Demographic and Nap-Related Variance of the MSLT: Results from 2,498 Suspected Hypersomnia Patients

Publication date: Available online 30 December 2018

Source: Sleep Medicine

Author(s): Alyssa Cairns, Lynn Marie Trotti, Richard Bogan

Abstract

Objective

The purpose of this study was to enhance our understanding of clinical trends in sleep and rapid eye movement (REM) propensity on the multiple sleep latency test (MSLT). Demographic variables of interest included early childhood/advanced age, gender, race, and REM-suppressant use.

Methods

Nocturnal sleep studies and 5-nap multiple sleep latency tests were retrieved from a large repository of deidentified studies from various US sleep clinics between 2007 and 2015. Studies were signal processed, human-edited, and underwent rigorous quality assurance for inclusion.

Results

The final sample consisted of N=2498 MSLTs (24.2% Black, 34.2% Men; Age 4-89). In adults (age>21), sleep propensity modestly decreased across nap (90% at nap 1 to 80% at nap 5; p<.001). Children <12 years were least likely to fall asleep on any nap (∼55% at nap 5). REM propensity troughed at nap 4 (13%) and varied with age. Advanced age (>60 years; OR: 0.28, p<.001), REM-suppressant use (OR:0.52; p<.001), and female sex (men OR: 1.48; p=.012) was associated with a decreased proportion of >2 REMs in adjusted logistic models. Children often demonstrated only 1 REM and generally had long sleep latencies, yielding a low proportion of MSLTs consistent with narcolepsy (11.0% vs. 19.2% and 16.8% in those between 13-59 yr., respectively; p=.003).

Conclusions

MSLT outcomes vary greatly across age, gender, and use of medication. Demographic variance should be considered when interpreting MSLT results. Robust age effects questions the appropriateness of the MSLT as currently designed and implemented for children and older adults.

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