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Zhao W, Zhang B, Yan Z, Zhao M, Zhang X, Zhang X, Liu X, Tang J. Correlation analysis between HLA-DQA1*0102/DQB1*0602 genotypes and narcolepsy patients in China. Front Neurol 2024; 15:1379723. [PMID: 38725645 PMCID: PMC11079304 DOI: 10.3389/fneur.2024.1379723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024] Open
Abstract
Background and objective At present, the etiology of narcolepsy is not fully understood, and it is generally believed to be an autoimmune reaction caused by interactions between environmental and genetic factors. Human leukocyte antigen (HLA) class II genes are strongly associated with this gene, especially HLA-DQB1*0602/DQA1*0102. In this study, we mainly analyzed the correlation between different genotypes of HLA-DQB1*0602/DQA1*0102 and clinical manifestations in Chinese patients with narcolepsy. Experimental method Narcolepsy patients who were treated at the Department of Neurology, The First Affiliated Hospital of Shandong First Medical University from January 2021 to September 2023 were selected. General information, sleep monitoring data, cerebrospinal fluid (CSF) orexin levels, and human leukocyte antigen gene typing data were collected. The statistical analysis was performed using SPSS 26.0, and the graphs were drawn using GraphPad Prism 9.5. Main results A total of 78 patients were included in this study. The DQA1 and DQB1 gene loci were detected in 54 patients, and only the DQB1 gene locus was detected in 24 narcoleptic patients. The most common allele at the HLA-DQB1 locus was *0602 (89.7%), and the most common genotype at this locus was *0602*0301 (19.2%), followed by *0602*0602 (17.9%). The most common phenotype of the HLA-DQA1 locus is *0102 (92.6%), and the most common genotype of this locus is *0102*0102 (27.8%), followed by *0102*0505 (14.8%). There were significant differences (p < 0.05) between HLA-DQB1*0602-positive and HLA-DQB1*0602-negative patients in terms of orexin-A levels, presence or absence of cataplexy, UNS, PSG sleep latency, REM sleep latency, N1 sleep percentage, oxygen depletion index, and average REM latency on the MSLT. The HLA-DQA1*0102-positive and HLA-DQA1*0102-negative patients showed significant differences (p < 0.05) in disease course, presence or absence of sudden onset, PSG REM sleep latency, N1 sleep percentage, and average REM latency on the MSLT. There were significant differences in the average REM latency of the MSLT between HLA-DQB1*0602/DQA1*0102 homozygous and heterozygous patients p < 0.05, and no differences were found in the baseline data, orexin-A levels, scale scores, or other sleep parameters. Conclusion Different genotypes of HLA-DQA1*0102/DQB1*0602 are associated with symptoms of cataplexy in Chinese narcoleptic patients. Homozygous individuals have a shorter mean REM latency in the MSLT, greater genetic susceptibility, and relatively more severe sleepiness.
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Affiliation(s)
- Wanyu Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Baokun Zhang
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zian Yan
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Mengke Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Xiao Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoyu Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Xiaomin Liu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Jiyou Tang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Chin WC, Huang YS, Trevor Lam NY, Mak KY, Tang I, Wang CH, Lin C. Effects of modafinil on nocturnal sleep patterns in patients with narcolepsy: A cohort study. Sleep Med 2024; 119:95-102. [PMID: 38669836 DOI: 10.1016/j.sleep.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Patients with narcolepsy often experience disturbed nighttime sleep. Modafinil is commonly prescribed for hypersomnolence, but its impacts on nocturnal sleep remain unclear. This study uses actigraphy to examine the effect of modafinil on both hypersomnolence and nocturnal sleep patterns in patients with narcolepsy. METHODS Prior to treatment, 87 patients with narcolepsy wore an actigraphy for 7-14 days to assess their nighttime sleep. After evaluation, they received a daily dose of 200-400 mg of modafinil in the morning and wore an actigraphy again six months after initiating treatment. Questionnaires, including the Epworth-Sleepiness-Scale (ESS), the Visual-Analogue-for-Hypersomnolence (VAS), and the Short-Form-36-Health-Survey (SF-36), were used to evaluate hypersomnolence and quality of life both before and after treatment. Paired t-tests and independent samples t-tests were used for pre- and post-treatment comparisons and subgroup analysis. We used the Pearson's correlation test to measure the correlations between the sleep parameters of the actigraphy and data of the questionnaires. RESULTS Improvements in hypersomnolence were noted following modafinil treatment, and we observed no significant deterioration in nocturnal sleep parameters by the actigraphy. The total number of awakenings by actigraphy significantly decreased (p = 0.005), especially in females (p = 0.008), while sleep onset latency significantly increased in children/adolescents (p = 0.014). Correlations were found between the sleep parameters of the actigraphy and ESS, VAS, and SF-36 scores. CONCLUSION Modafinil treatment may not worsen nighttime sleep in patients with narcolepsy. However, it should be administered with care in children and adolescents.
