Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test

Abstract

Characterization of excessive sleepiness is an important task for the sleep clinician, and assessment requires a thorough history and in many cases, objective assessment in the sleep laboratory. These practice parameters were developed to guide the sleep clinician on appropriate clinical use of the Multiple Sleep Latency Test (MSLT), and the Maintenance of Wakefulness Test (MWT). These recommendations replace those published in 1992 in a position paper produced by the American Sleep Disorders Association. A Task Force of content experts was appointed by the American Academy of Sleep Medicine to perform a comprehensive review of the scientific literature and grade the evidence regarding the clinical use of the MSLT and the MWT. Practice parameters were developed based on this review and in most cases evidence based methods were used to support recommendations. When data were insufficient or inconclusive, the collective opinion of experts was used to support recommendations. These recommendations were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. The MSLT is indicated as part of the evaluation of patients with suspected narcolepsy and may be useful in the evaluation of patients with suspected idiopathic hypersomnia. The MSLT is not routinely indicated in the initial evaluation and diagnosis of obstructive sleep apnea syndrome, or in assessment of change following treatment with nasal continuous positive airway pressure (CPAP). The MSLT is not routinely indicated for evaluation of sleepiness in medical and neurological disorders (other than narcolepsy), insomnia, or circadian rhythm disorders. The MWT may be indicated in assessment of individuals in whom the inability to remain awake constitutes a safety issue, or in patients with narcolepsy or idiopathic hypersomnia to assess response to treatment with medications. There is little evidence linking mean sleep latency on the MWT with risk of accidents in real world circumstances. For this reason, the sleep clinician should not rely solely on mean sleep latency as a single indicator of impairment or risk for accidents, but should also rely on clinical judgment. Assessment should involve integration of findings from the clinical history, compliance with treatment, and, in some cases, objective testing using the MWT. These practice parameters also include recommendations for the MSLT and MWT protocols, a discussion of the normative data available for both tests, and a description of issues that need further study.

Correlations between subjective and objective features of nocturnal sleep and excessive diurnal sleepiness in patients with narcolepsy

“…All patients met criteria for diagnosis of narcolepsy as described in the International Classification of Sleep Disorders 13 and responded to the Epworth Sleep scale (ESS) instrument 14 . Additionally, nocturnal polysomnographic (PSG) records 15,16 and the multiple sleep latency test (MSLT) 17,18 were performed on each patient.…”

“…MSLT was performed the subsequent morning with simultaneous recording of EEG, EOG, and EMG in four sessions at 9:30 a.m., 11:30 a.m., 13:30 p.m., and 15:30 p.m. (only four nap opportunities due to the presence of REM sleep in at least two sessions) 18 .…”

Comprehensive assessment of Somnolence Syndrome in patients undergoing radiation to the brain

“…The conventional montage for the MSLT included central EEG (C3-A2, C4-A1) and occipital (O1-A2, O2-A1) derivations, left and right eye electrooculograms (EOGs), mental/submental electromyogram (EMG), and electrocardiogram (EKG). 18 We called it the screening-SLT. Our study is the first of its kind to have employed this assessment technique to quantify SS.…”

Sleepiness in critical care nurses: Results of a pilot study

“…Standard guidelines for the test were followed. 13 Nurses were given $25 gift certificates on completion of the study.…”