Measurement of Sleepiness/Alertness: Multiple Sleep Latency Test
01 Jan 1994-pp 133-139
TL;DR: The multiple sleep latency test (MSLT) is a test of the rapidity with which a subject falls asleep in a standardized, sleep-conducive setting; the test is repeated at 2-hour intervals throughout the day.
Abstract: Publisher Summary This chapter provides an overview of the multiple sleep latency test (MSLT) for the measurement of sleepiness/alertness. Normal and pathologic variations in daytime sleepiness and alertness—used as antonyms—can be directly assessed and quantified by the MSLT. It is a test of the rapidity with which a subject falls asleep in a standardized, sleep-conducive setting; the test is repeated at 2-hour intervals throughout the day. The MSLT uses standard sleep recording methods to document both the rate of sleep onset and the appearance of rapid eye movement (REM) episodes at sleep onset. Other procedures that have been used to quantify sleepiness/alertness, including pupillometry, subjective rating scales, and tests of vigilance or reaction time, are all correlated to some extent with the MSLT, but because of a variety of shortcomings, these are not widely used. The MSLT has become the standard method in clinical sleep disorders medicine for documenting complaints of excessive daytime sleepiness. It is also used to document sleep onset REM periods, a diagnostic sign of narcolepsy.
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TL;DR: In assessing the clinical significance of mild SDB, it is estimated that an AHI of 15 is equivalent to the decrement in psychomotor efficiency associated with 5 additional yr of age, or to 50% of the decrements associated with hypnosedative use.
Abstract: The relationship of sleep-disordered breathing (SDB) to neuropsychological deficits was investigated with cross-sectional data from the Wisconsin Sleep Cohort Study, a population-based study of the natural history of SDB. A sample of 841 employed men and women ages 30 to 60 yr was studied by overnight polysomnography to assess the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI). Prior to overnight polysomnography, the participants were given a battery of neuropsychological tests for functionally important capacities including motor skills, attention, concentration, information processing, and memory. Principal factor analysis of all the neuropsychological test data revealed a psychomotor efficiency and a memory factor. Multiple regression analysis showed a significant negative association between logarithmically transformed AHI (LogAHI) and psychomotor efficiency score independent of age, gender, and educational status (p = 0.017). The relationship was not explained by self...
285 citations
TL;DR: The present updated guidelines reflect the consensus of a global panel of EEG experts and are intended to assist investigators using pharmaco-EEG in clinical research, by providing clear and concise recommendations and thereby enabling standardisation of methodology and facilitating comparability of data across laboratories.
Abstract: The International Pharmaco-EEG Society (IPEG) presents updated guidelines summarising the requirements for the recording and computerised evaluation of pharmaco-EEG data in man. Since the publication of the first pharmaco-EEG guidelines in 1982, technical and data processing methods have advanced steadily, thus enhancing data quality and expanding the palette of tools available to investigate the action of drugs on the central nervous system (CNS), determine the pharmacokinetic and pharmacodynamic properties of novel therapeutics and evaluate the CNS penetration or toxicity of compounds. However, a review of the literature reveals inconsistent operating procedures from one study to another. While this fact does not invalidate results per se, the lack of standardisation constitutes a regrettable shortcoming, especially in the context of drug development programmes. Moreover, this shortcoming hampers reliable comparisons between outcomes of studies from different laboratories and hence also prevents pooling of data which is a requirement for sufficiently powering the validation of novel analytical algorithms and EEG-based biomarkers. The present updated guidelines reflect the consensus of a global panel of EEG experts and are intended to assist investigators using pharmaco-EEG in clinical research, by providing clear and concise recommendations and thereby enabling standardisation of methodology and facilitating comparability of data across laboratories.
141 citations
TL;DR: An interesting finding was that whereas all other insomnia phenotypes showed evidence of an elevated wake drive both at night and during the day, the 'neither criterion' phenotype did not; this latter phenotype exhibited significantly higher daytime sleepiness despite subthreshold onset and maintenance difficulties.
Abstract: Study objectives We examined the 1-y stability of four insomnia symptom profiles: sleep onset insomnia; sleep maintenance insomnia; combined onset and maintenance insomnia; and neither criterion (i.e., insomnia cases that do not meet quantitative thresholds for onset or maintenance problems). Insomnia cases that exhibited the same symptom profile over a 1-y period were considered to be phenotypes, and were compared in terms of clinical and demographic characteristics. Design Longitudinal. Setting Urban, community-based. Participants Nine hundred fifty-four adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition based current insomnia (46.6 ± 12.6 y; 69.4% female). Interventions None. Measurements and results At baseline, participants were divided into four symptom profile groups based on quantitative criteria. Follow-up assessment 1 y later revealed that approximately 60% of participants retained the same symptom profile, and were hence judged to be phenotypes. Stability varied significantly by phenotype, such that sleep onset insomnia (SOI) was the least stable (42%), whereas combined insomnia (CI) was the most stable (69%). Baseline symptom groups (cross-sectionally defined) differed significantly across various clinical indices, including daytime impairment, depression, and anxiety. Importantly, however, a comparison of stable phenotypes (longitudinally defined) did not reveal any differences in impairment or comorbid psychopathology. Another interesting finding was that whereas all other insomnia phenotypes showed evidence of an elevated wake drive both at night and during the day, the 'neither criterion' phenotype did not; this latter phenotype exhibited significantly higher daytime sleepiness despite subthreshold onset and maintenance difficulties. Conclusions By adopting a stringent, stability-based definition, this study offers timely and important data on the longitudinal trajectory of specific insomnia phenotypes. With the exception of daytime sleepiness, few clinical differences are apparent across stable phenotypes.
