Univ. Bordeaux, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France.
Univ. Bordeaux, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France; Service Universitaire de Médecine du Sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, 33 076 Bordeaux, France.
Neurophysiol Clin. 2024 Apr;54(2):102938. doi: 10.1016/j.neucli.2023.102938. Epub 2024 Feb 23.
Excessive daytime sleepiness (EDS) is multifactorial. It combines, among other things, an excessive propensity to fall asleep ("physiological sleepiness") and a continuous non-imperative sleepiness (or drowsiness/hypo-arousal) leading to difficulties remaining awake and maintaining sustained attention and vigilance over the long term ("manifest sleepiness"). There is no stand-alone biological measure of EDS. EDS measures can either capture the severity of physiological sleepiness, which corresponds to the propensity to fall asleep, or the severity of manifest sleepiness, which corresponds to behavioral consequences of sleepiness and reduced vigilance. Neuropsychological tests (The psychomotor vigilance task (PVT), Oxford Sleep Resistance Test (OSLeR), Sustained Attention to Response Task (SART)) explore manifest sleepiness through several sustained attention tests but the lack of normative values and standardized protocols make the results difficult to interpret and use in clinical practice. Neurophysiological tests explore the two main aspects of EDS, i.e. the propensity to fall asleep (Multiple sleep latency test, MSLT) and the capacity to remain awake (Maintenance of wakefulness test, MWT). The MSLT and the MWT are widely used in clinical practice. The MSLT is recognized as the "gold standard" test for measuring the severity of the propensity to fall asleep and it is a diagnostic criterion for narcolepsy. The MWT measures the ability to stay awake. The MWT is not a diagnostic test as it is recommended only to evaluate the evolution of EDS and efficacy of EDS treatment. Even if some efforts to standardize the protocols for administration of these tests have been ongoing, MSLT and MWT have numerous limitations: age effect, floor or ceiling effects, binding protocol, no normal or cutoff value (or determined in small samples), and no or low test-retest values in some pathologies. Moreover, the recommended electrophysiological set-up and the determination of sleep onset using the 30‑sec epochs scoring rule show some limitations. New, more precise neurophysiological techniques should aim to detect very brief periods of physiological sleepiness and, in the future, the brain local phenomenon of sleepiness likely to underpin drowsiness, which could be called "physiological drowsiness".
日间过度嗜睡（EDS）是多因素的。它结合了其他因素，包括过度的入睡倾向（“生理性嗜睡”）和持续的非强制性嗜睡（或昏昏欲睡/低觉醒），导致难以保持清醒并长期保持持续注意力和警觉（“明显嗜睡”）。没有单独的生物学指标可以测量 EDS。EDS 测量可以捕捉到生理性嗜睡的严重程度，这对应于入睡倾向，或者捕捉到明显嗜睡的严重程度，这对应于嗜睡和警觉性降低的行为后果。神经心理学测试（精神运动警觉任务（PVT）、牛津睡眠抵抗测试（OSLeR）、维持注意力反应任务（SART））通过多项持续注意力测试来探索明显嗜睡，但缺乏规范值和标准化协议使得结果难以解释和在临床实践中使用。神经生理测试探索了 EDS 的两个主要方面，即入睡倾向（多次睡眠潜伏期测试，MSLT）和保持清醒的能力（保持清醒测试，MWT）。MSLT 和 MWT 在临床实践中广泛使用。MSLT 被认为是测量入睡倾向严重程度的“金标准”测试，也是嗜睡症的诊断标准。MWT 测量保持清醒的能力。MWT 不是诊断测试，因为仅建议使用它来评估 EDS 的演变和 EDS 治疗的效果。尽管一直在努力标准化这些测试的管理协议，但 MSLT 和 MWT 存在许多限制：年龄效应、地板或天花板效应、绑定协议、没有正常或截止值（或在小样本中确定），以及在某些病理情况下没有或低的测试-重测值。此外，推荐的电生理设置和使用 30 秒时段评分规则确定睡眠起始存在一些限制。新的、更精确的神经生理技术应旨在检测非常短暂的生理性嗜睡期，并且在未来，可能会发现嗜睡的大脑局部现象，这可能被称为“生理性困倦”。
