{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:19:47Z","timestamp":1790806787299,"version":"4.1.0"},"reference-count":84,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>Narcolepsy type 1 (NT1) is characterized by fragmented sleep, yet brief transitions may be concealed in traditional 30-s epochs. We therefore aimed to assess sleep fragmentation in NT1 patients and their non-narcoleptic siblings using 5-s mini-epochs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed sleep stages from human-scored 30-s epochs and automatically (U-Sleep) scored 5-s mini-epochs in polysomnographies from 125 NT1 patients and their 100 non-narcoleptic siblings. Sleep fragmentation was quantified using transition indices and probabilities in epochs and mini-epochs, furthermore, stratified by 1st and 2nd night-half. Predictors (H1N1-vaccination, CSF hypocretin-1 deficiency severity (low [40\u2013150\u00a0pg\/mL]; undetectable [&amp;lt;40\u00a0pg\/mL]), HLA-DQB1*06:02-positivity, narcolepsy core symptom severity) for sleep transitions were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>NT1 patients had significantly higher all-stages and sleep\u2013wake transition indices compared to siblings in epochs and mini-epochs. Both epoch and mini-epoch transition indices varied significantly from 1st to 2nd night-half. Only in mini-epochs, sleep\u2013wake fragmentation was (a) higher in patients with severe core symptoms, and (b) increased in the 2nd night-half in NT1 patients with severe hypocretin-1 deficiency (&amp;lt;40\u00a0pg\/mL) and\/or severe core symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that sleep fragmentation, a core feature of NT1, is associated with disease severity and hypocretin deficiency severity when high-resolution sleep stages are analyzed. Five-second sleep staging and split-night analyses enhance detection of sleep instability and reveal new specific patterns and clinical associations. Automated mini-epoch analyses may improve future NT1 phenotyping and possibly its borderland by supplementing with clinically relevant high-resolution features otherwise hidden in traditional full-night 30-s epoch analyses.<\/jats:p>\n                    <jats:p>Statement of Significance This study demonstrates that high-resolution 5-s sleep staging provides more detailed sleep characterization than epochs and additionally uncovers clinically relevant sleep fragmentation patterns in narcolepsy type 1 which remain hidden in traditional 30-s analyses. By combining 5-s mini-epoch scoring with split-night analyses, we identified specific associations between disease severity and increased sleep\u2013wake fragmentation. In mini-epochs, but not in epochs, sleep\u2013wake fragmentation was significantly higher in patients with all core narcolepsy symptoms and increased significantly from the 1st to the 2nd night-half in patients with undetectable hypocretin-1 levels (&amp;lt;40\u00a0pg\/mL) and\/or all core narcolepsy symptoms. These findings highlight the clinical value of high-resolution, temporally sensitive sleep stage analyses for detailed phenotyping and detection of future disease biomarkers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag015","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:39:19Z","timestamp":1769171959000},"source":"Crossref","is-referenced-by-count":1,"title":["High-resolution sleep fragmentation assessment in narcolepsy type 1 and their non-narcoleptic siblings: a 5-s mini-epoch study"],"prefix":"10.1093","volume":"49","author":[{"given":"Louise Fr\u00f8strup","family":"Follin","sequence":"first","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rannveig","family":"Viste","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janita","family":"Vevelstad","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Langdalen","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berit Hjelde","family":"Hansen","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragnhild Kristine Berling","family":"Grande","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Centre for Precision Psychiatry, Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]},{"name":"Department of Psychiatry and Psychotherapy, University of T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]},{"name":"German Center for Mental Health (DZPG), Partner site T\u00fcbingen , T\u00fcbingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4225-3359","authenticated-orcid":false,"given":"Julie Anja Engelhard","family":"Christensen","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Primary Packaging Development, Novo Nordisk , Hiller\u00f8d ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6881-9766","authenticated-orcid":false,"given":"Alexander Neergaard","family":"Zahid","sequence":"additional","affiliation":[{"name":"AI Center of Excellence, WS Audiology , Lynge ,","place":["Denmark"]},{"name":"Department of Applied Mathematics and Computer Science, Technical University of Denmark , Kgs. Lyngby ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3917-9269","authenticated-orcid":false,"given":"Marte Kathrine","family":"Viken","sequence":"additional","affiliation":[{"name":"Department of Immunology, University of Oslo and Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Department of Medical Genetics, University of Oslo and Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6796-7177","authenticated-orcid":false,"given":"Hilde T","family":"Juvodden","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1946-1125","authenticated-orcid":false,"given":"Stine","family":"Knudsen-Heier","sequence":"additional","affiliation":[{"name":"Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"2026051210221144200_ref1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.100","article-title":"Narcolepsy","volume":"3","author":"Kornum","year":"2017","journal-title":"Nat Rev Dis Primer"},{"key":"2026051210221144200_ref2","volume-title":"International Classification of Sleep Disorders (ICSD)","author":"American Academy of Sleep Medicine","year":"2014","edition":"3rd"},{"issue":"9","key":"2026051210221144200_ref3","doi-asserted-by":"publisher","first-page":"955","DOI":"10.5664\/jcsm.3004","article-title":"Disrupted nighttime sleep in narcolepsy","volume":"9","author":"Roth","year":"2013","journal-title":"J Clin Sleep Med"},{"issue":"1","key":"2026051210221144200_ref4","doi-asserted-by":"publisher","first-page":"289","DOI":"10.5664\/jcsm.9638","article-title":"Disrupted nighttime sleep and sleep instability in narcolepsy","volume":"18","author":"Maski","year":"2022","journal-title":"J Clin Sleep Med"},{"issue":"4","key":"2026051210221144200_ref5","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/s0092-8674(00)81973-x","article-title":"Narcolepsy in orexin knockout mice: molecular genetics of sleep regulation","volume":"98","author":"Chemelli","year":"1999","journal-title":"Cell."},{"issue":"3","key":"2026051210221144200_ref6","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1016\/S0896-6273(00)00058-1","article-title":"Reduced number of hypocretin neurons in human narcolepsy","volume":"27","author":"Thannickal","year":"2000","journal-title":"Neuron."},{"issue":"9197","key":"2026051210221144200_ref7","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/S0140-6736(99)05582-8","article-title":"Hypocretin (orexin) deficiency in human narcolepsy","volume":"355","author":"Nishino","year":"2000","journal-title":"Lancet."},{"issue":"1","key":"2026051210221144200_ref8","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1146\/annurev.neuro.24.1.429","article-title":"To eat or to sleep? 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