0607 Patients Whose Multiple Sleep Latency Tests (MSLTs) Have Fewer Than Two Sleep-onset Rem Periods (soremps) Respond Well To Sodium Oxybate

Abstract Introduction Presence of sleep onset REM episodes often raises concerns of narcolepsy. However other conditions have shown to have presence of sleep on REM episodes which include but not limited to obstructive sleep apnea, sleep wake schedule disturbance, alcoholism, neurodegenerative disorders, depression and anxiety Report of Case Here we present a case of 30 year old female with history of asthma, patent foraman ovale, migraine headache, and anxiety who presented with daytime sleepiness, falling asleep while at work, occasional scheduled naps, non-restorative sleep, sleep paralysis, and hypnopompic hallucination. Pertinent physical exam included; mallampati score of 4/4, retrognathia, high arched hard palate, crowded posterior oropharynx. She had a score of 16 on Epworth sleepiness scale. Patient previously had multiple sleep latency test at outside facility which revealed 4/5 SOREM, with mean sleep onset latency of 11.5 minutes. She however was diagnosed with narcolepsy and tried on modafinil which she failed to tolerate. She was tried on sertraline as well which was discontinued due to lack of benefit. She had repeat multiple sleep latency test work up which revealed 2/5 SOREM, with mean sleep onset latency was 13.1 minutes. Her overnight polysomnogram prior to repeat MSLT showed SOREM with sleep onset latency of 10 minutes. Actigraphy showed consistent sleep pattern overall with sufficient sleep time but was taking hydroxyzine and herbal medication. Patient did not meet criteria for hypersomnolence disorder and sleep disordered breathing. Conclusion There is possibility her medication may have played pivotal role with her daytime symptoms. We also emphasize SOREMs can be present in other disorders such as anxiety in this case and not solely in narcolepsy

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Validation of Multiple Sleep Latency Test for the diagnosis of pediatric narcolepsy type 1

Neurology ◽

10.1212/wnl.0000000000008094 ◽

2019 ◽

Vol 93 (11) ◽

pp. e1034-e1044 ◽

Cited By ~ 10

Author(s):

Fabio Pizza ◽

Lucie Barateau ◽

Isabelle Jaussent ◽

Stefano Vandi ◽

Elena Antelmi ◽

...

Keyword(s):

Roc Curve ◽

Sleep Latency ◽

Pediatric Population ◽

Sleep Onset ◽

Biological Data ◽

Multiple Sleep Latency Test ◽

Roc Curve Analysis ◽

Specificity And Sensitivity ◽

Multiple Sleep Latency

ObjectiveTo validate polysomnographic markers (sleep latency and sleep-onset REM periods [SOREMPs] at the Multiple Sleep Latency Test [MSLT] and nocturnal polysomnography [PSG]) for pediatric narcolepsy type 1 (NT1) against CSF hypocretin-1 (hcrt-1) deficiency and presence of cataplexy, as no criteria are currently validated in children.MethodsClinical, neurophysiologic, and, when available, biological data (HLA-DQB1*06:02 positivity, CSF hcrt-1 levels) of 357 consecutive children below 18 years of age evaluated for suspected narcolepsy were collected. Best MSLT cutoffs were obtained by receiver operating characteristic (ROC) curve analysis by contrasting among patients with available CSF hcrt-1 assay (n = 228) with vs without CSF hcrt-1 deficiency, and further validated in patients without available CSF hcrt-1 against cataplexy (n = 129).ResultsPatients with CSF hcrt-1 deficiency were best recognized using a mean MSLT sleep latency ≤8.2 minutes (area under the ROC curve of 0.985), or by at least 2 SOREMPs at the MSLT (area under the ROC curve of 0.975), or the combined PSG + MSLT (area under the ROC curve of 0.977). Although specificity and sensitivity of reference MSLT sleep latency ≤8 minutes and ≥2 SOREMPs (nocturnal SOREMP included) was 100% and 94.87%, the combination of MSLT sleep latency and SOREMP counts did not improve diagnostic accuracy. Age or sex also did not significantly influence these results in our pediatric population.ConclusionsAt least 2 SOREMPs or a mean sleep latency ≤8.2 minutes at the MSLT are valid and reliable markers for pediatric NT1 diagnosis, a result contrasting with adult NT1 criteria.Classification of evidenceThis study provides Class III evidence that for children with suspected narcolepsy, polysomnographic and MSLT markers accurately identify those with narcolepsy type 1.

