Plante David T
Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Sleep Med Rev. 2017 Feb;31:48-57. doi: 10.1016/j.smrv.2016.01.004. Epub 2016 Jan 14.
Hypersomnolence plays a sizeable role in the course and morbidity of psychiatric disorders. Current sleep medicine nosology is reliant on the multiple sleep latency test (MSLT) to segregate hypersomnolence associated with psychiatric disorders from other central nervous system causes. However, the evidence base regarding sleep propensity in psychiatric hypersomnolence as measured by the MSLT has not been systematically evaluated, which is vital to clarify the utility and validity of current nosological schema. In this review, the use of sleep propensity assessed by the MSLT in patients with psychiatric hypersomnolence is systematically evaluated, using both qualitative and quantitative assessment. Findings demonstrate high heterogeneity and potential for bias among studies, with a pooled estimate of sleep propensity among patients with psychiatric hypersomnolence similar to normative values. Additionally, approximately 25% of patients with psychiatric hypersomnolence demonstrate a mean sleep latency below 8 min, the current cutpoint to define pathologic sleepiness. These data underscore the limitations of the MSLT in segregating psychiatric hypersomnolence from other central nervous system hypersomnias. Further research is warranted to evaluate novel measures and biomarkers of excessive sleepiness to advance clinical practice, as well as dimensional approaches to classification of hypersomnolence disorders.
过度嗜睡在精神疾病的病程和发病中起着相当大的作用。当前的睡眠医学分类学依赖多次睡眠潜伏期试验（MSLT）来区分与精神疾病相关的过度嗜睡和其他中枢神经系统病因导致的过度嗜睡。然而，关于通过MSLT测量的精神性过度嗜睡中的睡眠倾向的证据基础尚未得到系统评估，而这对于阐明当前分类模式的效用和有效性至关重要。在本综述中，使用定性和定量评估方法，对MSLT评估的睡眠倾向在精神性过度嗜睡患者中的应用进行了系统评估。研究结果表明，各研究之间存在高度异质性和偏倚可能性，精神性过度嗜睡患者的睡眠倾向合并估计值与正常数值相似。此外，约25%的精神性过度嗜睡患者的平均睡眠潜伏期低于8分钟，这是目前定义病理性嗜睡的切点。这些数据突显了MSLT在区分精神性过度嗜睡与其他中枢神经系统性失眠症方面的局限性。有必要进行进一步研究，以评估过度嗜睡的新测量方法和生物标志物，从而推动临床实践，以及评估过度嗜睡障碍分类维度方法。
