P106 Evaluating the correlation between objective daytime sleepiness, daytime functioning and subjective sleepiness

Abstract Introduction Daytime sleepiness is typically assessed in clinical settings with the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). However, these tests do not necessarily assess daytime functioning. This study aimed to assess the correlation between a 10-min Psychomotor Vigilance Test (PVT), as a measure of daytime functioning, and excessive daytime sleepiness as measured with the MSLT or MWT. Methods Patients attending the sleep clinic for assessments of daytime sleepiness underwent overnight polysomnography (PSG) and completed the Epworth Sleepiness Scale (ESS). The following day, patients completed four test sessions every 2h starting 1.5h after waking. Testing sessions included the Stanford Sleepiness Scale (SSS), PVT, MWT or MSLT. PVT lapses (reaction time >500ms), SSS score and sleep latencies (MSLT and MWT) were averaged within participants across sessions and regression analyses performed to assess the relationship between PVT lapses and sleepiness measures. Results A total of 41 patients (BMI: 33.7±8.7kg/m²; aged 44.8±17.8 years) completed the study. Of these, 22 (19 F) underwent the MSLT and 19 (2 F) underwent the MWT. PVT lapses correlated with MWT mean sleep latency (r²=0.62; p<0.001), ESS (r²= 0.19; p<0.01) and SSS (r²= 0.12; p<0.05) but not MSLT mean sleep latency (r²= 0.02; p = 0.50). Discussion In clinical practice, MWT and ESS are often used in conjunction to assess daytime functioning. Results suggest that the PVT could be used alongside MWT to aid clinical judgments around an individuals’ daytime functioning.

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Differential and interacting effects of age and sleep restriction on daytime sleepiness and vigilance in adolescence: a longitudinal study

SLEEP ◽

10.1093/sleep/zsy177 ◽

2018 ◽

Vol 41 (12) ◽

Cited By ~ 4

Author(s):

Ian G Campbell ◽

Hans P A Van Dongen ◽

Marcus Gainer ◽

Emmad Karmouta ◽

Irwin Feinberg

Keyword(s):

Daytime Sleepiness ◽

Age Effect ◽

Vigilance Performance ◽

Psychomotor Vigilance Test ◽

Time In Bed ◽

Contradictory Evidence ◽

Psychomotor Vigilance ◽

Electroencephalogram Eeg ◽

Multiple Sleep Latency ◽

Adolescent Brain Development

AbstractStudy ObjectivesThere is contradictory evidence on whether sleep need decreases across adolescence. We investigated this question longitudinally with a dose-response design to test the effects of varied sleep durations on daytime sleepiness and on vigilance and to test whether these relations change with age across early and mid-adolescence.MethodsData from 76 participants who completed at least 2 years of the 3-year study are included in this report. Annually, participants ranging in age from 9.8 to 16.2 years completed three different time in bed (TIB) schedules each consisting of four consecutive nights of 7, 8.5, or 10 hours. Daytime sleepiness (multiple sleep latency test [MSLT]) and vigilance (psychomotor vigilance test [PVT]) were measured on the day following the fourth night of each TIB schedule.ResultsElectroencephalogram (EEG)-measured sleep durations changed linearly with TIB. MSLT-measured daytime sleepiness decreased with longer TIB and increased with age. The TIB and age effects interacted such that the TIB effect decreased with age. PVT performance improved with longer TIB and improved with age, but the benefit that increased TIB conferred on PVT performance did not change with age.ConclusionsThese results seem paradoxical because daytime sleepiness increased but vigilance improved with age. The significant age effect on the relation between TIB and sleepiness compared to the lack of an age effect on the relation between TIB and vigilance performance suggests different rates of maturation in underlying brain systems. We interpret these findings in relation to our model of adolescent brain development driven by synaptic elimination.

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Late-Onset Narcolepsy: A Case Report with Brief Review of the Literature

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1722802 ◽

2021 ◽

Author(s):

Jeny Jacob ◽

Rajesh Venkataram ◽

Nandakishore Baikunje ◽

Rashmi Soori

Keyword(s):

Older Adults ◽

Case Report ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Late Onset ◽

Sleep Latency ◽

Early Adulthood ◽

Review Of The Literature ◽

Multiple Sleep Latency ◽

Overnight Polysomnography

AbstractNarcolepsy, a sleep disorder, has its onset in childhood and early adulthood but rarely in older adults. This case report focuses on a man in his late fifties who was noticed to have excessive daytime sleepiness during his stay in our hospital for an unrelated medical ailment. He was further evaluated with overnight polysomnography and next day multiple sleep latency test which confirmed the diagnosis of narcolepsy.

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1253 Multiple sleep onset REM episodes in middle age woman with excessive daytime sleepiness – Is this automatically assumed narcolepsy?

