多导睡眠潜伏期试验中快速眼动睡眠持续时间诊断下丘脑分泌素缺乏性嗜睡症。

Rapid eye movement sleep duration during the multiple sleep latency test to diagnose hypocretin-deficient narcolepsy.

机构信息

Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.

National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.

出版信息

Sleep. 2023 Jan 11;46(1). doi: 10.1093/sleep/zsac247.

DOI:10.1093/sleep/zsac247

PMID:36222741

Abstract

STUDY OBJECTIVES

To assess the performances of alternative measures of the multiple sleep latency test (MSLT) to identify hypocretin-deficiency in patients with a complaint of hypersomnolence, including patients with narcolepsy.

METHODS

MSLT parameters from 374 drug-free patients with hypersomnolence, with complete clinical and polysomnographic (PSG) assessment and cerebrospinal hypocretin-1 measurement were collected. Conventional (sleep latency, number of sleep onset REM-SOREM-periods) and alternative (sleep duration, REM sleep latency and duration, sleep stage transitions) MSLT measures were compared as function of hypocretin-1 levels (≤110 vs > 110 pg/mL). We performed receiver-operating characteristics analyses to determine the best thresholds of MSLT parameters to identify hypocretin-deficiency in the global population and in subgroups of patients with narcolepsy (i.e. typical cataplexy and/or positive PSG/MSLT criteria, n = 223).

RESULTS

Patients with hypocretin-deficiency had shorter mean sleep and REM sleep latencies, longer mean sleep and REM sleep durations and more direct REM sleep transitions during the MSLT. The current standards of MSLT/PSG criteria identified hypocretin-deficient patients with a sensitivity of 0.87 and a specificity of 0.69, and 0.81/0.99 when combined with cataplexy. A mean REM sleep duration ≥ 4.1 min best identified hypocretin-deficiency in patients with hypersomnolence (AUC = 0.932, sensitivity 0.87, specificity 0.86) and ≥ 5.7 min in patients with narcolepsy (AUC = 0.832, sensitivity 0.77, specificity 0.82).

CONCLUSION

Compared to the current neurophysiological standard criteria, alternative MSLT parameters would better identify hypocretin-deficiency among patients with hypersomnolence and those with narcolepsy. We highlighted daytime REM sleep duration as a relevant neurophysiological biomarker of hypocretin-deficiency to be used in clinical and research settings.

摘要

研究目的

评估多睡眠潜伏期试验（MSLT）替代测量方法的性能，以识别有嗜睡主诉的患者（包括发作性睡病患者）的下丘脑分泌素缺乏。

方法

收集了 374 例无药物治疗的嗜睡症患者的 MSLT 参数，这些患者均进行了完整的临床和多导睡眠图（PSG）评估以及脑脊液下丘脑分泌素-1 测量。比较了传统（睡眠潜伏期、睡眠起始 REM 期的数量）和替代（睡眠持续时间、REM 睡眠潜伏期和持续时间、睡眠阶段转换）MSLT 测量方法，作为下丘脑分泌素-1 水平（≤110 与＞110 pg/mL）的函数。我们进行了受试者工作特征分析，以确定 MSLT 参数的最佳阈值，以在整个人群和发作性睡病患者亚组（即典型猝倒和/或阳性 PSG/MSLT 标准，n=223）中识别下丘脑分泌素缺乏。

结果

下丘脑分泌素缺乏的患者在 MSLT 中具有更短的平均睡眠和 REM 睡眠潜伏期、更长的平均睡眠和 REM 睡眠持续时间以及更多的直接 REM 睡眠转换。当前的 MSLT/PSG 标准可识别出下丘脑分泌素缺乏的患者，其敏感性为 0.87，特异性为 0.69，当与猝倒结合时，敏感性为 0.81，特异性为 0.99。REM 睡眠持续时间的平均值≥4.1 分钟可最好地识别出有嗜睡主诉的患者（AUC=0.932，敏感性 0.87，特异性 0.86）和发作性睡病患者（AUC=0.832，敏感性 0.77，特异性 0.82）的下丘脑分泌素缺乏。