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Correlates of sleep-onset REM periods during the Multiple Sleep Latency Test in community adults

Brain ◽

10.1093/brain/awl079 ◽

2006 ◽

Vol 129 (6) ◽

pp. 1609-1623 ◽

Cited By ~ 169

Author(s):

E. Mignot

Keyword(s):

Sleep Latency ◽

Sleep Onset ◽

Multiple Sleep Latency Test ◽

Multiple Sleep Latency

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The Assessment of ‘Sleepiness’ in Human Drug Trials: A New Perspective

Current Psychopharmacologye ◽

10.2174/2211556007666180503170231 ◽

2019 ◽

Vol 8 (1) ◽

pp. 5-26

Author(s):

Murray Johns

Keyword(s):

Sleep Latency ◽

Sleep Onset ◽

Face Validity ◽

Drug Trials ◽

Efficacy And Safety ◽

Short Term ◽

Maintenance Of Wakefulness Test ◽

New Perspective ◽

The Relationship ◽

Multiple Sleep Latency

The investigation of the efficacy and safety of drugs requires assessments of their effects on alertness/sleepiness. Unfortunately, there is confusion about the nature of ‘sleepiness’, the factors which influence it, and how it can be measured under different circumstances. This review aims to clarify these matters and to offer some suggestions about how current difficulties might be overcome. Different meanings of the word ‘sleepiness’ are examined initially. Methods that purport to measure ‘sleepiness’ are then examined, including their testretest reliability and the relationship between the results of different measurements within the same subjects. Some objective methods are found not to be as reliable as was initially reported. Information about the reliability of several other methods is either inadequate or nonexistent. One assumption which underlies two frequently used objective methods for measuring ‘sleepiness’ (the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test) is that the ‘sleepier’ a person is, the quicker they will fall asleep. While this assumption has face validity, other assumptions about these tests are re-examined and are found wanting, at least sometimes. The difficulty arises in part because it is not always clear when the sleep onset process begins and ends. ‘Sleepiness’ is found to be influenced much more by short-term factors, such as the subject’s posture at the time and during the preceding few minutes, than has been acknowledged previously. Some possible solutions to these difficulties are suggested, including a new conceptual model of sleep-wake control, with implications for the design of drug trials.

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0738 Advance Taper of Antidepressants Prior to Multiple Sleep Latency Testing Increases the Number of Sleep-Onset Rapid Eye Movement Periods and Reduces Mean Sleep Latency

SLEEP ◽

10.1093/sleep/zsaa056.734 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A281-A281

Author(s):

B Kolla ◽

M Jahani Kondori ◽

M Silber ◽

H Samman ◽

S Dhankikar ◽

...

Keyword(s):

Eye Movement ◽

Sleep Latency ◽

Sleep Onset ◽

Initial Assessment ◽

Rapid Eye Movement ◽

Regression Analyses ◽

Practice Parameters ◽

The Impact ◽

Multiple Sleep Latency ◽

Multiple Sleep Latency Testing

Abstract Introduction Patients presenting with excessive sleepiness are frequently on antidepressant medication(s). While practice parameters recommend discontinuation of antidepressants prior to multiple sleep latency testing (MSLT), data examining the impact of tapering these medications on MSLT results are limited. Methods Adult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014-2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement suppressing antidepressants (REMS-AD) at assessment and during testing, actigraphy and polysomnography data were manually abstracted. The difference in number of sleep-onset rapid eye movement periods (SOREMS), proportion with ≥2 SOREMS and mean sleep latency (MSL) in patients who were on REMS-AD and discontinued prior to testing versus those who remained on REMS-AD were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT wherever feasible; fluoxetine is stopped 4 weeks prior. Regression analyses accounting for demographic, clinical and other medication-related confounders were performed. Results A total of 502 patients (age=38.18±15.90 years; 67% female) underwent MSLT; 178 (35%) were on REMS-AD at the time of assessment. REMS-AD were discontinued prior to testing in 121/178 (70%) patients. Patients tapered off REMS-AD were more likely to have ≥2 SOREMS (OR-12.20; 95%CI=1.60-92.94) compared to patients who remained on REMS-AD at the time of the MSLT. They also had shorter MSL (8.77±0.46 vs 10.21±0.28; p>0.009) and higher odds of having ≥2 SOREMS (OR=2.22; 95%CI=1.23-3.98) compared to patients not on REMS-AD at initial assessment. These differences persisted after regression analyses accounting for confounders. Conclusion Patients who taper off REMS-AD prior to MSLT are more likely to demonstrate ≥2SOREMs and have a shorter MSL. Pending further prospective investigations, clinicians should preferably withdraw REMs-AD before an MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results. Support None

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