Optimizing MSLT Specificity in Narcolepsy With Cataplexy.
- Murer T Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Imbach LL Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Hackius M Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Taddei RN Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Werth E Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Poryazova R Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Gavrilov YV Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Winkler S Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Waldvogel D Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Baumann CR Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- Valko PO Department of Neurology, University Hospital Zurich, Zürich, Switzerland.
- 2017-10-26
Published in:
- Sleep. - 2017
MSLT
Narcolepsy
R latency
SOREMP
specificity
Adult
Aged
Cataplexy
Disorders of Excessive Somnolence
Female
Humans
Male
Middle Aged
Narcolepsy
Polysomnography
Reproducibility of Results
Retrospective Studies
Sleep Apnea Syndromes
Sleep Deprivation
Sleep Latency
Sleep, REM
English
Study Objectives
Multiple sleep onset rapid eye movement (R) periods (SOREMPs) and a mean sleep latency of ≤8 minutes on the multiple sleep latency test (MSLT) are diagnostic criteria of narcolepsy (NC), but also occur in other conditions with increased sleep pressure, including insufficient sleep syndrome (ISS), sleep-disordered breathing (SDB), or Parkinson's disease (PD). These false positives are common, may create diagnostic uncertainty, and highlight the need for complementary MSLT measures with high specificity for NC.
Methods
Detailed analysis of MSLT findings in 56 NC, 83 PD, 89 SDB, and 23 ISS patients, using receiver operating characteristic curves.
Results
A positive MSLT (mean sleep latency ≤ 8.0 minutes and ≥2 SOREMPs) was found in 53 NC (95%), 1 PD (1%), 8 SDB (9%), and 12 ISS patients (52%). MSLT-based differentiation between NC and non-NC patients was best when applying a mean R latency of ≤5 minutes (sensitivity/specificity/positive predictive value [PPV]: 49%/95%/96%) or a mean percentage of sleep stage R ≥ 40% (sensitivity/specificity/PPV: 60%/100%/100%) as cutoffs. When analyzing all 252 naps with SOREMPs in isolation, the combination of both R latency of ≤5 minutes and R percentage of ≥50% yielded a sensitivity/specificity/PPV of 50%/99%/99%. In addition, a sleep stage sequence with R occurring prior to N2 was more common in NC than in non-NC (71% vs. 32%, p < .001), and in combination with R percentage of ≥50% yielded a sensitivity/specificity/PPV of 53%/96%/97%.
Conclusions
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.
Multiple sleep onset rapid eye movement (R) periods (SOREMPs) and a mean sleep latency of ≤8 minutes on the multiple sleep latency test (MSLT) are diagnostic criteria of narcolepsy (NC), but also occur in other conditions with increased sleep pressure, including insufficient sleep syndrome (ISS), sleep-disordered breathing (SDB), or Parkinson's disease (PD). These false positives are common, may create diagnostic uncertainty, and highlight the need for complementary MSLT measures with high specificity for NC.
Methods
Detailed analysis of MSLT findings in 56 NC, 83 PD, 89 SDB, and 23 ISS patients, using receiver operating characteristic curves.
Results
A positive MSLT (mean sleep latency ≤ 8.0 minutes and ≥2 SOREMPs) was found in 53 NC (95%), 1 PD (1%), 8 SDB (9%), and 12 ISS patients (52%). MSLT-based differentiation between NC and non-NC patients was best when applying a mean R latency of ≤5 minutes (sensitivity/specificity/positive predictive value [PPV]: 49%/95%/96%) or a mean percentage of sleep stage R ≥ 40% (sensitivity/specificity/PPV: 60%/100%/100%) as cutoffs. When analyzing all 252 naps with SOREMPs in isolation, the combination of both R latency of ≤5 minutes and R percentage of ≥50% yielded a sensitivity/specificity/PPV of 50%/99%/99%. In addition, a sleep stage sequence with R occurring prior to N2 was more common in NC than in non-NC (71% vs. 32%, p < .001), and in combination with R percentage of ≥50% yielded a sensitivity/specificity/PPV of 53%/96%/97%.
Conclusions
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/sleep/zsx173
- PMID 29069490
- Persistent URL
- https://sonar.ch/global/documents/298473
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