0505 Maintenance of Wakefulness Test Characteristics In Pediatric Populations With Central Hypersomnia

Abstract

Abstract Introduction Children with central hypersomnia often have residual daytime sleepiness despite treatment with medical therapies. The Maintenance of Wakefulness Test (MWT) is an objective measure used to assess daytime alertness and responsiveness to treatment in patients with hypersomnia. There are limited data on MWT characteristics among pediatric populations. The purpose of this study was to: (1.) Compare MWT characteristics and subjective assessment between patients who passed and failed the MWT; (2.) Determine clinical management changes following MWT. Methods A retrospective review was conducted of all children who underwent MWT at Cincinnati Children’s Hospital Medical Center from September, 2008 to June, 2021. Pass and fail assessment designations were determined by the clinician as recorded in the medical record. Demographics, Epworth Sleepiness Scores (ESS), MWT characteristics, and pharmacological modifications were recorded. A majority of patients underwent MWT prior to driving. Descriptive statistics as well as Chi-square, Fisher’s exact, and Wilcoxon rank-sum testing were utilized. All variables were reported as medians with interquartile ranges. Results 109 MWTs were performed on 79 children with a median age of 17.7 years [16.6, 18.6]. MWTs were indicated for 4 primary diagnoses: hypersomnia (n=5), idiopathic hypersomnia (n=11), narcolepsy type 1 (n=56), and narcolepsy type 2 (n=37). 55 (50.5%) were documented as pass (P) and 54 as fail (F). No differences in age (17.5 years) [16.2,18.5] (P) vs. (17.8) [16.9,18.9] (F) (p=NS) or other demographics existed between the two groups. As expected, mean sleep latency was significantly higher among those who passed (37.3 minutes) [31.2,40.0] (P) vs. (10.8) [7.9,16.6] (F) (p<0.001). However, no significant differences were observed in ESS 12.0 [8.0,17.0] (P) vs. 11.0 (6.0,14.0) (F) (p=NS). Pharmacologic adjustments were made in 42/54 (77.8%) (F) vs. 17/54 (31.5%) (P). Medications were not modified in 12/54 (22.2%) (F) assessments. Conclusion MWT provides useful objective assessment and often leads to management changes in adolescents with central hypersomnia. A subjective sleepiness assessment (ESS) does not correlate with objective MWT assessments. We speculate that an altered perception of sleepiness in children with hypersomnia may play a role in the inaccuracy of subjective assessments commonly utilized in clinical practice. Support (If Any) Cincinnati Children’s Research Foundation.