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Affiliation(s)
- Wei-Chih Chin
- Division of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; College of Life Sciences and Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Shu Huang
- Division of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ngo Yan Trevor Lam
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Yu Mak
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - I Tang
- Division of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Huan Wang
- Department of Psychology, Zhejiang Normal University, Jinhua, China
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
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Maski KP, Amos LB, Carter JC, Koch EE, Kazmi U, Rosen CL. Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in children: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med 2024; 20:631-641. [PMID: 38149645 PMCID: PMC10985297 DOI: 10.5664/jcsm.10974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 12/28/2023]
Abstract
The American Academy of Sleep Medicine commissioned a task force of clinical experts in pediatric sleep medicine to review published literature on performing the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test for diagnosis and management of central disorders of hypersomnolence among children and adolescents. This paper follows a format similar to that of the paper "Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine" that was published in 2021. Since there is insufficient evidence to specify a recommended protocol for the Maintenance of Wakefulness Test in children and adolescents, this paper focuses only on the MSLT protocol. This protocol paper provides guidance to health care providers who order, sleep specialists who interpret, and technical staff who administer the MSLT to pediatric patients. Similar to the adult protocol paper, this document provides guidance based on pediatric expert consensus and evidence-based data when available. Topics include patient preparation, evaluation of medication and substance use, sleep needs before testing, scheduling considerations, optimal test conditions for youth, and documentation. Specific changes recommended for pediatric MSLT protocols include (1) provision of a minimum of 7 hours of sleep (with a minimum 8-hour recording time) on polysomnography the night before the MSLT, ideally meeting age-based needs; (2) use of clinical judgment to guide the need for sleep-disordered breathing treatments before polysomnography-MSLT testing; and (3) shared patient-health care provider decision-making regarding modifications in the protocol for children and adolescents with neurodevelopmental/neurological disorders, young age, and/or delayed sleep phase. CITATION Maski KP, Amos LB, Carter JC, Koch EE, Kazmi U, Rosen CL. Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in children: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med. 2024;20(4):631-641.
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Affiliation(s)
- Kiran P. Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Louella B. Amos
- Pediatric Pulmonology and Sleep Medicine, Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John C. Carter
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ellen E. Koch
- American Academy of Sleep Medicine, Darien, Illinois
| | - Uzma Kazmi
- American Academy of Sleep Medicine, Darien, Illinois
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- American Academy of Sleep Medicine, Darien, Illinois
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Torstensen EW, Haubjerg Østerby NC, Kornum BR, Wanscher B, Mignot E, Barløse M, Jennum PJ. Repeated polysomnography and multiple sleep latency test in narcolepsy type 1 and other hypersomnolence disorders. Sleep Med 2023; 110:91-98. [PMID: 37544279 DOI: 10.1016/j.sleep.2023.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The diagnosis of narcolepsy is based on clinical information, combined with polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). PSG and the MSLT are moderately reliable at diagnosing narcolepsy type 1 (NT1) but unreliable for diagnosing narcolepsy type 2 (NT2). This is a problem, especially given the increased risk of a false-positive MSLT in the context of circadian misalignment or sleep deprivation, both of which commonly occur in the general population. AIM We aimed to clarify the accuracy of PSG/MSLT testing in diagnosing NT1 versus controls without sleep disorders. Repeatability and reliability of PSG/MSLT testing and temporal changes in clinical findings of patients with NT1 versus patients with hypersomnolence with normal hypocretin-1 were compared. METHOD 84 patients with NT1 and 100 patients with non-NT1-hypersomnolence disorders, all with congruent cerebrospinal fluid hypocretin-1 (CSF-hcrt-1) levels, were included. Twenty-five of the 84 NT1 patients and all the hypersomnolence disorder patients underwent a follow-up evaluation consisting of clinical assessment, PSG, and a modified MSLT. An additional 68 controls with no sleep disorders were assessed at baseline. CONCLUSION Confirming results from previous studies, we found that PSG and our modified MSLT accurately and reliably diagnosed hypocretin-deficient NT1 (accuracy = 0.88, reliability = 0.80). Patients with NT1 had stable clinical and electrophysiological presentations over time that suggested a stable phenotype. In contrast, the PSG/MSLT results of patients with hypersomnolence, and normal CSF-hcrt-1 had poor reliability (0.32) and low repeatability.
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Affiliation(s)
- Eva Wiberg Torstensen
- Danish Center for Sleep Medicine, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.
| | | | | | | | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Mads Barløse
- Department of Functional and Diagnostic Imaging, Hvidovre Hospital, Copenhagen, Denmark; Danish Headache Center, Rigshospitalet, Glostrup, Denmark.
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.
