Dataset Information

Multimodal assessment increases objective identification of hypersomnolence in patients referred for multiple sleep latency testing.

ABSTRACT:

Study objectives

The multiple sleep latency test (MSLT) has limitations when evaluating disorders of hypersomnolence with unknown etiology. Alternative measures of hypersomnolence may objectively identify pathology in patients with complaints of daytime sleepiness that may not be captured by the MSLT alone. This study evaluated the impact of a multimodal hypersomnolence assessment relative to MSLT in patients with unexplained hypersomnolence.

Methods

Seventy-five patients with unexplained hypersomnolence were included in the analyzed sample. Polysomnography was performed without prescribed wake time, and the psychomotor vigilance task and pupillographic sleepiness test were completed between MSLT nap opportunities. Presence or absence of hypersomnolence for each assessment was defined using a priori cutpoints. Proportions of patients identified as hypersomnolent using the multimodal assessment relative to MSLT alone were evaluated, as well as the sensitivity and specificity of ancillary hypersomnolence measures relative to MSLT as a gold standard.

Results

The multimodal assessment more than doubled the proportion of patients identified as having objective deficits relative to MSLT ≤ 8 minutes alone. The combination of excessive sleep duration, lapses on the psychomotor vigilance task, and impairments on the pupillographic sleepiness test also had perfect sensitivity in identifying all patients identified as sleepy by the MSLT across 3 different MSLT cutpoints (5, 8, and 10 minutes).

Conclusions

These data demonstrate the insufficiency of the MSLT as a singular tool to identify objective pathology in persons with unexplained hypersomnolence. Further efforts to refine and standardize multimodal assessments will likely improve diagnostic acumen and research into the causes of these disorders.

SUBMITTER: Plante DT

PROVIDER: S-EPMC7446098 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Study objectivesPatients presenting with excessive sleepiness are frequently using 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.MethodsAdult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014 and 2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement-suppressing antidepressants (REMS-ADs) 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 in patients who were using REMS-ADs and discontinued prior to testing versus those who remained on REMS-ADs were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT, wherever feasible; fluoxetine is stopped 6 weeks prior. Regression analyses accounting for demographic, clinical, and other medication-related confounders were performed.ResultsA total of 502 patients (age = 38.18 ± 15.90 years; 67% female) underwent MSLT; 178 (35%) were taking REMS-ADs at the time of assessment. REMS-AD was discontinued prior to MSLT in 121/178 (70%) patients. Patients whose REMS-AD was discontinued prior to MSLT were more likely to have ≥2 SOREMs (odds ratio: 12.20; 95% confidence interval: 1.60-92.94) compared with patients on REMS-ADs at MSLT. They also had shorter mean sleep latency (8.77 ± 0.46 vs 10.21 ± 0.28 minutes; P > .009) and higher odds of having ≥2 SOREMs (odds ratio: 2.22; 95% confidence interval: 1.23-3.98) compared with patients not taking REMS-ADs at initial assessment. These differences persisted after regression analyses accounting for confounders.ConclusionsPatients who taper off REMS-ADs prior to MSLT are more likely to demonstrate ≥2 SOREMs and have a shorter mean sleep latency. Pending further prospective investigations, clinicians should preferably withdraw REMS-ADs before MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results.