Spectral and Microstate EEG Analysis in Narcolepsy Type 1 and Type 2 Across Sleep Stages

The primary distinction between narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2) is the presence or absence of cataplexy, which is commonly determined through clinical interviews, though it can be prone to error due to vague patients descriptions.

This study aimed to investigate EEG microstate differences between NT1 and NT2 and their correlation with clinical assessments.

Polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT) were performed on 14 NT1 and 13 NT2 patients from three hospitals, with data from the ISRUC-SLEEP dataset serving as the comparison group. After EEG preprocessing, we performed the spectral analysis in NT1 and NT2, followed by microstate analysis. Grand mean maps were used for backfitting to obtain microstate parameters. Then, Spearman correlation was performed between the microstate parameters and the ESS and MSLT parameters.

We found that the relative delta power in N2 was lower in the NT1 group compared to the NT2 group. Four microstates were clustered in all groups, and no statistical differences were observed in the microstate parameters between NT1 and NT2 groups. In the NT1 group, microstate D during wakefulness showed a positive correlation with ESS, while in the NT2 group, microstate D during wakefulness showed a negative correlation with ESS.

There are spectral differences between the NT1 and NT2 groups, and the opposite correlation between microstate D and ESS during wakefulness in NT1 and NT2 suggest that the underlying mechanisms leading to excessive daytime sleepiness in the two groups may be different.