Test–Retest Reliability of the Multiple Sleep Latency Test in Central Disorders of Hypersomnolence

Lopez, Régis; Doukkali, Anis; Barateau, Lucie; Evangelista, Elisa; Chenini, Sofiène; Jaussent, Isabelle; Dauvilliers, Yves

doi:10.1093/sleep/zsx164

Cited by 116 publications

(66 citation statements)

References 27 publications

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“…Lopez et al. () classified patients under a generic name of “subjects with Central Disorders of Hypersomnolence” (CDH), including patients with narcolepsy‐cataplexy (type‐1 narcoleptics), non‐cataplectic‐narcoleptics (type‐2), idiopathic hypersomniacs and unspecified hypersomnolence, in a retrospective study looking at the findings with repeat MSLTs at about 2 years apart (Lopez et al., ). They showed the presence of an instability of findings in the MSLT in the “non‐cataplectic patients” independently of their initial classification.…”

Section: Discussionmentioning

confidence: 99%

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Huang

Guilleminault

Lin

et al. 2018

Journal of Sleep Research

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Excessively sleepy teenagers and young adults without sleep-disordered breathing are diagnosed with either narcolepsy type 1 or narcolepsy type 2, or hypersomnia, based on the presence/absence of cataplexy and the results of a multiple sleep latency test. However, there is controversy surrounding this nomenclature. We will try to find the differences between different diagnoses of hypersomnia from the results of the long-term follow-up evaluation of a sleep study. We diagnosed teenagers who had developed excessive daytime sleepiness based on the criteria of the International Classification of Sleep Disorders, 3rd edition. Each individual received the same clinical neurophysiologic testing every year for 5 years after the initial diagnosis of narcolepsy type 1 (n = 111) or type 2 (n = 46). The follow-up evaluation demonstrated that narcolepsy type 1 (narcolepsy-cataplexy) is a well-defined clinical entity, with very reproducible clinical neurophysiologic findings over time, whereas patients with narcolepsy type 2 presented clear clinical and test variability. By the fifth year of the follow-up evaluation, 17.6% of subjects did not meet the diagnostic criteria of narcolepsy type 2, and 23.9% didn't show any two sleep-onset rapid eye movement periods in multiple sleep latency during the 5-year follow-up. Therefore narcolepsy type 1 (narcolepsy-cataplexy) is a well-defined syndrome, with the presentation clearly related to the known consequences of destruction of hypocretin/orexin neurons. Narcolepsy type 2 covers patients with clinical and test variability over time, thus bringing into question the usage of the term "narcolepsy" to label these patients.

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Section: Discussionmentioning

confidence: 99%

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Huang

Guilleminault

Lin

et al. 2018

Journal of Sleep Research

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“…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]. UNS is not supposed to replace MSLT in the diagnosis as they are two totally different tests.…”

Section: Discussionmentioning

confidence: 99%

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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“…[18][19][20][21][22][23] Current diagnostic criteria remain controversial, with frequent overlaps and changes found between nonhypocretin-deficient central disorders of hypersomnolence. 8,9 The MSLT was initially developed as a tool to measure daytime sleep propensity after sleep deprivation. It became the neurophysiological gold standard test to diagnose narcolepsy, with several revisions concerning its interpretation and cutoffs.…”

Section: Discussionmentioning

confidence: 99%

“…40% of patients with IH have MSL > 8 minutes, 5,7 with major latency changes in test-retest. 8,9 Moreover, abnormal MSLT latency is frequently found in the general population (ie, 10-25%) 10,11 and thus cannot be a major criterion for an orphan disease diagnosis. The PSG-MSLT procedure also requires waking up the patient in the morning to perform the first session, thus precluding the recording of prolonged nighttime sleep, which is a typical symptom of IH.…”

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confidence: 99%

Alternative diagnostic criteria for idiopathic hypersomnia: A 32‐hour protocol

Evangelista

Lopez

Barateau

et al. 2018

Annals of Neurology

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Test–Retest Reliability of the Multiple Sleep Latency Test in Central Disorders of Hypersomnolence

Abstract: The PSG-MSLT measures and classification are not stable in patients with NCHS, with frequent diagnostic changes, particularly for NT2 and IH, compared with NT1. MSLT needs to be repeated at regular intervals to confirm a stable hypersomnia and provide an accurate diagnosis of NT2 and IH.

Cited by 116 publications

References 27 publications

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Multiple sleep latency test in narcolepsy type 1 and narcolepsy type 2: A 5‐year follow‐up study

Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy

Alternative diagnostic criteria for idiopathic hypersomnia: A 32‐hour protocol

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