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Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.In comparison 4, an REML of 8 minutes or less (specificity, 87.3% sensitivity, 44.1% ) was the best cutoff for the diagnosis of narcolepsy with low CSF hypocretin-1 levels vs narcolepsy with normal CSF hypocretin-1 levels (AUC, 0.628 ). In comparison 3, an REML of 17 minutes or less (specificity, 95.5% sensitivity, 58.2% ) was the best cutoff for the diagnosis of narcolepsy with low CSF hypocretin-1 levels vs narcolepsy with normal hypocretin-1 levels, idiopathic hypersomnia, and Kleine-Levin syndrome (AUC, 0.765 ). In comparison 2, an REML of 16 minutes or less (specificity, 99.6% sensitivity, 42.9% ) was the best cutoff for the diagnosis of narcolepsy/hypocretin deficiency vs other sleep disorders (AUC, 0.704 ). B, Receiver operating characteristic curves in 14 patients with narcolepsy/hypocretin deficiency vs 735 patients with other sleep disorders (comparison 2), 122 patients with narcolepsy/hypocretin deficiency vs 132 patients with narcolepsy without hypocretin deficiency, idiopathic hypersomnia, and Kleine-Levin syndrome (high pretest probability sample, comparison 3), and 118 patients with narcolepsy with low CSF hypocretin-1 levels vs 118 patients with narcolepsy with normal CSF hypocretin-1 levels (comparison 4). An REML of 18 minutes or less (specificity, 99.2% sensitivity, 51.6% ) was the best cutoff for optimal specificity in comparison 1 (AUC, 0.799 ).

In patients with low CSF hypocretin-1 levels (comparison 1a), the optimal cutoff was a rapid eye movement sleep latency (REML) of 17 minutes or less (specificity, 97.8% sensitivity, 44.9% area under the curve, 0.704 ) in patients with cataplexy and HLA-DQB1*06:02 positivity (comparison 1b), the optimal cutoff was an REML of 21 minutes or less (specificity, 99.5% sensitivity, 53.9% AUC, 0.820 ). A, Receiver operating characteristic curves in 89 patients with narcolepsy with low cerebrospinal fluid (CSF) hypocretin-1 levels vs 89 controls (comparison 1a), 427 patients with narcolepsy with cataplexy and HLA-DQB1*06:02 positivity vs 427 controls (comparison 1b), and 516 patients with narcolepsy with either low CSF hypocretin-1 levels or cataplexy and HLA-DQB1*06:02 positivity vs 516 controls (comparison 1).