Plante David T, Cook Jesse D, Prairie Michael L
Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin.
Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin.
J Clin Sleep Med. 2020 Aug 15;16(8):1241-1248. doi: 10.5664/jcsm.8470.
The multiple sleep latency test (MSLT) has limitations when evaluating disorders of hypersomnolence with unknown etiology. Alternative measures of hypersomnolence may objectively identify pathology in patients with complaints of daytime sleepiness that may not be captured by the MSLT alone. This study evaluated the impact of a multimodal hypersomnolence assessment relative to MSLT in patients with unexplained hypersomnolence.
Seventy-five patients with unexplained hypersomnolence were included in the analyzed sample. Polysomnography was performed without prescribed wake time, and the psychomotor vigilance task and pupillographic sleepiness test were completed between MSLT nap opportunities. Presence or absence of hypersomnolence for each assessment was defined using a priori cutpoints. Proportions of patients identified as hypersomnolent using the multimodal assessment relative to MSLT alone were evaluated, as well as the sensitivity and specificity of ancillary hypersomnolence measures relative to MSLT as a gold standard.
The multimodal assessment more than doubled the proportion of patients identified as having objective deficits relative to MSLT ≤ 8 minutes alone. The combination of excessive sleep duration, lapses on the psychomotor vigilance task, and impairments on the pupillographic sleepiness test also had perfect sensitivity in identifying all patients identified as sleepy by the MSLT across 3 different MSLT cutpoints (5, 8, and 10 minutes).
These data demonstrate the insufficiency of the MSLT as a singular tool to identify objective pathology in persons with unexplained hypersomnolence. Further efforts to refine and standardize multimodal assessments will likely improve diagnostic acumen and research into the causes of these disorders.
在评估病因不明的发作性睡病时，多次睡眠潜伏期试验（MSLT）存在局限性。对于主诉日间嗜睡但仅通过MSLT可能无法发现病变的患者，发作性睡病的其他评估方法可能有助于客观地识别病变。本研究评估了多模式发作性睡病评估相对于MSLT在不明原因发作性睡病患者中的影响。
75例不明原因发作性睡病患者纳入分析样本。在无规定起床时间的情况下进行多导睡眠监测，并在MSLT小睡机会之间完成精神运动警觉任务和瞳孔嗜睡试验。每次评估时发作性睡病的有无通过预先设定的切点来定义。评估了相对于单独使用MSLT，通过多模式评估确定为发作性睡病的患者比例，以及相对于作为金标准的MSLT，辅助发作性睡病测量方法的敏感性和特异性。
相对于单独MSLT≤8分钟，多模式评估使确定存在客观缺陷的患者比例增加了一倍多。睡眠时间过长、精神运动警觉任务失误以及瞳孔嗜睡试验受损的综合情况，在通过3个不同的MSLT切点（5、8和10分钟）确定为嗜睡的所有患者中，也具有完美的敏感性。
这些数据表明，MSLT作为一种单一工具，不足以识别不明原因发作性睡病患者的客观病变。进一步完善和规范多模式评估的努力可能会提高诊断敏锐性，并有助于对这些疾病病因的研究。