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Siegenthaler P, Valko PO, Renzel R, Werth E, Poryazova R, Baumann CR, Büchele F. How reliable is a simplified MSLT nap termination protocol? Sleep Med 2023; 109:285-292. [PMID: 37499464 DOI: 10.1016/j.sleep.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE According to current practical guidelines, naps of the Mean Sleep Latency Test (MSLT) must be terminated 15 min after sleep onset, which requires ad hoc scoring. For clinical convenience, some sleep clinics use a simplified protocol with fixed nap lengths of 20min. Its diagnostic accuracy remains unknown. METHODS A subset of MSLT naps of 56 narcolepsy type 1 (NT1), 98 Parkinson's disease (PD), 117 sleep disordered breathing (SDB), 22 insufficient sleep syndrome (ISS) patients, and 24 patients with idiopathic hypersomnia (IH), originally performed according to the simplified protocol, were retrospectively adjusted to standard protocol (nap termination 15min after sleep onset or after 20min when no sleep occurs). This was feasible in 60% of MSLT naps; in this subset, we compared sensitivity and specificity of both MSLT protocols for identification of patients with and without NT1. RESULTS Sensitivity of classical MSLT criteria for NT1, i.e. mean sleep latency ≤8.0min and ≥2 sleep onset rapid eye movement periods (SOREMPs), did not differ between protocols (95%). Specificity, however, was slightly lower (88.1% vs. 89.7%) in the simplified nap termination protocol, with 3 SDB patients and 1 ISS patient having false-positive MSLT findings in the simplified but not in the standard protocol. CONCLUSIONS The use of a simplified MSLT protocol with fixed nap duration had no impact on MSLT sensitivity for NT1, but the longer sleep periods in the simplified protocol increased the likelihood of REM sleep occurrence particularly in non-NT1 conditions, resulting in a slightly lower MSLT specificity compared to the standard protocol.
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Affiliation(s)
- Philippe Siegenthaler
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Philipp Oliver Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Roland Renzel
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Christian Rainer Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
| | - Fabian Büchele
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zürich, Switzerland.
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Romigi A, Caccamo M, Testa F, Ticconi D, Cappellano S, Di Gioia B, Vitrani G, Rosenzweig I, Centonze D. Muscle atonia index during multiple sleep latency test: A possible marker to differentiate narcolepsy from other hypersomnias. Clin Neurophysiol 2023; 149:25-31. [PMID: 36870217 DOI: 10.1016/j.clinph.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The complexity and delay of the diagnosis of narcolepsy require several diagnostic tests and invasive procedures such as lumbar puncture. Our study aimed to determine the changes in muscle tone (atonia index, AI) at different levels of vigilance during the entire multiple sleep latency test (MSLT) and each nap in people with narcolepsy type 1 (NT1) and 2 (NT2) compared with other hypersomnias and its potential diagnostic value. METHODS Twenty-nine patients with NT1 (11 M 18F, mean age 34.9 years, SD 16.8) and sixteen with NT2 (10 M 6F, mean age 39 years, SD 11.8) and 20 controls with other hypersomnias (10 M, 10F mean age 45.1 years, SD 15.1) were recruited. AI was evaluated at different levels of vigilance (Wake and REM sleep) in each nap and throughout the MSLT of each group. The validity of AI in identifying patients with narcolepsy (NT1 and NT2) was analyzed using receiver operating characteristic (ROC) curves. RESULTS AI during wakefulness (WAI) was significantly higher in the narcolepsy groups (NT1 and NT2 p < 0.001) compared to the hypersomniac group. AI during REM sleep (RAI) (p = 0.03) and WAI in nap with sudden onsets of REM sleep periods (SOREMP) (p = 0.001) were lower in NT1 than in NT2. The ROC curves showed high AUC values for WAI (NT1 0.88; Best Cut-off > 0.57, Sensitivity 79.3 % Specificity 90 %; NT2 0.89 Best Cut-off > 0.67 Sensitivity 87.5 % Specificity 95 %; NT1 and NT2 0.88 Best Cut-off > 0.57 Sensitivity 82.2 % Specificity 90 %) in discriminating subjects suffering from other hypersomnias. RAI and WAI in nap with SOREMP showed a poor AUC value (RAI AUC: 0.7 Best cutoff 0.7 Sensitivity 50 % Specificity 87.5 %; WAI in nap before SOREMP AUC: 0.66, Best cut-off < 0.82 sensitivity 61.9 % and specificity 67.35 %) differentiating NT1 and NT2. CONCLUSIONS WAI may represent an encouraging electrophysiological marker of narcolepsy and suggests a vulnerable tendency to dissociative wake / sleep dysregulation lacking in other forms of hypersomnia. SIGNIFICANCE AI during wakefulness may help distinguish between narcolepsy and other hypersomnias.
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Affiliation(s)
- A Romigi
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy.
| | - M Caccamo
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - F Testa
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - D Ticconi
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - S Cappellano
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - B Di Gioia
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - G Vitrani
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - I Rosenzweig
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - D Centonze
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
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Martin VP, Lopez R, Dauvilliers Y, Rouas JL, Philip P, Micoulaud-Franchi JA. Sleepiness in adults: An umbrella review of a complex construct. Sleep Med Rev 2023; 67:101718. [PMID: 36455433 DOI: 10.1016/j.smrv.2022.101718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
Sleepiness involves many dimensions that require investigation. Since sleepiness is often defined operationally, we exhaustively inventoried all the assessment tools designed to measure it in an umbrella review, without any preconceptions, i.e. a review of reviews. We included all reviews and systematic reviews related to sleepiness assessment tools published up to March 2021. Three investigators independently assessed the eligibility of studies for inclusion and identified 36 relevant reviews. In total, 99 tools were identified and classified into 8 categories. We classified them depending on their category, their publication year and the number of mentions in the 36 included reviews. The 6 most frequently cited were the Epworth sleepiness scale, the multiple sleep latency test, the maintenance of wakefulness test, the Stanford sleepiness scale, the Karolinska sleepiness scale, and the psychomotor vigilance task. Despite the limitation that we may have missed some recently developed tools, this historical perspective on sleepiness measurement is a first step toward a better delineation of the different dimensions underlying the constructs of sleepiness, and will serve as a basis for further discussion in the clinical and research sleep community.
