0654 PSG AND MSLT CHARACTERIZATION OF REM SLEEP WITHOUT ATONIA AND REM BEHAVIOR DISORDER AMONG PEDIATRIC PATIENTS WITH NARCOLEPSY
Bibliographic record
Abstract
In this study, we aim to determine the prevalence of nocturnal RWA and RBD in a drug-naïve pediatric narcolepsy population and compare findings to pediatric patients with other central nervous system hypersomnias and controls. We additionally aim to determine the prevalence of RWA and RBD during daytime REM bouts captured during MSLT testing. Given that RSWA, RBD and cataplexy are thought to underlie dysfunction within REM on/off neurons, we hypothesize that RSWA and RBD will be found only during the daytime and nighttime REM periods among patients with narcolepsy type 1. Based on sleep study results and clinical history, we grouped subjects as narcolepsy type 1 (N1, n=11), narcolepsy type 2 (N2, n=4), idiopathic hypersomnia (IH, n=5) and controls (C, n=11). Mean age of patients was 13 years and 49% were female. RSWA and RBD were scored based on American Academy of Sleep Medicine specifications. We calculated a RSWA index for each subject (number of REM epochs with RSWA/total REM epochs). On the PSG, we only detected RBD among N1 patients (2/11, 18%) but found no difference in the frequency of RSWA among groups (P=0.18). Notably, all N1 patients had RSWA and the RSWA index was 5.5x higher on their nocturnal PSGs compared to all other groups (P=0.002). On MSLT, 82% of N1 patients had RSWA and RSWA was not detected in any other groups. The two N1 patients with RBD during the PSG also had RBD on the MSLT. RSWA is uniquely detected among N1 patients on the MSLT but not the PSG. However, the frequency of nocturnal RSWA is markedly higher in N1 pediatric patients compared to other groups, findings consistent with adult narcolepsy data. Our findings have practical implications about scoring pediatric MSLTs as epochs of REM may lack the classic atonia in N1. Furthermore, the frequent presence of RSWA across day and night REM periods and higher mean RSWA index in the N1 group suggest that greater hypocretin loss results in phenotypic changes in REM sleep in addition to dysregulated REM sleep bouts. None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".