Optimizing MSLT Specificity in Narcolepsy With Cataplexy

Murer, Tobias; Imbach, Lukas L.; Hackius, Marc; Taddei, Raquel N.; Werth, Esther; Poryazova, Rositsa; Gavrilov, Yu. V.; Winkler, Sophie; Waldvogel, Daniel; Baumann, Christian R.; Valko, Philipp O.

doi:10.1093/sleep/zsx173

Cited by 31 publications

(11 citation statements)

References 32 publications

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“…These findings are in line with other published reports [12][13][14]. The specificity of MSLT could be increased by reducing mean sleep latency limit to 5 min and analyzing both the proportion of REM sleep in all the naps and the sequence of occurring sleep stages-whether REM sleep occurs before stage N2 sleep-but this would also reduce the sensitivity to around 50% [15,16]. A test-retest reliability of MSLT is also limited, especially in other diseases than NT1 [17].…”

Section: Discussionsupporting

confidence: 90%

Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy

Sarkanen

Alakuijala

Partinen

2018

Sleep

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Study objectives: To validate Ullanlinna Narcolepsy Scale (UNS) as a screening tool for narcolepsy in a clinical population and to compare it with Swiss Narcolepsy Scale (SNS) and Epworth Sleepiness Scale (ESS). Methods: UNS questionnaires of 267 participants visiting Helsinki Sleep Clinic were analyzed. The diagnoses of the participants were narcolepsy type 1 (NT1, n = 89), narcolepsy type 2 (NT2, n = 10), other hypersomnias (n = 24), sleep apnea (n = 37), restless legs syndrome or periodic limb movement disorder (n = 56), and other sleep-related disorders (n = 51). In addition, ESS and SNS scores in a subset of sample (total N = 167) were analyzed and compared to UNS. Results: Mean UNS score in NT1 was 22.0 (95% confidence interval [CI] = 20.4 to 23.6, range 9-43), which was significantly higher than in other disorders, including NT2 (mean 13.7, 95% CI = 10.3 to 17.1, range 7-21, p = .0013). Sensitivity and specificity of UNS in separating NT1 from other disorders were 83.5% and 84.1%, respectively. Positive and negative predictive values were 82.5% and 85.1%, respectively. Sensitivities of SNS and ESS in NT1 were 77.2% and 88.6%, and specificities 88.6% and 45.5%, respectively. There were no differences in receiver operating characteristic curves between UNS and SNS. UNS had moderate negative correlation with hypocretin-1 levels (r s =-.564, p < .001), and mean sleep latency in multiple sleep latency test (r s =-.608, p < .001). Conclusions: UNS has high specificity and sensitivity for NT1 in a sleep clinic setting. UNS scores below 9 strongly suggest against the diagnosis of narcolepsy.

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Section: Discussionsupporting

confidence: 90%

Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy

Sarkanen

Alakuijala

Partinen

2018

Sleep

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“…One study examined the use of a fixed duration of nap trials on the MSLT findings but further research is needed on the impact of changes in nap duration on SOREMPS. 61 Data show that MSLT findings vary by age suggesting that age specific diagnostic criteria may need to be developed particularly for children and older adults. 19 Research on MWT results and their relationship to driving and workplace safety are needed and could potentially provide diagnostic and treatment cutoffs.…”

Section: Discussionmentioning

confidence: 98%

Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine

Krahn

Arand

Avidan

et al. 2021

Journal of Clinical Sleep Medicine

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Journal of Clinical Sleep Medicine is dedicated to advancing the science of clinical sleep medicine. In order to provide subscribers with access to new scientific developments as early as possible, accepted papers are posted prior to their final publication in an issue.These papers are posted as received-without copyediting or formatting by the publisher. In some instances, substantial changes are made during the copyediting and formatting processes; therefore, the final version of the paper may differ significantly from this version.Unless indicated otherwise, all papers are copyright of the American Academy of Sleep Medicine. No paper in whole or in part may be used in any form without written permission from the American Academy of Sleep Medicine.

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“…Insufficient sleep syndrome was the leading sleep diagnosis on re-evaluation in this patient cohort. The average TST of the cohort (404 min) by actigraphy was less than the AASM recommended adult sleep duration of 7-9 h, with several [10]. As noted previously, inadequate sleep duration is a significant problem in active duty military members with as many as 72% of soldiers reporting 6 or less hours of sleep per night [21].…”

Section: Discussionmentioning

confidence: 81%

“…A recent case series in three active duty service members suggested that misdiagnosis occurs in the military as well as civilian population [9]. SOREMPs, an essential diagnostic criterion for narcolepsy, have been noted in several other sleep disorders including OSA, circadian rhythm sleep-wake disorders, and insufficient sleep syndrome [10][11][12][13][14]. Therefore, judicious use of diagnostic tests is recommended including polysomnography (PSG) and actigraphy to evaluate for these confounding conditions [2,[15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Diagnosing narcolepsy in the active duty military population

Villarreal

Brock

et al. 2021

Sleep Breath

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Purpose Narcolepsy type I and type II are central hypersomnias characterized by excessive daytime sleepiness and nocturnal sleep disruptions. These rare disorders make the diagnosis complex, as multiple sleep disorders are known to cause false-positive results on testing. There is a high incidence of sleep disorders in the military, and the diagnosis of narcolepsy can have serious career implications. This study looked to assess for the presence of confounding disorders in patients previously diagnosed with narcolepsy. Methods We conducted a retrospective analysis of patients aged 18-65 previously diagnosed with narcolepsy at an outside facility, referred for repeat evaluation at the Wilford Hall Sleep Disorders Center. Previous test results from the time of original diagnosis were reviewed if available and compared with repeat evaluation which included actigraphy, in-laboratory polysomnography, and multiple sleep latency testing. Results Of the 23 patients, 2 (9%) retained a diagnosis of narcolepsy after repeat testing. Ten patients (43%) had insufficient sleep syndrome, five (22%) had significant circadian rhythm sleep-wake disorders, and nine (39%) patients were diagnosed with mild obstructive sleep apnea (OSA). Four of the nine patients with OSA (44%) had supine predominant OSA. Conclusion Diagnostic testing for narcolepsy may be influenced by the presence of comorbid sleep disorders including sleepdisordered breathing, insufficient sleep duration, and circadian misalignment which are common in active military personnel. This study emphasizes the importance of excluding these comorbid diagnoses in this population.

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Optimizing MSLT Specificity in Narcolepsy With Cataplexy

Abstract: A better characterization of R sleep by latency, duration, and sleep stage sequence facilitates detection of false positives and, hence, contributes to a higher MSLT specificity in NC.

Cited by 31 publications

References 32 publications

Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy

Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy

Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine

Diagnosing narcolepsy in the active duty military population

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