Dietmann Anelia, Gallino Camilla, Wenz Elena, Mathis Johannes, Bassetti Claudio L A
Department of Neurology, Sleep-Wake-Epilepsy-Center, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Department of Neurology, Sleep-Wake-Epilepsy-Center, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Sleep Med. 2021 Mar;79:6-10. doi: 10.1016/j.sleep.2020.12.037. Epub 2021 Jan 2.
A multiple sleep latency test (MSLT) with occurrence of sleep onset REM periods (SOREMP) is considered one of the central diagnostic criteria for narcolepsy according to the International Classification of Sleep Disorders, but its sensitivity and specificity have been questioned. This study aims to describe MSLT and polysomnography (PSG) findings, including frequency and distribution of SOREMP during the day, in a large cohort of patients with central disorders of hypersomnolence (CDH). We retrospectively analyzed electrophysiological data from MSLT and PSG in 370 consecutive patients with narcolepsy type 1 (NT1, n = 97), type 2 (NT2, n = 31), idiopathic hypersomnia (IH, n = 48), nonorganic hypersomnia (NOH, n = 116) and insufficient sleep syndrome (ISS, n = 78). NT1 and NT2 patients had a significantly shorter mean Sleep Latency (mSL) and REM-Latency (REML) in MSLT and PSG. SOREMP occurred more frequently in narcoleptic vs. non-narcoleptic patients in MSLT and PSG. Occurrence of 3 or more SOREMP in MSLT and a SOREMP in PSG had a very high specificity and positive predictive value (98%/96% and 100% respectively), however relatively low sensitivity (65% and 45% respectively). NT1 more than NT2 patients have shorter mSL and more frequent SOREMP in MSLT and shorter SL as well as REML during nocturnal PSG. Increasing numbers of SOREMP in MSLT and especially SOREMP during PSG increase specificity on the expense of sensitivity in diagnosing narcolepsy. Therefore, frequency of SOREMP in MSLT naps and PSG can help to discriminate but not clearly separate narcoleptic from non-narcoleptic patients.
根据《国际睡眠障碍分类》，出现睡眠始发快速眼动期（SOREMP）的多次睡眠潜伏期试验（MSLT）被认为是发作性睡病的核心诊断标准之一，但其敏感性和特异性一直受到质疑。本研究旨在描述一大群中枢性过度嗜睡症（CDH）患者的MSLT和多导睡眠图（PSG）结果，包括白天SOREMP的频率和分布。我们回顾性分析了370例连续的1型发作性睡病（NT1，n = 97）、2型发作性睡病（NT2，n = 31）、特发性嗜睡症（IH，n = 48）、非器质性嗜睡症（NOH，n = 116）和睡眠不足综合征（ISS，n = 78）患者的MSLT和PSG电生理数据。NT1和NT2患者在MSLT和PSG中的平均睡眠潜伏期（mSL）和快速眼动潜伏期（REML）明显更短。在MSLT和PSG中，发作性睡病患者比非发作性睡病患者更频繁地出现SOREMP。MSLT中出现3次或更多次SOREMP以及PSG中出现一次SOREMP具有非常高的特异性和阳性预测值（分别为98%/96%和100%），然而敏感性相对较低（分别为65%和45%）。在MSLT中，NT1患者比NT2患者的mSL更短，SOREMP更频繁，夜间PSG期间的SL和REML也更短。MSLT中SOREMP数量的增加，尤其是PSG期间的SOREMP增加，以牺牲敏感性为代价提高了发作性睡病诊断的特异性。因此，MSLT小睡和PSG中SOREMP的频率有助于区分发作性睡病患者和非发作性睡病患者，但不能明确将两者区分开来。
