it
- Narcolepsy and psychosis: A systematic review.Acta psychiatrica Scandinavica · 2021Pooled it
- On the connection between autoimmunity, tic disorders and obsessive-compulsive disorders: a meta-analysis on anti-streptolysin O titres.Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology · 2014Pooled it
- Safety and persistence of the humoral and cellular immune responses induced by 2 doses of an AS03-adjuvanted A(H1N1)pdm09 pandemic influenza vaccine administered to infants, children and adolescents: Two open, uncontrolled studies.Human vaccines & immunotherapeutics · 2015Trial
- Narcolepsy is (not) an autoimmune disease.Nature reviews. Neurology · 2026Review
- Immunocyte phenotypes underlying the causal autoimmune features in narcolepsy type 1.Journal of thoracic disease · 2026Article
- Therapeutic potential of targeting the orexin (hypocretin) system in sleep disorders.Nature reviews. Endocrinology · 2026Review
- HLA-DQB1*03:01 strongly affects age of onset of type 1 narcolepsy independently of DQA1 and ethnicity.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- A Comprehensive Review of Current and Emerging Treatments for Narcolepsy Type 1.Journal of clinical medicine · 2025Review
- Comorbidity of obstructive sleep apnea and narcolepsy: A challenging diagnosis and complex management.Sleep medicine: X · 2024Review
- The Role of T Cells in the Pathogenesis of Narcolepsy Type 1: A Narrative Review.International journal of molecular sciences · 2024Review
- Cell-based vs enzyme-linked immunosorbent assay for detection of anti-Tribbles homolog 2 autoantibodies in Chinese patients with narcolepsy.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2024Article
- Characterization of the Increase in Narcolepsy following the 2009 H1N1 Pandemic in Sweden.Journal of clinical medicine · 2024Article
- Streptococcal infection and autoimmune diseases.Frontiers in immunology · 2024Review
- The immunopathogenesis of narcolepsy type 1.Nature reviews. Immunology · 2024Review
- Narcolepsy type I-associated DNA methylation and gene expression changes in the human leukocyte antigen region.Scientific reports · 2023Article
- Narcolepsy following COVID-19: A case report and review of potential mechanisms.Clinical case reports · 2023Article
- Article
- Narcolepsy risk loci outline role of T cell autoimmunity and infectious triggers in narcolepsy.Nature communications · 2023Article
- What triggered narcolepsy: H1N1 vaccination, virus, or both? Important lessons learned from China.Sleep · 2023Article
67 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 4 countries.
Funding
Abstract
STUDY
objectivesNarcolepsy-cataplexy has long been thought to have an autoimmune origin. Although susceptibility to narcolepsy, like many autoimmune conditions, is largely genetically determined, environmental factors are involved based on the high discordance rate (approximately 75%) of monozygotic twins. This study evaluated whether Streptococcus pyogenes and Helicobacter pylori infections are triggers for narcolepsy.
designRetrospective, case-control.
settingSleep centers of general hospitals.
participants200 patients with narcolepsy/hypocretin deficiency, with a primary focus on recent onset cases and 200 age-matched healthy controls. All patients were DQB1*0602 positive with low CSF hypocretin-1 or had clear-cut cataplexy. MEASUREMENTS AND
resultsParticipants were tested for markers of immune response to beta hemolytic streptococcus (anti-streptolysin O [ASO]; anti DNAse B [ADB]) and Helicobacter pylori [Anti Hp IgG], two bacterial infections known to trigger autoimmunity. A general inflammatory marker, C-reactive protein (CRP), was also studied. When compared to controls, ASO and ADB titers were highest close to narcolepsy onset, and decreased with disease duration. For example, ASO > or = 200 IU (ADB > or = 480 IU) were found in 51% (45%) of 67 patients within 3 years of onset, compared to 19% (17%) of 67 age matched controls (OR = 4.3 [OR = 4.1], P < 0.0005) or 20% (15%) of 69 patients with long-standing disease (OR = 4.0 [OR = 4.8], P < 0.0005]. CRP (mean values) and Anti Hp IgG (% positive) did not differ from controls.
conclusionsStreptococcal infections are probably a significant environmental trigger for narcolepsy.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.