Des Champs de Boishebert Ludivine, Pradat Pierre, Bastuji Hélène, Ricordeau François, Gormand Frédéric, Le Cam Pierre, Stauffer Emeric, Petitjean Thierry, Peter-Derex Laure
Center for Sleep Medicine and Respiratory Diseases, Hospices Civils de Lyon, 69004 Lyon, France.
Center for Clinical Research, Hospices Civils de Lyon, 69004 Lyon, France.
Clocks Sleep. 2021 Apr 30;3(2):259-273. doi: 10.3390/clockssleep3020016.
The interpretation of the Maintenance Wakefulness Test (MWT) relies on sleep onset detection. However, microsleeps (MSs), i.e., brief periods of sleep intrusion during wakefulness, may occur before sleep onset. We assessed the prevalence of MSs during the MWT and their contribution to the diagnosis of residual sleepiness in patients treated for obstructive sleep apnea (OSA) or hypersomnia. The MWT of 98 patients (89 OSA, 82.6% male) were analyzed for MS scoring. Polysomnography parameters and clinical data were collected. The diagnostic value for detecting sleepiness (Epworth Sleepiness Scale > 10) of sleep onset latency (SOL) and of the first MS latency (MSL) was assessed by the area under the receiver operating characteristic (ROC) curve (AUC, 95% CI). At least one MS was observed in 62.2% of patients. MSL was positively correlated with SOL (r = 0.72, < 0.0001) but not with subjective scales, clinical variables, or polysomnography parameters. The use of SOL or MSL did not influence the diagnostic performance of the MWT for subjective sleepiness assessment (AUC = 0.66 95% CI (0.56, 0.77) versus 0.63 95% CI (0.51, 0.74)). MSs are frequent during MWTs performed in patients treated for sleep disorders, even in the absence of subjective sleepiness, and may represent physiological markers of the wake-to-sleep transition.
维持觉醒试验（MWT）的解读依赖于睡眠起始检测。然而，微睡眠（MSs），即在清醒期间短暂的睡眠侵入，可能在睡眠起始前发生。我们评估了MWT期间MSs的发生率及其对阻塞性睡眠呼吸暂停（OSA）或发作性睡病患者残余嗜睡诊断的贡献。对98例患者（89例OSA，男性占82.6%）的MWT进行MS评分分析。收集多导睡眠图参数和临床数据。通过受试者操作特征（ROC）曲线下面积（AUC，95%CI）评估睡眠起始潜伏期（SOL）和首个MS潜伏期（MSL）对检测嗜睡（爱泼沃斯嗜睡量表>10）的诊断价值。62.2%的患者观察到至少一次MS。MSL与SOL呈正相关（r = 0.72，<0.0001），但与主观量表、临床变量或多导睡眠图参数无关。使用SOL或MSL对MWT主观嗜睡评估的诊断性能没有影响（AUC = 0.66 95%CI（0.56，0.77）对0.63 95%CI（0.51，0.74））。在接受睡眠障碍治疗的患者进行MWT期间，MSs很常见，即使没有主观嗜睡，并且可能代表从清醒到睡眠转变的生理标志物。
