Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
Department of General Pathology and Pathological Physiology, Institute of Experimental Medicine, St. Petersburg, Russia.
Sleep. 2017 Dec 1;40(12). doi: 10.1093/sleep/zsx173.
Multiple sleep onset rapid eye movement (R) periods (SOREMPs) and a mean sleep latency of ≤8 minutes on the multiple sleep latency test (MSLT) are diagnostic criteria of narcolepsy (NC), but also occur in other conditions with increased sleep pressure, including insufficient sleep syndrome (ISS), sleep-disordered breathing (SDB), or Parkinson's disease (PD). These false positives are common, may create diagnostic uncertainty, and highlight the need for complementary MSLT measures with high specificity for NC.
Detailed analysis of MSLT findings in 56 NC, 83 PD, 89 SDB, and 23 ISS patients, using receiver operating characteristic curves.
A positive MSLT (mean sleep latency ≤ 8.0 minutes and ≥2 SOREMPs) was found in 53 NC (95%), 1 PD (1%), 8 SDB (9%), and 12 ISS patients (52%). MSLT-based differentiation between NC and non-NC patients was best when applying a mean R latency of ≤5 minutes (sensitivity/specificity/positive predictive value [PPV]: 49%/95%/96%) or a mean percentage of sleep stage R ≥ 40% (sensitivity/specificity/PPV: 60%/100%/100%) as cutoffs. When analyzing all 252 naps with SOREMPs in isolation, the combination of both R latency of ≤5 minutes and R percentage of ≥50% yielded a sensitivity/specificity/PPV of 50%/99%/99%. In addition, a sleep stage sequence with R occurring prior to N2 was more common in NC than in non-NC (71% vs. 32%, p < .001), and in combination with R percentage of ≥50% yielded a sensitivity/specificity/PPV of 53%/96%/97%.
A better characterization of R sleep by latency, duration, and sleep stage sequence facilitates detection of false positives and, hence, contributes to a higher MSLT specificity in NC.
多次睡眠潜伏期试验（MSLT）中出现多个睡眠起始快速眼动（R）期（SOREMPs）和平均睡眠潜伏期≤8 分钟，是嗜睡症（NC）的诊断标准，但也出现在其他睡眠压力增加的情况下，包括睡眠不足综合征（ISS）、睡眠呼吸障碍（SDB）或帕金森病（PD）。这些假阳性很常见，可能会导致诊断不确定，并突出表明需要使用对 NC 具有高特异性的补充 MSLT 措施。
对 56 例 NC、83 例 PD、89 例 SDB 和 23 例 ISS 患者的 MSLT 结果进行详细分析，使用受试者工作特征曲线。
53 例 NC（95%）、1 例 PD（1%）、8 例 SDB（9%）和 12 例 ISS 患者（52%）出现阳性 MSLT（平均睡眠潜伏期≤8.0 分钟，≥2 个 SOREMPs）。当应用平均 R 潜伏期≤5 分钟（灵敏度/特异性/阳性预测值[PPV]：49%/95%/96%）或平均 R 期百分比≥40%（灵敏度/特异性/PPV：60%/100%/100%）作为截止值时，基于 MSLT 的 NC 和非 NC 患者之间的区分效果最佳。当单独分析所有 252 次有 SOREMPs 的小睡时，将 R 潜伏期≤5 分钟和 R 期百分比≥50%两者结合使用，其灵敏度/特异性/PPV 为 50%/99%/99%。此外，在 NC 中，R 期发生在 N2 之前的睡眠阶段序列比在非 NC 中更为常见（71%比 32%，p<.001），并且与 R 期百分比≥50%结合使用时，其灵敏度/特异性/PPV 为 53%/96%/97%。
通过潜伏期、持续时间和睡眠阶段序列更好地描述 R 睡眠，有助于发现假阳性，从而提高 NC 中 MSLT 的特异性。
