Clinical caveat: prior sleep deprivation can affect the MSLT for days

Janjua, Tariq; Samp, Talley; Cramer-Bornemann, Michel; Hannon, Holly; Mahowald, Mark W.

doi:10.1016/s1389-9457(02)00065-5

Cited by 21 publications

(17 citation statements)

References 6 publications

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“…Possible explanations are first night effect leading to degraded sleep architecture on the preceding nocturnal in-laboratory study or chronic behavioral-induced insufficient sleep syndrome (BIISS). The high prevalence of BIISS (Komada et al, 2008) and its impact on mean SL has been previously reported (Janjua et al, 2003; Marti et al, 2009). We found a negative correlation between total sleep time (TST) on the preceding nocturnal PSG and mean SL on the following MSLT ( r = −0.37; p = 0.005) in the control group as has been previously reported (Bonnet and Arand, 1995).…”

Section: Discussionmentioning

confidence: 79%

Pupillometric Assessment of Sleepiness in Narcolepsy

et al. 2011

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Purpose: Excessive daytime sleepiness is highly prevalent in the general population, is the hallmark of narcolepsy, and is linked to significant morbidity. Clinical assessment of sleepiness remains challenging and the common objective multiple sleep latency test (MSLT) and subjective Epworth sleepiness scale (ESS) methods correlate poorly. We examined the relative utility of pupillary unrest index (PUI) as an objective measure of sleepiness in a group of unmedicated narcoleptics and healthy controls in a prospective, observational pilot study. Methods: Narcolepsy (n = 20; untreated for >2 weeks) and control (n = 56) participants were tested under the same experimental conditions; overnight polysomnography was performed on all participants, followed by a daytime testing protocol including: MSLT, PUI, sleepiness visual analog scale (VAS), ESS, and the psychomotor vigilance test (PVT). Results: The narcolepsy and control groups differed significantly on psychomotor performance and each measure of objective and subjective sleepiness, including PUI. Across the entire sample, PUI correlated significantly with objective (mean sleep latency, SL) and subjective (ESS and VAS) sleepiness, but none of the sleepiness measures correlated with performance (PVT). Among narcoleptics, VAS correlated with PVT measures. Within the control group, mean PUI was the only objective sleepiness measure that correlated with subjective sleepiness. Finally, in an ANCOVA model, SL and ESS were significantly predictive of PUI as measure of sleepiness. Conclusion: The role of PUI in quantifying and distinguishing sleepiness of narcolepsy from sleep-satiated healthy controls merits further investigation as it is a portable, brief, and objective test.

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Section: Discussionmentioning

confidence: 79%

Pupillometric Assessment of Sleepiness in Narcolepsy

et al. 2011

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“…In adolescence, narcolepsy without typical cataplexy should be diagnosed with caution even if the criteria on the MSLT are met. Nocturnal sleep disruption or sleep deprivation might have reduced sleep latency and induced SOREMPs on the following day in subjects without narcolepy (22–25). Adolescents experience chronic sleep deprivation because of increased academic responsibilities and various activities.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of narcolepsy-cataplexy in Korean adolescents

et al. 2008

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“…An example of how the MSLT can show a short MSL and two or more SOREMPs and result in the misdiagnosis narcolepsy was recently published by Janjua et al (2003). They reported a 19-year-old woman who was diagnosed as narcoleptic based on a clinical history of sleepiness since junior high school without any other clinical symptoms of narcolepsy.…”

Section: Narcolepsymentioning

confidence: 99%

ACNS Clinical Controversy: MSLT and MWT Have Limited Clinical Utility

Bonnet

2006

Journal of Clinical Neurophysiology

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The Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT) are two commonly used laboratory-based objective tests to measure sleepiness and alertness, respectively. Data suggest both are extremely sensitive tests when measuring the effects of sleep deprivation within subjects, but are less sensitive for confirming sleepiness and response to treatment in groups of patients with different sleep disorders. Inconsistent and even sometimes paradoxical test results may be partly explained by data that show the MSLT and MWT are not selectively sensitive to either sleepiness or alertness, but sensitive to both the sleep and the arousal systems. Sleep latencies seen on both the MSLT and MWT are affected to varying degrees by a myriad of internal and external influences that can alter what we would prefer each test to show. If we continue to use these tests to measure sleepiness or alertness in patients with different sleep disorders, we need to understand more about the nature and impact of different sources of internal and external arousal so that we can better control the test environment. Improved understanding of the determinants of sleep onset is essential because excessive sleepiness has important consequences for both individuals and society.

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Clinical caveat: prior sleep deprivation can affect the MSLT for days

Cited by 21 publications

References 6 publications

Pupillometric Assessment of Sleepiness in Narcolepsy

Pupillometric Assessment of Sleepiness in Narcolepsy

Prevalence of narcolepsy-cataplexy in Korean adolescents

ACNS Clinical Controversy: MSLT and MWT Have Limited Clinical Utility

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