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. 2013 Aug 15;9(8):789-95.
doi: 10.5664/jcsm.2922.

Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia

Lynn Marie Trotti  1 , Beth A Staab, David B Rye
Affiliations

Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia

Lynn Marie Trotti et al. J Clin Sleep Med. .

Abstract

Study objectives: Differentiation of narcolepsy without cataplexy from idiopathic hypersomnia relies entirely upon the multiple sleep latency test (MSLT). However, the test-retest reliability for these central nervous system hypersomnias has never been determined.

Methods: Patients with narcolepsy without cataplexy, idiopathic hypersomnia, and physiologic hypersomnia who underwent two diagnostic multiple sleep latency tests were identified retrospectively. Correlations between the mean sleep latencies on the two studies were evaluated, and we probed for demographic and clinical features associated with reproducibility versus change in diagnosis.

Results: Thirty-six patients (58% women, mean age 34 years) were included. Inter -test interval was 4.2 ± 3.8 years (range 2.5 months to 16.9 years). Mean sleep latencies on the first and second tests were 5.5 (± 3.7 SD) and 7.3 (± 3.9) minutes, respectively, with no significant correlation (r = 0.17, p = 0.31). A change in diagnosis occurred in 53% of patients, and was accounted for by a difference in the mean sleep latency (N = 15, 42%) or the number of sleep onset REM periods (N = 11, 31%). The only feature predictive of a diagnosis change was a history of hypnagogic or hypnopompic hallucinations.

Conclusions: The multiple sleep latency test demonstrates poor test-retest reliability in a clinical population of patients with central nervous system hypersomnia evaluated in a tertiary referral center. Alternative diagnostic tools are needed.

Keywords: CNS hypersomnia; Multiple sleep latency test; idiopathic hypersomnia; narcolepsy without cataplexy; tes-tretest reliability.

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Figures

Figure 1
Figure 1. Bland-Altman plots for test-retest reliability of mean sleep latency and sleep onset REMs
Horizontal dashed lines are drawn at the 95% limits of agreement. MSL, mean sleep latency; MSL1, MSL on first test; MSL2, MSL on second test; SOREMs, sleep onset REM period (SOREM1 and SOREM2 for first and second test, respectively).
Figure 2
Figure 2. MSLT-based diagnosis on repeat MSLT
Arrows represent patients whose diagnosis changed from the first to the second MSLT. MSLT1, first MSLT; MSLT2, second MSLT; SOREMs, sleep onset REM periods. N-C, narcolepsy without cataplexy; IH, idiopathic hypersomnia.
See this image and copyright information in PMC

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