Stichting Epilepsie Instellingen Nederland, Sleep-Wake Center, Heemstede, The Netherlands.
Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
Sleep. 2022 Aug 11;45(8). doi: 10.1093/sleep/zsac091.
To review the Maintenance of Wakefulness Test (MWT) as assessment of daytime sleepiness in the evaluation of treatment effects and driving fitness in central disorders of hypersomnolence (CDH).
We performed a scoping review of studies using the MWT in patients with CDH (i.e. narcolepsy types 1 and 2, and idiopathic hypersomnia). N = 20 articles were included, comprising 683 patients and 129 controls. MWT effect sizes were compared to the Clinical Global Impression (GCI) scale and the Epworth Sleepiness Scale (ESS). MWT sleep latency was correlated to objective driving performances. The role of motivation was evaluated by comparing MWTs of treatment studies (low motivation) to driving fitness studies (high motivation to stay awake). Healthy controls were compared to norm values.
MWT and CGI were both impacted by the same treatment; however, the MWT has higher effect sizes and was more sensitive to measure these effects. The MWT correlated fairly to moderately (ρ = -0.26 to -0.56; p ≤ .05) to objective driving performance. Motivation played a major role on MWT sleep latencies (d = 0.76 to 1.43; p ≤ .001). Current norm values may not be valid, as sleep latency may be impacted by age.
The MWTs applicability to measure treatment effects in CDH was confirmed, but age-adjusted norm values are needed. For a more complete evaluation of EDS it should be combined with subjective measures. Its reliability for driving fitness evaluation is insufficient, and motivation plays a major role. To predict or monitor driving performance in CDH, valid and easy methods should be developed.
回顾维持觉醒测试（MWT）作为评估中枢性睡眠过度障碍（CDH）中治疗效果和驾驶能力的日间嗜睡评估方法。
我们对使用 MWT 评估 CDH 患者（即 1 型和 2 型发作性睡病和特发性嗜睡症）的研究进行了范围综述。共纳入 20 篇文章，包括 683 例患者和 129 例对照。比较 MWT 效应大小与临床总体印象（GCI）量表和 Epworth 嗜睡量表（ESS）。MWT 睡眠潜伏期与客观驾驶表现相关。通过比较治疗研究（低动机）和驾驶能力研究（保持清醒的高动机）的 MWT，评估动机的作用。将健康对照与正常值进行比较。
MWT 和 CGI 均受到相同治疗的影响；然而，MWT 的效应量更大，更能敏感地测量这些效果。MWT 与客观驾驶性能呈中等至中度相关（ρ=-0.26 至-0.56；p≤0.05）。动机对 MWT 睡眠潜伏期有重要影响（d=0.76 至 1.43；p≤0.001）。目前的正常值可能无效，因为睡眠潜伏期可能受年龄影响。
MWT 可用于测量 CDH 中的治疗效果，但需要调整年龄的正常值。为了更全面地评估 EDS，它应与主观测量相结合。其用于评估驾驶能力的可靠性不足，动机起着重要作用。为了预测或监测 CDH 中的驾驶表现，应开发有效的简单方法。