69 citations
TL;DR: A close connection with N-C was found particularly in REM behavior disorder (RBD), and association with other sleep disorders had no significant effect on nocturnal sleep (with the exception of obstructive sleep apnea), and the sleep comorbidities under study had no noticeable effect on daytime sleepiness.
Abstract: Narcolepsy-cataplexy (N-C) is a focal neurodegenerative disease with a genetic predisposition and autoimmune etiology; the pathogenesis of narcolepsy without cataplexy (Nw/oC) is less clear. One hundred and forty eight patients underwent clinical face-to face interviews, polysomnography, multiple sleep latency testing and HLA-DQB1*0602 typing. The cohort was divided into four age groups: children and adolescents under 19 years (N = 31), adults aged 20–39 years (N = 51), 40–59 years (N = 28) and over 60 years (N = 38). N-C was found in 93 adults (79.5 %) compared with 16 pediatric patients (51.6 %) (p < 0.01), suggesting that at least some of the children were candidates for developing cataplexy in the future. Statistical evaluation showed an increasing age-related proportion of associated sleep disorders—obstructive sleep apnea, periodic leg movements and restless leg syndrome (p < 0.001). Nw/oC patients showed sleep comorbidities less frequently than N-C group. A close connection with N-C was found particularly in REM behavior disorder (RBD) (p < 0.05). RBD affected a third of the patients in the youngest as well as in the oldest groups. However, association with other sleep disorders had no significant effect on nocturnal sleep (with the exception of obstructive sleep apnea), and the sleep comorbidities under study had no noticeable effect on daytime sleepiness.
50 citations
Cites methods from "Measurement of Sleepiness/Alertness..."
...test of the speed of falling asleep in a standardized, sleepconducive setting repeated at 2-h intervals (9, 11, 13, 15, 17 h)—five times during the following day [30]....
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TL;DR: Narcolepsy in childhood leaves very little scope for the prediction of cataplexy later in life, according to the evaluated clinical and polysomnographic parameters.
37 citations
References
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TL;DR: The Stanford Sleepiness Scale (SSS) as discussed by the authors is a self-rating scale which is used to quantify progressive steps in sleepiness and it is cross-validated with performance on mental tasks.
Abstract: The Stanford Sleepiness Scale (SSS) is a self-rating scale which is used to quantify progressive steps in sleepiness. The present study investigated whether the SSS cross-validates with performance on mental tasks and whether the SSS demonstrates changes in sleepiness with sleep loss. Five college student Ss were given a brief test of memory and the Wilkinson Addition Test in 2 test sessions and The Wilkinson Vigilance Test in 2 other sessions spaced throughout a 16-hr day for 6 days. Ss made SSS ratings every 15 min during their waking activities. On night 4, Ss underwent all night sleep deprivation. On all other nights, Ss were allowed only 8 hrs in bed. Mean SSS ratings correlated r= .68 with performance on the Wilkinson Tests. Discrete SSS ratings correlated r= .47 with performance on the memory test. Moreover, mean baseline SSS ratings were found to be significantly lower than corresponding ratings of the deprivation period.
2,300 citations
1,543 citations
TL;DR: Insomnia, nightmares, and hypersomnia were correlated with more frequent general physical and mental health problems and were often chronic and usually started early in life.
Abstract: The authors determined the prevalence of sleep disorders in a general population through a survey of 1,006 representative households in the Los Angeles metropolitan area. They found an overall prevalence of current or previous sleep disorders in adults of 52.1%. Specifically, they found a 42.5% prevalence of insomnia, 11.2% of nightmares, 7.1% of excessive sleep, 5.3% of sleeptalking, and 2.5% of sleepwalking. These conditions were often chronic and usually started early in life. Insomnia was more frequent in older people, particularly older women, and in people of lower educational socioeconomic status. Insomnia, nightmares, and hypersomnia were correlated with more frequent general physical and mental health problems.
836 citations
TL;DR: The findings suggested that clinical data on symptom control in narcolepsy do not predict ability to stay awake, and objective measures of the ability are potentially more useful in evaluating treatment.
514 citations
TL;DR: During the recovery period, daytime sleepiness returned to basal values on all three measures following one full night of sleep; with a daytime nap, no further cumulative effects of sleep restriction were seen.
Abstract: Sleep and daytime sleepiness were evaluated in 10 young adult subjects to determine whether restricting nocturnal step by a constant amount produces cumulative impairment. Subjects were studied for 12 consecutive days, including 3 baseline days with a 10-hr time in bed, 7 days with sleep restricted to 5 hrs, and 2 recovery days. In 5 subjects, recovery included a 10-hr time in bed; in the remaining subject, recovery induced a 5-hr time in bed with a 1-hr daytime nap. Sleepiness was measured using two self-rating scales and the multiple sleep latency test. During sleep restriction, nocturnal stage 2 and REM sleep were reduced and slow wave sleep was unaffected. Stanford Sleepiness Scales showed an immediate increase in daytime sleepiness that reached a plateau after 4 days. An analog sleepiness rating scale showed increased sleepiness after 2 restricted nights and leveled off after the fourth restricted night. The multiple sleep latency tests showed no effect of sleep restriction until the second day, followed by a progressive increase in sleepiness that persisted through the seventh sleep restriction day. During the recovery period, daytime sleepiness returned to basal values on all three measures following one full night of sleep; with a daytime nap, no further cumulative effects of sleep restriction were seen.
483 citations