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Affiliation(s)
- Vincent P Martin
- Univ. Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, F-33400, Talence, France; Université de Bordeaux, SANPSY UMR 6033, F-33000, Bordeaux, France.
| | - Régis Lopez
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Jean-Luc Rouas
- Univ. Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, F-33400, Talence, France
| | - Pierre Philip
- Service de Médecine Universitaire du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, Bordeaux, France; Université de Bordeaux, SANPSY UMR 6033, F-33000, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Service de Médecine Universitaire du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, Bordeaux, France; Université de Bordeaux, SANPSY UMR 6033, F-33000, Bordeaux, France.
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8
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Mayà G, Gaig C, Iranzo A, Santamaria J. Temporal distribution of sleep onset REM periods and N3 sleep in the MSLT and night polysomnogram of narcolepsy type 1 and other hypersomnias. Sleep Med 2023; 102:32-38. [PMID: 36592569 DOI: 10.1016/j.sleep.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The presence of ≥2 sleep onset REM periods (SOREMP) in the Multiple Sleep Latency Test (MSLT) and the previous night polysomnogram (PSG) is part of the diagnostic criteria of narcolepsy, with every SOREMP having the same diagnostic value, despite evidence suggesting that time of SOREMP appearance and their preceding sleep stage might be relevant. We studied the temporal distribution of SOREMPs and associated sleep stages in the MSLT of patients with narcolepsy type 1 (NT1) and other hypersomnias (OH). METHODS We reviewed consecutive five-nap MSLTs and their preceding PSG from 83 untreated adult patients with hypersomnolence and ≥1 SOREMPs. Wake/N1(W/N1)-SOREMPs, N2-SOREMPs, and N3 sleep presence and time of appearance were analyzed. RESULTS Thirty-nine patients had NT1 and 44 OH. There were 183 (78%) SOREMPs in patients with NT1 and 83 (31%) in OH. Sixty-seven percent of SOREMPs in NT1 were from W/N1, and 20% -none from wake-in OH (p < 0.001). Most patients (94%) with ≥2 W/N1-SOREMPs had NT1 (specificity 95%, sensitivity 82%). In patients with NT1 but not in OH, W/N1-SOREMPs decreased throughout the day (from 79% in the 1st nap to 33% in the preceding night, p < 0.001), whereas N2-SOREMPs did not change. N3 sleep frequency in the 5th nap was higher in NT1 than in OH (28% vs. 7%, p:0.009). Nocturnal-SOREMP plus ≥4 daytime SOREMPs, Wake-REM transitions, and REM followed by N3 were only seen in NT1. CONCLUSION Measuring the sleep stage sequence and temporal distribution of SOREMP helps to identify patients with narcolepsy in the MSLT.
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Affiliation(s)
- Gerard Mayà
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain.
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain.
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain.
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain.
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9
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Dauvilliers Y, Bogan RK, Arnulf I, Scammell TE, St Louis EK, Thorpy MJ. Clinical considerations for the diagnosis of idiopathic hypersomnia. Sleep Med Rev 2022; 66:101709. [PMID: 36401976 DOI: 10.1016/j.smrv.2022.101709] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/19/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Idiopathic hypersomnia is a sleep disorder of neurologic origin characterized by excessive daytime sleepiness, with sleep inertia, long, unrefreshing naps, and prolonged nighttime sleep being key symptoms in many patients. Idiopathic hypersomnia is described in the International Classification of Sleep Disorders, 3rd Edition as a central disorder of hypersomnolence with distinct clinical features and diagnostic criteria; however, confirming the diagnosis of idiopathic hypersomnia is often challenging. Diagnosis of idiopathic hypersomnia is based on objective sleep testing and the presence of associated clinical features but may be difficult for clinicians to recognize and correctly diagnose because of its low prevalence, clinical heterogeneity, and symptoms, which are similar to those of other sleep disorders. The testing required for diagnosis of idiopathic hypersomnia also presents logistical barriers, and reliability of objective sleep measures is suboptimal. The pathophysiology of idiopathic hypersomnia remains unknown. In this review, clinical considerations related to the pathogenesis, diagnosis, and management of idiopathic hypersomnia will be discussed, including perspectives from the European Union and United States.
