Aldrich M S, Chervin R D, Malow B A
University of Michigan Department of Neurology, Ann Arbor 48109, USA.
Sleep. 1997 Aug;20(8):620-9.
Since its introduction, the multiple sleep latency test (MSLT) has played a major role in the diagnosis of narcolepsy. We assessed its diagnostic value in a series of 2,083 subjects of whom 170 (8.2%) were diagnosed with narcolepsy. The sensitivity of the combination of two or more sleep onset rapid eye movement (REM) periods (SOREMPs) with a mean sleep latency of < 5 minutes on an initial MSLT was 70% with a specificity of 97%, but 30% of all subjects with this combination of findings did not have narcolepsy. In some narcoleptics who had more than one MSLT, the proportion of naps with SOREMPs varied substantially from the initial MSLT to the follow-up test. The highest specificity (99.2%) and positive predictive value (PPV) (87%) for MSLT findings was obtained with the criteria of three or more SOREMPs combined with a mean sleep latency of < 5 minutes, but the sensitivity of this combination was only 46%. The combination of a SOREMP with a sleep latency < 10 minutes on polysomnography yielded a specificity (98.9%) and PPV (73%) almost equal to those obtained from combinations of MSLT findings, but the sensitivity was much lower. Our results suggest that the MSLT cannot be used in isolation to confirm or exclude narcolepsy, is indicated only in selected patients with excessive daytime sleepiness, and is most valuable when interpreted in conjunction with clinical findings.
自引入以来，多次睡眠潜伏期试验（MSLT）在发作性睡病的诊断中发挥了重要作用。我们在2083名受试者中评估了其诊断价值，其中170人（8.2%）被诊断为发作性睡病。在初始MSLT中，两个或更多睡眠起始快速眼动（REM）期（SOREMPs）且平均睡眠潜伏期<5分钟这一组合的敏感性为70%，特异性为97%，但有此检查结果组合的所有受试者中，30%没有发作性睡病。在一些进行了不止一次MSLT的发作性睡病患者中，从初始MSLT到后续检查，出现SOREMPs的小睡比例有很大差异。对于MSLT检查结果，采用三个或更多SOREMPs且平均睡眠潜伏期<5分钟的标准，可获得最高特异性（99.2%）和阳性预测值（PPV）（87%），但此组合的敏感性仅为46%。多导睡眠图上出现一个SOREMP且睡眠潜伏期<10分钟的组合，其特异性（98.9%）和PPV（73%）几乎与从MSLT检查结果组合中获得的结果相同，但敏感性要低得多。我们的结果表明，MSLT不能单独用于确诊或排除发作性睡病，仅适用于选定的日间过度嗜睡患者，且与临床检查结果结合解读时最有价值。
