Distinguishing between children referred for assessment of excessive daytime sleepiness using polysomnographic measures.

Abstract

BackgroundCurrently, diagnosing narcolepsy and idiopathic hypersomnia (IH) in subjectively sleepy children requires an overnight polysomnographic sleep study followed by a daytime multiple sleep latency test (MSLT). We aimed to compare sleep macro-architecture to identify differences between these groups. MethodsAll children referred for a MSLT between May 2010 to December 2023 whose parent consented for their data be used in research were eligible. Each child was age- and sex- matched to a control. Sleep stability was defined as the maintenance of a particular sleep stage before waking or transitioning to another sleep state. As a measure of sleep disturbance, the number and duration of bouts of each sleep stage was recorded. Results28 children with Narcolepsy, 11 with IH and 26 with subjective sleepiness were included. Children with narcolepsy exhibited higher numbers of transitions to wake after sleep onset compared to their controls and to the subjectively sleepy group (p<0.001 for both). The number of REM bouts was greater in the narcolepsy group compared to their control group (p<0.001), the IH group (p<0.05) and the subjectively sleepy group (p<0.05), while the average duration of REM bouts was shorter in the narcolepsy group compared to both the IH group (p<0.05) and subjectively sleepy group (p<0.05). Mean sleep latency on the MSLT was correlated with a number of polysomnographic variables. ConclusionsOur study suggests that specific sleep architecture patterns could potentially serve as diagnostic biomarkers for distinguishing paediatric narcolepsy from those with IH and those with a non-diagnostic MSLT.