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Affiliation(s)
- Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France; University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France.
| | - Richard K Bogan
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France
| | | | - Erik K St Louis
- Mayo Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
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Thomas CL, Vattikuti S, Shaha D, Werner JK, Hansen S, Collen J, Capaldi VF, Williams S. Central disorders of hypersomnolence: diagnostic discrepancies between military and civilian sleep centers. J Clin Sleep Med 2022; 18:2433-2441. [PMID: 35855527 PMCID: PMC9516578 DOI: 10.5664/jcsm.10144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The majority of active-duty service members obtain insufficient sleep, which can influence diagnostic evaluations for sleep disorders, including disorders of hypersomnolence. An incorrect diagnosis of hypersomnia may be career ending for military service or lead to inappropriate medical care. This study was conducted to assess the rates at which narcolepsy (Nc) and idiopathic hypersomnia (IH) are diagnosed by military vs civilian sleep disorders centers. METHODS This retrospective study utilized claims data from the Military Health System Data Repository. The analyses compared diagnostic rates of military personnel by provider type-either civilian provider or military provider-from January 1, 2016 to December 31, 2019. Three diagnostic categories for Nc and IH: Nc or IH, Nc only, and IH only, were assessed with multivariate logistic regression models. RESULTS We found that among service members evaluated for a sleep disorder, the odds ratios of a positive diagnosis at a civilian facility vs a military facility for Nc or IH was 2.1, for Nc only was 2.1, and IH only was 2.0 over the 4-year period. CONCLUSIONS Civilian sleep specialists were twice as likely to diagnose central disorders of hypersomnolence compared to military specialists. Raising awareness about this discrepancy is critical given the occupational and patient care-related implications of misdiagnoses. CITATION Thomas CL, Vattikuti S, Shaha D, et al. Central disorders of hypersomnolence: diagnostic discrepancies between military and civilian sleep centers. J Clin Sleep Med. 2022;18(10):2433-2441.
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Affiliation(s)
- Connie L. Thomas
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shashaank Vattikuti
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Shaha
- Sleep Disorders Clinic, Department of Medicine, Womack Army Medical Center, Fort Bragg, North Carolina
| | - J. Kent Werner
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Shana Hansen
- Department of Sleep Medicine, San Antonio Military Medical Center, San Antonio, Texas
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Vincent F. Capaldi
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Scott Williams
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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The REM-sleep related characteristics of narcolepsy: A nation-wide multi-center study in Turkey, the REMCON study. Sleep Med 2022; 94:17-25. [DOI: 10.1016/j.sleep.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
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12
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REM sleep latency changes after version 2.1 of the AASM manual for scoring sleep. Sleep Med 2022; 90:142-144. [DOI: 10.1016/j.sleep.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/21/2021] [Accepted: 01/21/2022] [Indexed: 11/22/2022]
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13
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Krahn LE, Arand DL, Avidan AY, Davila DG, DeBassio WA, Ruoff CM, Harrod CG. Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med 2021; 17:2489-2498. [PMID: 34423768 DOI: 10.5664/jcsm.9620] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article updates the American Academy of Sleep Medicine protocols for the administration of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. The American Academy of Sleep Medicine commissioned a task force of clinical experts in sleep medicine to review published literature on the performance of these tests since the publication of the 2005 American Academy of Sleep Medicine practice parameter paper. Although no evidence-based changes to the protocols were warranted, the task force made several changes based on consensus. These changes included guidance on patient preparation, medication and substance use, sleep before testing, test scheduling, optimum test conditions, and documentation. This article provides guidance to providers who order and administer the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. CITATION Krahn LE, Arand DL, Avidan AY, et al. Recommended protocols for the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med. 2021;17(12):2489-2498.
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Affiliation(s)
| | - Donna L Arand
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Alon Y Avidan
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - David G Davila
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
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High prevalence of pathological alertness and wakefulness on maintenance of wakefulness test in adults with focal-onset epilepsy. Epilepsy Behav 2021; 125:108400. [PMID: 34800802 DOI: 10.1016/j.yebeh.2021.108400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a common complaint in adults with epilepsy (AWE), but objective evaluation is lacking. We used the maintenance of wakefulness test (MWT) to objectively measure the ability of adults with focal-onset epilepsy to maintain wakefulness in soporific conditions. METHODS Adults with epilepsy participating in a study investigating the effects of lacosamide on sleep and wakefulness underwent baseline ambulatory polysomnography (PSG)/EEG followed by MWT. Mean sleep latency (MSL) and mean percent sleep time (MST, mean percentage of non-wake EEG scored in 3-sec bins from lights out to sleep onset averaged over the 4 MWT trials) were quantified. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS). Spearman correlation and linear regression assessed relationships between MWT parameters, ESS and relevant sleep and epilepsy-related variables. RESULTS Maintenance of wakefulness test MSL in 51 AWE (mean age 43.5 ± 13 years, 69% female, mean BMI 24.6 ± 11.2 kg/m2) was 21.7 ± 11.9 min; 45.1% had an abnormally short MSL <19.4 min and 15.7% <8 min. MST was 9.3% [3.3, 19.1]. Mean ESS score was 8.8 ± 5.7; 39% had elevated ESS (>10). No correlation between subjective ESS and objective MSL (p = 0.67) or MST (p = 0.61) was found. MSL was significantly shorter in subjects with focal to bilateral tonic-clonic seizures (FBTCS; 7.9 min [13.6, 22.3]) compared to those without (27.4 min [21.2, 33.6], p = 0.013). Younger subjects had shorter MSL; MSL increased 3.2 min for every 10-year increase in age. CONCLUSION We found a high prevalence of objective sleepiness/difficulty maintaining wakefulness on the MWT and subjective sleepiness using the ESS in AWE without a correlation between the two. More severe objective sleepiness was found in subjects with a history of FBTCS and younger age. Further research is needed to determine mechanistic underpinnings and optimal measurements of pathological sleepiness in people with epilepsy given the burden of it on quality of life.
