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Sleepy Kids: are the current diagnostic criteria for multiple sleep latency tests enough?
Aveena Anantharajah1, Margot J Davey2, Gillian M Nixon2
1Melbourne Children's Sleep Centre, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
Insights
Pediatric excessive daytime sleepiness (EDS) diagnosis using the multiple sleep latency test (MSLT) may miss cases with adult criteria. A 12-minute mean sleep latency threshold and fewer naps could improve pediatric narcolepsy and idiopathic hypersomnia detection.
Area of Science:
- Neurology
- Sleep Medicine
- Pediatric Neurology
Background:
- Excessive daytime sleepiness (EDS) is prevalent in children.
- Current diagnostic criteria for EDS via the multiple sleep latency test (MSLT) are based on adult standards.
- The utility of a 12-minute mean sleep latency (MSL) threshold and the impact of a fifth nap in pediatric MSLTs require investigation.
Purpose of the Study:
- To describe pediatric MSLT results using a proposed 12-minute MSL threshold.
- To assess the diagnostic yield of a fifth nap in pediatric MSLTs.
- To evaluate the suitability of current adult MSLT criteria for diagnosing narcolepsy and idiopathic hypersomnia (IH) in children.
Main Methods:
- Retrospective analysis of 214 pediatric MSLTs conducted between 2004 and 2021.
- Application of standard definitions for narcolepsy (MSL ≤8min, ≥2 sleep onset REM periods) and IH (MSL ≤8min, <2 SOREMs).
- Analysis of ambiguous MSLT results (MSL 8-12min and/or ≥2 SOREMs) and the effect of a fifth nap.
Main Results:
- Narcolepsy was diagnosed in 22% (n=48), IH in 10% (n=22), and 21% (n=44) had ambiguous results.
- Ambiguous MSLT results were more common in older children and females.
- A fifth nap rarely altered the MSLT outcome, often increasing the MSL.
Conclusions:
- A significant proportion of pediatric MSLTs yield ambiguous results using adult criteria, potentially leading to missed diagnoses of narcolepsy and IH.
- A modified MSLT protocol with a 12-minute MSL threshold may enhance diagnostic accuracy in children.
- A four-nap MSLT protocol appears sufficient for most pediatric cases, with a fifth nap only necessary in borderline situations.
Abstract:
Excessive daytime sleepiness (EDS) is common in childhood and is currently quantified using adult criteria on a multiple sleep latency test (MSLT). This study aimed to describe paediatric MSLT results, particularly focussing on a previously proposed alternative mean sleep latency (MSL) threshold for children of 12 min, and assess the impact of a 5th nap. We performed a retrospective analysis of MSLTs at a single paediatric centre from 2004 to 2021. Narcolepsy was defined as a mean sleep latency (MSL) ≤8min with ≥2 sleep onset REM (SOREM) periods. Idiopathic Hypersomnia (IH) was defined as a MSL ≤8min with <2 SOREMs. An ambiguous MSLT result was defined as a MSL 8-12min and/or ≥2 SOREM periods. Of 214 MSLTs [50 % female, median age 14.0y (range 3.3-20.1y)], narcolepsy was diagnosed in 48 (22 %), IH in 22 (10 %) and the result was ambiguous in 44 (21 %). Those with ambiguous MSLT results were older (15.6 vs 13.4y, p = 0.006) with a higher proportion of females (61 % vs 35 %, p = 0.01) in comparison to the narcolepsy group. A 5th nap was performed in 60 (28 %) of MSLTs and only changed the outcome in one case. In conclusion, MSLT results are borderline in 21 % of paediatric cases, suggesting that current adult diagnostic criteria may miss narcolepsy and IH in children. A 5th nap usually makes no difference or increases the MSL, suggesting that a four nap MSLT protocol could be used apart from rare cases where the result is borderline after the 4th nap.
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