{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:18:23Z","timestamp":1790842703994,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T00:00:00Z","timestamp":1646611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Study Objectives<\/jats:title>\n                  <jats:p>The diagnosis of narcolepsy type 1 (NT1) is based upon the presence of cataplexy and\/or a cerebrospinal fluid (CSF) hypocretin-1\/orexin-A level\u2005\u2264\u2005110 pg\/mL. We determined the clinical and diagnostic characteristics of patients with intermediate hypocretin-1 levels (111\u2013200 pg\/mL) and the diagnostic value of cataplexy characteristics in individuals with central disorders of hypersomnolence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective cross-sectional study of 355 people with known CSF hypocretin-1 levels who visited specialized Sleep-Wake Centers in the Netherlands. For n\u2005=\u2005271, we had full data on cataplexy type (\u201ctypical\u201d or \u201catypical\u201d cataplexy).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared to those with normal hypocretin-1 levels (&amp;gt;200 pg\/mL), a higher percentage of individuals with intermediate hypocretin-1 levels had typical cataplexy (75% or 12\/16 vs 9% or 8\/88, p\u2005&amp;lt;\u2005.05), and\/or met the diagnostic polysomnographic (PSG) and Multiple Sleep Latency Test (MSLT) criteria for narcolepsy (50 vs 6%, p\u2005&amp;lt;\u2005.001). Of those with typical cataplexy, 88% had low, 7% intermediate, and 5% normal hypocretin-1 levels (p\u2005&amp;lt;\u2005.001). Atypical cataplexy was also associated with hypocretin deficiency but to a lesser extent. A hypocretin-1 cutoff of 150 pg\/mL best predicted the presence of typical cataplexy and\/or positive PSG and MSLT findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Individuals with intermediate hypocretin-1 levels or typical cataplexy more often have outcomes fitting the PSG and MSLT criteria for narcolepsy than those with normal levels or atypical cataplexy. In addition, typical cataplexy has a much stronger association with hypocretin-1 deficiency than atypical cataplexy. We suggest increasing the NT1 diagnostic hypocretin-1 cutoff and adding the presence of clearly defined typical cataplexy to the diagnostic criteria of NT1.<\/jats:p>\n                  <jats:p>Clinical trial information: This study is not registered in a clinical trial register, as it has a retrospective database design.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/sleep\/zsac052","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T17:37:11Z","timestamp":1646674631000},"source":"Crossref","is-referenced-by-count":37,"title":["Intermediate hypocretin-1 cerebrospinal fluid levels and typical cataplexy: their significance in the diagnosis of narcolepsy type 1"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3255-8506","authenticated-orcid":false,"given":"Adrienne Elisabeth","family":"van der Hoeven","sequence":"first","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands"},{"name":"Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1935-7603","authenticated-orcid":false,"given":"Rolf","family":"Fronczek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands"},{"name":"Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7901-0353","authenticated-orcid":false,"given":"Mink Sebastian","family":"Schinkelshoek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands"},{"name":"Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik Willem Cornelis","family":"Roelandse","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2918-7361","authenticated-orcid":false,"given":"Jaap Adriaan","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6445-9836","authenticated-orcid":false,"given":"Sebastiaan","family":"Overeem","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center, Kempenhaeghe, Heeze, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5169-9830","authenticated-orcid":false,"given":"Denise","family":"Bijlenga","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands"},{"name":"Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert Jan","family":"Lammers","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands"},{"name":"Sleep-Wake Center, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the 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