ArticleSleep and biological rhythms2026
Clinical significance of nocturnal sleep onset REM periods in narcolepsy diagnosis and diagnostic stability.
Article in Sleep and biological rhythms, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Narcolepsy diagnosis relies on polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT), though concerns remain regarding their diagnostic accuracy and reliability. Nocturnal sleep-onset rapid eye movement periods (SOREMPs) are a known feature of narcolepsy. This study investigated the clinical significance of nocturnal SOREMP in narcolepsy diagnosis and its association with test-retest reliability. Methods: We retrospectively reviewed 109 patients who underwent at least two MSLTs. Patients were categorized into nocturnal SOREMP (n = 40) and non-nocturnal SOREMP (n = 69) groups based on PSG findings. Only MSLT-identified SOREMPs were used for diagnosis. Group comparisons and follow-up changes were analyzed using t-tests, chi-square tests, or Wilcoxon signed-rank tests. Results: The nocturnal SOREMP group had more SOREMPs (3.50 vs. 2.23), shorter mean sleep latency (1.99 vs. 4.77), and higher initial narcolepsy diagnosis rates (92.5% vs. 63.8%). Diagnostic stability was significantly higher in the nocturnal group (90.0% vs. 50.7%). Among narcolepsy type 2 (NT2) patients, those with nocturnal SOREMP showed complete diagnostic retention (100%), whereas only 27.3% of those without nocturnal SOREMP did. In a subgroup analysis, patients who had a nocturnal SOREMP on at least one of the two PSGs exhibited significantly higher diagnostic stability (93.9%) than those without nocturnal SOREMP on either test (50.0%). Similarly, NT2 retention was 100% in the former versus 16.7% in the latter. Conclusions: Nocturnal SOREMP may serve as a specific marker for narcolepsy, suggesting potential utility in supporting diagnostic consistency. Its presence appears to be associated with improved diagnostic reliability, particularly in NT2. Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-025-00598-5.
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