It is hypothesized that narcolepsy type 1 (NT1) develops in genetically susceptible people who encounter environmental triggers leading to immune-mediated hypocretin-1 deficiency. The pathophysiologies of narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) remain unknown. The main aim of this study was to collect all reported immunological events before onset of a central disorder of hypersomnolence. Medical records of 290 people with NT1, and 115 with NT2 or IH were retrospectively reviewed to extract infection and influenza vaccination history. Prevalence, distribution of immunological events, and time until hypersomnolence onset were compared between NT1 and the combined group of NT2 and IH. Immunological events were frequently reported before hypersomnolence disorder onset across groups. Flu and H1N1 influenza vaccination were more common in NT1, and Epstein–Barr virus and other respiratory and non-respiratory infections in NT2 and IH. Distributions of events were comparable between NT2 and IH. Rapid symptom onset within one month of infection was frequent across groups, especially after flu infection in NT1. Hypersomnolence disorder progression after an immunological event was reported in ten individuals. Our findings suggest a variety of immunological triggers potentially related to NT1, including H1N1 influenza infection or vaccination, infection with other flu types, and other respiratory and non-respiratory infections. Frequent reports of immunological events (other than those reported in NT1) immediately prior to the development of NT2 and IH support the specificity of triggers for NT1, and open important new research avenues into possible underlying immunological mechanisms in NT2 and IH.

中文翻译：

---

发作性睡病和特发性嗜睡症的潜在免疫触发因素：关于感染和流感疫苗接种的真实见解

据推测，1 型发作性睡病 (NT1) 发生在遗传易感人群中，这些人群遇到环境诱因，导致免疫介导的下丘脑分泌素-1 缺乏症。 2 型发作性睡病 (NT2) 和特发性嗜睡症 (IH) 的病理生理学仍然未知。本研究的主要目的是收集中枢性嗜睡症发作前报告的所有免疫学事件。回顾性审查了 290 名 NT1 患者和 115 名 NT2 或 IH 患者的医疗记录，以提取感染和流感疫苗接种史。比较 NT1 与 NT2 和 IH 联合组之间的患病率、免疫学事件的分布以及嗜睡发作的时间。在各组过度嗜睡症发作之前，经常报道免疫学事件。流感和 H1N1 流感疫苗接种在 NT1 中更为常见，而 Epstein-Barr 病毒和其他呼吸道和非呼吸道感染在 NT2 和 IH 中更为常见。 NT2 和 IH 之间的事件分布相当。感染后一个月内迅速出现症状的情况在各组中都很常见，尤其是 NT1 感染流感后。据报道，有 10 个人在免疫事件后出现嗜睡症进展。我们的研究结果表明多种免疫触发因素可能与 NT1 相关，包括 H1N1 流感感染或疫苗接种、其他流感类型感染以及其他呼吸道和非呼吸道感染。在 NT2 和 IH 发生之前频繁报道的免疫事件（NT1 中报道的事件除外）支持 NT1 触发因素的特异性，并为 NT2 和 IH 中可能的潜在免疫机制开辟了重要的新研究途径。