0408 A Narcolepsy Detection Paradigm: Automated Nocturnal Detection and Notification of Sleep Onset Rapid Eye Movement Periods

Abstract

Abstract Introduction Rapid eye movement (REM) sleep detected by polysomnography (PSG) occurring within 15 minutes of nocturnal sleep (sleep onset REM period; SOREMP) is a known biomarker for hypocretin-deficient narcolepsy. However, the SOREMP is often underappreciated when observed in patients undergoing routine diagnostic sleep testing, evidenced by the paucity of further evaluation for hypersomnia in these individuals. To enhance identification of SOREMP episodes, we developed an automated process to detect and advise sleep clinicians of sleep onset REMs. This study aimed to evaluate the impact of automated SOREMP notification on clinician recommendations for narcolepsy diagnostic evaluation and multiple sleep latency test (MSLT) outcomes. Methods The automated SOREMP notification program was offered to all sleep clinicians within a large multicenter sleep clinic network. De-identified sleep studies were uploaded to a secure data cloud for real-time automated SOREMP detection. Algorithmic-determined SOREMPs underwent human adjudication by a team of expert registered sleep scorers. Clinicians were advised of the presence of SOREMPs within the interpretation platform via a visual banner. Clinician recommendations and future testing (including MSLTs) were naturalistically tracked. Results Of 17,447 sleep studies processed over 3 years, 145 exhibited a SOREMP (0.8%). Five studies were excluded from primary analyses because of a prescheduled MSLT (n=2 narcolepsy; n=2 idiopathic hypersomnia; n=1 “normal”). Of the remaining 140 patients, 19 (14%) were recommended for further narcolepsy evaluation/MSLT; to date, 4 patients have had an MSLT (n=3 narcolepsy; n=1 “normal”). Excluding the PSG SOREMP, MSLT outcomes were #1: 2 SOREMPs and MSL=4.7 min; #2: 3 SOREMPs and MSL=3.0 min; #3: 5 SOREMPs and MSL=4.6 min; #4: 0 SOREMPs and MSL=11.7 min. Conclusion This study implemented enhanced identification and subsequent clinician notification of nocturnal SOREMPs using a novel sensitive SOREMP detection paradigm. This methodology resulted in recommendation of 19 patients, who otherwise may have gone undetected, for further narcolepsy evaluation. When conducted, MSLTs most often supported a narcolepsy diagnosis. This is a call to action for medical providers to critically evaluate patients who exhibit a PSG SOREMP, as it may provide a unique opportunity to identify and treat narcolepsy. Further research is needed to better understand the low referral rate. Support (If Any) Jazz Pharmaceuticals.