Table 1.
| ICSD-3 [47] | DSM-5 [12] |
|---|---|
| NT1: both criteria A and B must be met | A. Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months |
| A. The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months | B. The presence of at least one of the following: |
|
B. The presence of one (or both) of the following: 1. Cataplexy and a mean sleep latency of ≤ 8 min and ≥ 2 SOREMPs on an MSLT performed according to standard techniques. A SOREMP (within 15 min of sleep onset) on the preceding nocturnal PSG may replace one of the SOREMPs on the MSLT 2. CSF hypocretin-1 concentration, measured by immunoreactivity, is either less than or equal to 110 pg/mL or less than one-third of mean values obtained in normal subjects with the same standardized assay |
1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month: (a) In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking (b) In children or individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers |
| NT2: criteria A–E must be met | 2. Hypocretin deficiency, as measured using CSF hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection |
| A. The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months | 3. Nocturnal sleep PSG showing REM sleep latency ≤ 15 min, or an MSLT showing a mean sleep latency ≤ 8 min and ≥ 2 SOREMPs |
| B. A mean sleep latency of ≤ 8 min and ≥ 2 SOREMPs are found on an MSLT performed according to standard techniques. A SOREMP (within 15 min of sleep onset) on the preceding nocturnal PSG may replace one of the SOREMPs on the MSLT | |
| C. Cataplexy is absent | |
| D. Either CSF hypocretin-1 concentration has not been measured or CSF hypocretin-1 concentration measured by immunoreactivity is either greater than 110 pg/mL or greater than one-third of mean values obtained in normal subjects with the same standardized assay | |
| E. The hypersomnolence and/or MSLT findings are not better explained by other causes, such as insufficient sleep, obstructive sleep apnea, delayed sleep phase disorder, or the effect of medication or substances or their withdrawal |
CSF cerebrospinal fluid, DSM-5 Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, ICSD-3 International Classification of Sleep Disorders Third Edition, MSLT multiple sleep latency test, NT1 narcolepsy type 1, NT2 narcolepsy type 2, PSG polysomnography, REM rapid eye movement, SOREMP sleep-onset rapid eye movement period