Francesco Biscarini, Fabio Pizza, Stefano Vandi, Alice Mazzoni, Lucie Barateau, Emmanuel Mignot, Yves Dauvilliers, Giuseppe Plazzi
Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Sleep. 2025 Jun 25. doi: 10.1093/sleep/zsaf165.
We aimed to describe the characteristics of standard maintenance of wakefulness test (MWT), outside of clinical trials, in a sample of drug-naïve patients with narcolepsy type 1 (NT1) and type 2 (NT2).
Consecutive drug-naïve patients with narcolepsy underwent two days of continuous PSG recording, the multiple sleep latency test (MSLT), then night-PSG and, on the following day, MWT. MWT results were correlated with MSLT and Epworth Sleepiness Scale (ESS). Patients in the two lower tertiles of MWT mean sleep latency (mSL) were compared to those in the upper tertile.
Seventy-eight NT1 (30.6 ± 11.4 years, 35 males) and 19 NT2 (31.0 ± 9.9 years, 12 males) were included. MWT results showed a bimodal distribution with a large peak with reduced mSL and a small peak with values towards 40 minutes. MWT mSL was lower in NT1 than in NT2 (10.7 ± 10.8 min vs 23.9 ± 11.5 min, p<.001). In the entire sample, lower MWT mSL was moderately correlated with lower MSLT mSL (Rho = 0.347, p=.001) and higher ESS (Rho = -0.398, p<.001). Patients with NT1 with MWT mSL in the two lower tertiles (≤11.2 min) had higher ESS than those in the upper tertile, without any difference in other clinical or neurophysiological features. In NT2, no significant correlations emerged between MWT, MSLT, and ESS.
MWT mSL is reduced in drug-naive narcolepsy, more severely in NT1 than in NT2. However, a minority of patients show normal MWT results. MSLT, MWT, and ESS measure different aspects of sleepiness in narcolepsy, and none can be considered a comprehensive measure of its severity.
我们旨在描述在未使用药物的1型发作性睡病（NT1）和2型发作性睡病（NT2）患者样本中，临床试验之外的标准清醒维持测试（MWT）的特征。
连续纳入未使用药物的发作性睡病患者，进行为期两天的连续多导睡眠图（PSG）记录、多次睡眠潜伏期测试（MSLT），然后是夜间PSG，并在次日进行MWT。MWT结果与MSLT和爱泼华嗜睡量表（ESS）相关。将MWT平均睡眠潜伏期（mSL）处于两个较低三分位数的患者与处于较高三分位数的患者进行比较。
纳入78例NT1患者（年龄30.6±11.4岁，男性35例）和19例NT2患者（年龄31.0±9.9岁，男性12例）。MWT结果显示出双峰分布，一个大峰值出现在mSL降低时，一个小峰值出现在接近40分钟的值处。NT1患者的MWT mSL低于NT2患者（10.7±10.8分钟对23.9±11.5分钟，p<0.001）。在整个样本中，较低的MWT mSL与较低的MSLT mSL中度相关（Rho=0.347，p=0.001），与较高的ESS相关（Rho=-0.398，p<0.001）。MWT mSL处于两个较低三分位数（≤11.2分钟）的NT1患者的ESS高于处于较高三分位数的患者，在其他临床或神经生理特征方面无差异。在NT2患者中，MWT、MSLT和ESS之间未出现显著相关性。
未使用药物的发作性睡病患者的MWT mSL降低，NT1患者比NT2患者更严重。然而，少数患者的MWT结果正常。MSLT、MWT和ESS测量发作性睡病嗜睡的不同方面，且均不能被视为其严重程度的综合测量指标。
