Rapid eye movement sleep muscle activity in routine polysomnography as a marker for narcolepsy

Abstract

Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and associated symptoms, including cataplexy, sleep paralysis, hypnagogic/hypnopompic hallucinations, and disrupted nocturnal sleep. It is classified into two subtypes: narcolepsy type 1 (NT1), which involves cataplexy and/or low cerebrospinal fluid (CSF) hypocretin-1 levels, and narcolepsy type 2 (NT2), which lacks cataplexy and has normal or intermediate CSF hypocretin-1 levels. Diagnosis is often delayed or missed due to symptom overlap with other sleep disorders, limited access to specialized testing, and low clinician awareness. Current diagnostic methods include the presence of cataplexy (specific to NT1), sleep-onset rapid eye movement periods (SOREMPs) detected through polysomnography (PSG) and multiple sleep latency tests, and low CSF hypocretin-1 levels (primarily for NT1). However, these methods have limitations, such as the invasiveness of CSF testing, variability in SOREMPs, and the absence of specific biomarkers for NT2. Emerging research suggests that electromyographic (EMG) activity during routine PSG, particularly elevated REM sleep without atonia, could serve as an alternative diagnostic marker for narcolepsy. This review explores the potential of EMG activity during REM sleep and the procedure of quantification in routine PSG, with the aim of improving early detection and reducing diagnostic delays in narcolepsy.

Keywords

electromyographic (EMG) activity / narcolepsy / REM sleep without atonia (RWA)

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