SLEEP ◽

10.1093/sleep/zsaa056.1247 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A477-A477

Author(s):

Kamal Patel ◽

Bianca J Lang

Keyword(s):

Daytime Sleepiness ◽

Sleep Latency ◽

Sleep Onset ◽

Sleep Time ◽

Multiple Sleep Latency Test ◽

Sleep Onset Latency ◽

Onset Latency ◽

Obstructive Sleep ◽

Falling Asleep ◽

Multiple Sleep Latency

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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0144 Relationship Between Sleep EEG K-Complex Slow Wave Coupling and Next-Day Thalamic Activity During Psychomotor Vigilance Test in Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.142 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A57-A57

Author(s):

A A Parekh ◽

K Kam ◽

A Mullins ◽

A Fakhoury ◽

B Castillo ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Slow Wave ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Wave Coupling ◽

Psychomotor Vigilance Test ◽

Obstructive Sleep ◽

Vigilance Test ◽

Psychomotor Vigilance

Abstract Introduction There is large inter-individual variability in the relationship between obstructive sleep apnea (OSA) severity and lapses in vigilance as measured using psychomotor vigilance test (PVT). We have previously shown that overnight sleep EEG K-complex slow wave coupling (∆SWAK) exhibits a dose-responsive relationship with next-day lapses in vigilance in OSA on and off treatment. We hypothesized that a variable thalamic dysfunction in OSA explains difference in lapses in vigilance and alterations in ∆SWAK across individuals. Methods Five newly diagnosed severe OSA subjects (mean apnea-hypopnea index [AHI4%=57.1±22.8/hr.]) with excessive daytime sleepiness (Epworth Sleepiness Scale=11±3.4) underwent nocturnal polysomnography followed by PVT testing within a 3T SKYRA MRI scanner. The PVT task inside the scanner (PVT-fMRI) was adapted to match the gold standard PVT-192 device. Each fMRI scanning session consisted of 2 10-min PVT runs interleaved with 2 control conditions wherein the subject pressed the response button at random intervals absent of a visual stimulus. fMRI data was analyzed in 2-step procedure (individual time-series followed by group analysis) using Analysis of Functional Neuroimages (AFNI) software package. To estimate thalamic activity during PVT-fMRI, parameter estimates of the %change in blood-oxygen-level-dependent (BOLD) signal using the contrast PVT-Control were used as the primary metric. The region of interest was limited to the bilateral thalamus using the Eickhoff-Zilles macro labels from the MNI N27 template. Results In a preliminary test, PVT performance for the subjects inside the scanner was not significantly different from that outside the scanner (PVTLapsesfMRI=7.3±2.1 vs. PVTLapsesPVT192=6.4±3.6 mean±std; PVTLapses=reaction time > 500 ms.). Within subjects, a trend toward lower thalamic recruitment was observed during PVT-fMRI (-0.17±0.2%; p=0.1). Further, lower thalamic activity during PVT-fMRI also showed a trend to lower overnight ∆SWAK (mean -1.2±1.4) values (r = 0.61, p = 0.17). Conclusion In severe OSA subjects with excessive daytime sleepiness, we observed a trend to reduced thalamic activity during daytime PVT. Overnight EEG K-complex slow wave coupling showed a similar trend with next-day thalamic activity during PVT, however the small sample size may have limited our ability to detect this association with statistical significance. Support AASM Foundation 199-FP-18; NIH K24HL109156

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Polysomnography

10.1093/med/9780190228484.003.0036 ◽

2017 ◽

Author(s):

Sudhansu Chokroverty ◽

Roberto Vertugno

Keyword(s):

Neurological Disorders ◽

Clinical Presentation ◽

Sleep Latency ◽

Clinical Aspects ◽

Physiological Changes ◽

Functional Neuroanatomy ◽

Maintenance Of Wakefulness Test ◽

Laboratory Procedures ◽

Clinical Considerations ◽

Multiple Sleep Latency

This chapter covers the technical and clinical aspects of polysomnography (PSG). Section 1 includes a brief review of the historical milestones, functional neuroanatomy of sleep, physiological changes (emphasizing those pertinent to overnight PSG interpretation) and clinical relevance as well as homeostatic and circadian factors, and functions of sleep. Section 2 deals with laboratory procedures, including PSG recording and scoring techniques, indications for PSG, video-PSG, ambulatory and computerized PSG, artifacts during PSG recording, and pitfalls of PSG. Section 3 includes clinical considerations, briefly describing the clinical presentation, diagnosis, and treatment but mainly focusing on PSG findings in common sleep disorders as well as sleep-related movement disorders, neurological disorders, and sleep-related epilepsies. Section 4 addresses related laboratory procedures for the assessment of sleep, including the multiple sleep latency test, the maintenance-of-wakefulness test, and actigraphy.

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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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