Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, California.
IRCCS Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy.
J Clin Sleep Med. 2018 Jan 15;14(1):65-74. doi: 10.5664/jcsm.6882.
To examine repeatability of Multiple Sleep Latency Test (MSLT) results in narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2) according to the criteria of the International Classification of Sleep Disorders, Third Edition (ICSD-3).
Repeatability of the MSLT was retrospectively evaluated in NT1 (n = 60) and NT2 (n = 54) cases, and controls (n = 15). All subjects had documented HLA-DQB1*06:02 status and/or hypocretin-1 levels from cerebrospinal fluid. All subjects had undergone 2 MSLTs (≥ 1 meeting ICSD-3 criteria for narcolepsy). Repeatability was explored in children versus adults and in those on versus not on medication(s). Subsample and multivariate analysis were performed.
Both MSLTs in unmedicated patients were positive for narcolepsy in 78%, 18%, and 7% of NT1, NT2, and controls, respectively. NT2 cases changed to idiopathic hypersomnia or to a negative MSLT 26% and 57% of the time, respectively. Although NT1 cases were 10 to 14 times more likely to demonstrate a second positive MSLT compared to NT2 cases ( < 10) and controls ( < 10), respectively, NT2 cases were not significantly different from controls ( = .64). Medication use ( = .009) but not adult versus children status ( = .85) significantly decreased the likelihood of a repeat positive MSLT.
In a clinical setting, a positive MSLT for narcolepsy is a more reproducible and stable feature in NT1 than NT2. The retrospective design of this study hinders interpretation of these data, as there are many different, and possibly opposing, reasons to repeat a MSLT in NT1 versus NT2 (ie, ascertainment bias). Additional systematic MSLT repeatability studies independent of confounds are ideally needed to confirm these findings.
根据《国际睡眠障碍分类，第三版》（ICSD-3）标准，检查 1 型发作性睡病（NT1）和 2 型发作性睡病（NT2）的多次睡眠潜伏期试验（MSLT）结果的可重复性。
回顾性评估 NT1（n=60）和 NT2（n=54）病例以及对照组（n=15）的 MSLT 可重复性。所有患者均有记录的 HLA-DQB1*06:02 状态和/或脑脊液中食欲素-1 水平。所有患者均接受了 2 次 MSLT（≥1 次符合 ICSD-3 发作性睡病标准）。研究人员在儿童与成人、用药与未用药患者之间探索了可重复性，并进行了亚组和多变量分析。
未用药患者的 2 次 MSLT 在 78%、18%和 7%的 NT1、NT2 和对照组中分别对发作性睡病呈阳性。NT2 病例分别有 26%和 57%的时间转为特发性嗜睡症或 2 次 MSLT 阴性。尽管 NT1 病例再次出现阳性 MSLT 的可能性是 NT2 病例（<10）和对照组（<10）的 10 至 14 倍，但 NT2 病例与对照组之间无显著差异（=0.64）。用药（=0.009）而非成人与儿童状态（=0.85）显著降低了重复出现阳性 MSLT 的可能性。
在临床环境中，与 NT2 相比，NT1 的 MSLT 阳性更具可重复性和稳定性。由于存在许多不同的、可能相反的原因会导致 NT1 与 NT2 重复进行 MSLT（即确认偏倚），因此本研究的回顾性设计限制了对这些数据的解释。需要进行额外的、不受混杂因素影响的 MSLT 重复性系统研究，以证实这些发现。