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Villarreal B, Powell T, Brock MS, Hansen S. Diagnosing narcolepsy in the active duty military population. Sleep Breath 2021; 25:995-1002. [PMID: 33629215 DOI: 10.1007/s11325-020-02163-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Narcolepsy type I and type II are central hypersomnias characterized by excessive daytime sleepiness and nocturnal sleep disruptions. These rare disorders make the diagnosis complex, as multiple sleep disorders are known to cause false-positive results on testing. There is a high incidence of sleep disorders in the military, and the diagnosis of narcolepsy can have serious career implications. This study looked to assess for the presence of confounding disorders in patients previously diagnosed with narcolepsy. METHODS We conducted a retrospective analysis of patients aged 18-65 previously diagnosed with narcolepsy at an outside facility, referred for repeat evaluation at the Wilford Hall Sleep Disorders Center. Previous test results from the time of original diagnosis were reviewed if available and compared with repeat evaluation which included actigraphy, in-laboratory polysomnography, and multiple sleep latency testing. RESULTS Of the 23 patients, 2 (9%) retained a diagnosis of narcolepsy after repeat testing. Ten patients (43%) had insufficient sleep syndrome, five (22%) had significant circadian rhythm sleep-wake disorders, and nine (39%) patients were diagnosed with mild obstructive sleep apnea (OSA). Four of the nine patients with OSA (44%) had supine predominant OSA. CONCLUSION Diagnostic testing for narcolepsy may be influenced by the presence of comorbid sleep disorders including sleep-disordered breathing, insufficient sleep duration, and circadian misalignment which are common in active military personnel. This study emphasizes the importance of excluding these comorbid diagnoses in this population.
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Affiliation(s)
- Bernadette Villarreal
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA.
| | - Tyler Powell
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA
| | - Matthew S Brock
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA
| | - Shana Hansen
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA
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Multiple sleep latency test and polysomnography in patients with central disorders of hypersomnolence. Sleep Med 2021; 79:6-10. [PMID: 33453460 DOI: 10.1016/j.sleep.2020.12.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 11/23/2022]
Abstract
A multiple sleep latency test (MSLT) with occurrence of sleep onset REM periods (SOREMP) is considered one of the central diagnostic criteria for narcolepsy according to the International Classification of Sleep Disorders, but its sensitivity and specificity have been questioned. This study aims to describe MSLT and polysomnography (PSG) findings, including frequency and distribution of SOREMP during the day, in a large cohort of patients with central disorders of hypersomnolence (CDH). We retrospectively analyzed electrophysiological data from MSLT and PSG in 370 consecutive patients with narcolepsy type 1 (NT1, n = 97), type 2 (NT2, n = 31), idiopathic hypersomnia (IH, n = 48), nonorganic hypersomnia (NOH, n = 116) and insufficient sleep syndrome (ISS, n = 78). NT1 and NT2 patients had a significantly shorter mean Sleep Latency (mSL) and REM-Latency (REML) in MSLT and PSG. SOREMP occurred more frequently in narcoleptic vs. non-narcoleptic patients in MSLT and PSG. Occurrence of 3 or more SOREMP in MSLT and a SOREMP in PSG had a very high specificity and positive predictive value (98%/96% and 100% respectively), however relatively low sensitivity (65% and 45% respectively). NT1 more than NT2 patients have shorter mSL and more frequent SOREMP in MSLT and shorter SL as well as REML during nocturnal PSG. Increasing numbers of SOREMP in MSLT and especially SOREMP during PSG increase specificity on the expense of sensitivity in diagnosing narcolepsy. Therefore, frequency of SOREMP in MSLT naps and PSG can help to discriminate but not clearly separate narcoleptic from non-narcoleptic patients.
