![]() The nocturnal PSG has been considered less helpful in diagnosing N+C, but recent research suggests that very early occur-rence of REM sleep may be diagnostically useful. Nevertheless, the MSLT is still considered the gold standard for confirming N+C in children in the International Classification of Sleep Disorders, 3 rd Edition (ICSD-3). 10 In children younger than 5 y, normative MSLT results have not been published, thus limiting the interpretation of the MSLT at younger ages. Up to 48% of adolescents can have at least one SOREMP, and 16% had two SOREMPS based on normative data. ![]() 7 Retrospective surveys have shown that these results from the MSLT are highly sensitive for detecting patients with confirmed N+C, 8, 9 but daytime SOREMPs are not necessarily specific for this diagnosis. On the MSLT, patients with narcolepsy usually have mean sleep latencies less than 5 min and multiple sleep onset rapid eye movement (REM) sleep periods (SOREMPs). Given the challenges and limitations of measuring cerebrospinal fluid hypocretin, the overnight polysomnography (PSG) and multiple sleep latency test (MSLT) remain the essential tests for diagnosing narcolepsy with and without cataplexy. Children may also have atypical presentations of cataplexy, with partial cataplexy, cataplectic facies, and unusual emotional precipitants 4 that may result in diagnostic uncertainty. Furthermore, children and adolescents may not report symptoms of hypnogogic/hypnopompic hallucinations, cataplexy, and/or sleep paralysis to their parents or guardians, and depending on their age, they may have difficulty understanding these symptoms when queried by a physician. Pediatric patients with narcolepsy commonly present with excessive daytime sleepiness (EDS), but EDS is reported in up to 15% of all school-aged children 3 and lacks diagnostic specificity. 2 This delay in diagnosis may be caused by difficulty recognizing core symptoms of N+C. ![]() Though most patients develop narcolepsy with cataplexy (N+C) in childhood or adolescence, 1 the diagnosis is frequently missed until adulthood.
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