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17
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Pimentel Filho LH, Gomes ACD, Frange C, Tufik S, Coelho FMS. Validation of the Brazilian Portuguese version of the narcolepsy severity scale. Sleep Med 2020; 76:134-139. [PMID: 33166827 DOI: 10.1016/j.sleep.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/22/2020] [Accepted: 10/16/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Narcolepsy type 1 is a sleep disorder and the most common cause of hypersonia of central origin. It is characterized by sleep attacks, cataplexy, sleep-related hallucinations, sleep paralysis and sleep fragmentation in a pleomorphic presentation. The Narcolepsy Severity Scale (NSS), questionnaire which assesses the frequency and impact of the main symptoms of narcolepsy was developed in order to determine its clinical severity, needing translation, cultural adaptation and validation in many languages. The objective is to validate the Brazilian Portuguese version of the NSS. METHODS The Brazilian version of the NSS was translated to Brazilian Portuguese and applied to patients with a diagnosis of narcolepsy type 1 at the Daytime Excessive Sleepiness Service, at Psychobiology Department of the Universidade Federal de São Paulo (UNIFESP) between February 2018 and July 2019. RESULTS A total of 52 patients completed the questionnaire. Cultural adaptations were made to better comprehension of patients. The Brazilian version of the NSS showed high internal consistency, demonstrated by the Cronbach's alpha coefficient of 0.82. It showed good reproducibility capacity, verified through the test-retest, whose intraclass correlation was 0.98. The average severity of Brazilian patients was 33.94 (±11.24), higher than the values found in other population, which also underwent validation of this scale. There was a correlation between sleep latency in diagnostic polysomnography and the NSS. CONCLUSIONS The Brazilian Portuguese version of NSS showed to be valid and reproducible tool for assessing the severity of patients with type 1 narcolepsy and have potential impact on clinical practice.
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Affiliation(s)
| | | | - Cristina Frange
- Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sérgio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | - Fernando Morgadinho Santos Coelho
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
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Lammers GJ, Bassetti CL, Dolenc-Groselj L, Jennum PJ, Kallweit U, Khatami R, Lecendreux M, Manconi M, Mayer G, Partinen M, Plazzi G, Reading PJ, Santamaria J, Sonka K, Dauvilliers Y. Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. Sleep Med Rev 2020; 52:101306. [DOI: 10.1016/j.smrv.2020.101306] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
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Daytime sleep state misperception in a tertiary sleep centre population. Sleep Med 2020; 69:78-84. [DOI: 10.1016/j.sleep.2019.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/13/2019] [Accepted: 12/27/2019] [Indexed: 12/22/2022]
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Grigg-Damberger M, Andrews N, Wang L, Bena J, Foldvary-Schaefer N. Subjective and objective hypersomnia highly prevalent in adults with epilepsy. Epilepsy Behav 2020; 106:107023. [PMID: 32213453 DOI: 10.1016/j.yebeh.2020.107023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Sleepiness is among the most common complaints of people with epilepsy, but objective documentation is lacking. We systematically investigated subjective and objective sleepiness in an observational cross-sectional cohort of adults with epilepsy (AWE). METHODS This is a prospective study of AWE consecutively recruited without foreknowledge of sleep/wake complaints. Polysomnography (PSG) with 18-channel electroencephalography (EEG) followed by multiple sleep latency testing (MSLT) was performed. Patients completed the Epworth Sleepiness Scale (ESS), a single-item question assessing excessive daytime sleepiness (EDS), and a 7-day sleep and seizure diary. Multivariable linear models were used to assess the association between MSLT mean sleep latency (MSL) and interests with adjustment of covariates of interest. Receiver operating characteristics (ROC) analysis was performed to evaluate the discrimination capability of ESS on MSL < 8 min and <5 min and investigate the optimal cutpoints. RESULTS Among 127 AWE (mean age: 38.7 ± 13.7 years), abnormal MSL (<8 min) was observed in 49.6% and MSL <5 min in 31.5%. While 78% reported feeling sleepy during the day on a single-item question, only 24% had elevated scores on the ESS (>10/24). The ESS score was associated with MSL even after adjusting for seizure frequency, antiseizure medication (ASM) standardized dose and number, age, gender, depression and insomnia symptom severity, and apnea-hypopnea index (HPI) and total sleep time on PSG (coefficients [95% confidence interval (CI)]: -0.26 [-0.48, -0.05], p = 0.018). The area under the curve (AUC) of the ESS ROC predicting MSL < 8 min and MSL < 5 min were similar: 0.62 (95%CI: 0.52-0.72) and 0.62 (95%CI: 0.51-0.74). CONCLUSIONS This is the largest prospective cross-sectional observational study to date using MSLT in AWE. We found subjective and objective daytime sleepiness highly prevalent in AWE and not explained by seizure frequency, ASM burden, symptoms of insomnia/depression, or PSG findings although those with MSL < 5 min were more likely to have obstructive sleep apnea (OSA). Pathologic sleepiness with MSL < 8 min was present in half of AWE. Nearly one-third of AWE unselected for sleep/wake complaints had MSL < 5 min, a range typical of narcolepsy.
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Affiliation(s)
- Madeleine Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | - Noah Andrews
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America
| | - Lu Wang
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - James Bena
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - Nancy Foldvary-Schaefer
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America.
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Kawai R, Watanabe A, Fujita S, Hirose M, Esaki Y, Arakawa C, Iwata N, Kitajima T. Utility of the sleep stage sequence preceding sleep onset REM periods for the diagnosis of narcolepsy: a study in a Japanese cohort. Sleep Med 2020; 68:9-17. [PMID: 31999982 DOI: 10.1016/j.sleep.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/14/2019] [Accepted: 04/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The minimum narcolepsy criteria "mean sleep latency (MSL) ≤8 min and ≥2 sleep onset rapid eye movement (REM) periods (SOREMPs) on polysomnography (PSG) and the multiple sleep latency test (MSLT)," according to The International Classification of Sleep Disorders, Third Edition (ICSD-3), are not specific to narcolepsy. Recently, the characteristic sleep stage sequences preceding SOREMPs in narcolepsy have received attention, but their diagnostic utility remains unclear. METHODS We retrospectively reviewed PSG/MSLT records and chart data for 102 Japanese patients with hypersomnia and at least one SOREMP. We examined the sporadic rates of two sleep stage sequences preceding the SOREMPs-wakefulness or stage 1 to REM (W/S1→R) and stage 2 to REM (S2→R)-comparing these between patient groups with narcolepsy type 1 (N = 28), narcolepsy type 2 (N = 19), and other hypersomnia (N = 55). We also examined the utility of three simple indices using the occurrence of W/S1→R SOREMPs for distinguishing between narcolepsy and other hypersomnia in patients who satisfied the minimum narcolepsy criteria. RESULTS W/S1→R SOREMPs were significantly more frequent in narcolepsy than in other hypersomnia, and this tendency was also observed even in the patients who satisfied the minimum narcolepsy criteria. The three indices had moderate sensitivities and specificities for distinguishing between narcolepsy and other hypersomnia in patients satisfying the minimum narcolepsy criteria. CONCLUSIONS The W/S1→R pattern was observed significantly more frequently in narcolepsy than in other hypersomnia, suggesting it may help with differentiating narcolepsy from other hypersomnia in patients demonstrating the narcolepsy criteria, although its ability to do so may be modest.
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Affiliation(s)
- Ryoko Kawai
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Akiko Watanabe
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shiho Fujita
- Department of Laboratory Medicine, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Marina Hirose
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yuichi Esaki
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Chiaki Arakawa
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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Rémi J, Pollmächer T, Spiegelhalder K, Trenkwalder C, Young P. Sleep-Related Disorders in Neurology and Psychiatry. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:681-688. [PMID: 31709972 PMCID: PMC6865193 DOI: 10.3238/arztebl.2019.0681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/07/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep-related disorders are a group of illnesses with marked effects on patients' quality of life and functional ability. Their diagnosis and treatment is a matter of common interest to multiple medical disciplines. METHODS This review is based on relevant publications retrieved by a selective search in PubMed (Medline) and on the guide- lines of the German Society for Sleep Medicine, the German Neurological Society, and the German Association for Psychiatry, Psychotherapy and Psychosomatics. RESULTS A pragmatic classification of sleep disorders by their three chief complaints-insomnia, daytime somnolence, and sleep-associated motor phenomena-enables tentative diagnoses that are often highly accurate. Some of these disorders can be treated by primary care physicians, while others call for referral to a neurologist or psychiatrist with special experience in sleep medicine. For patients suffering from insomnia as a primary sleep disorder, rather than a symptom of another disease, meta-analyses have shown the efficacy of cognitive behavioral therapy, with high average effect sizes. These patients, like those suffering from secondary sleep disorders, can also benefit from drug treatment for a limited time. Studies have shown marked improvement of sleep latency and sleep duration from short-term treatment with benzodiazepines and Z-drugs (non- benzodiazepine agonists such as zolpidem and zopiclone), but not without a risk of tolerance and dependence. For sleep disorders with the other two main manifestations, specific drug therapy has been found to be beneficial. CONCLUSION Sleep disorders in neurology and psychiatry are a heterogeneous group of disorders with diverse manifestations. Their proper diagnosis and treatment can help prevent secondary diseases and the worsening of concomitant conditions. Care structures for the treatment of sleep disorders should be further developed.
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Affiliation(s)
- Jan Rémi
- Department of Neurology, Medical Center of the Ludwig-Maximilians–University of Munich (LMU), Germany
| | | | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Medical Faculty, University of Freiburg, Germany
| | - Claudia Trenkwalder
- Center of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany and Department of Neurosurgery, University Medical Center Göttingen, Germany
| | - Peter Young
- Specialized Clinic for Therapies in Neurology, Medical Park Reithofpark, Bad Feilnbach, Germany
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Pizza F, Filardi M, Moresco M, Antelmi E, Vandi S, Neccia G, Mazzoni A, Plazzi G. Excessive daytime sleepiness in narcolepsy and central nervous system hypersomnias. Sleep Breath 2019; 24:605-614. [DOI: 10.1007/s11325-019-01867-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023]
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Sarkanen T, Alakuijala A, Partinen M. Ullanlinna Narcolepsy Scale in diagnosis of narcolepsy. Sleep 2019; 42:5208781. [PMID: 30476331 DOI: 10.1093/sleep/zsy238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/12/2018] [Indexed: 01/06/2023] Open
Abstract
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 (rs = -.564, p < .001), and mean sleep latency in multiple sleep latency test (rs= -.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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Affiliation(s)
- Tomi Sarkanen
- Department of Neurology, Tampere University Hospital, Tampere, Finland
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Anniina Alakuijala
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Partinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
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