Abstract
The interpretation of the Maintenance Wakefulness Test (MWT) relies on sleep onset detection. However, microsleeps (MSs), i.e., brief periods of sleep intrusion during wakefulness, may occur before sleep onset. We assessed the prevalence of MSs during the MWT and their contribution to the diagnosis of residual sleepiness in patients treated for obstructive sleep apnea (OSA) or hypersomnia. The MWT of 98 patients (89 OSA, 82.6% male) were analyzed for MS scoring. Polysomnography parameters and clinical data were collected. The diagnostic value for detecting sleepiness (Epworth Sleepiness Scale > 10) of sleep onset latency (SOL) and of the first MS latency (MSL) was assessed by the area under the receiver operating characteristic (ROC) curve (AUC, 95% CI). At least one MS was observed in 62.2% of patients. MSL was positively correlated with SOL (r = 0.72, p < 0.0001) but not with subjective scales, clinical variables, or polysomnography parameters. The use of SOL or MSL did not influence the diagnostic performance of the MWT for subjective sleepiness assessment (AUC = 0.66 95% CI (0.56, 0.77) versus 0.63 95% CI (0.51, 0.74)). MSs are frequent during MWTs performed in patients treated for sleep disorders, even in the absence of subjective sleepiness, and may represent physiological markers of the wake-to-sleep transition.
Highlights
Introduction iationsExcessive daytime sleepiness affects more than 5% of the general population [1].Its consequences involve both the academic/professional area, with impaired cognitive performances [2], and the risk of accidents, especially on the road [3]
Obstructive sleep apnea syndrome (OSA) and hypersomnia significantly increase the risk of accidents, which highlights the importance of sleepiness assessment in patients suffering from these disorders [5,6,7,8]
The Epworth Sleepiness Scale (ESS) was normal in 66.3% of patients and the Observation and Interview-based Diurnal Sleepiness Inventory (ODSI) score was normal in 57.5%
Summary
Excessive daytime sleepiness affects more than 5% of the general population [1]. Its consequences involve both the academic/professional area, with impaired cognitive performances [2], and the risk of accidents, especially on the road [3]. A recent metaanalysis reported an increased risk of motor vehicle accidents 1.87, 3.39)) associated with sleepiness at the wheel [4]. Obstructive sleep apnea syndrome (OSA) and hypersomnia significantly increase the risk of accidents, which highlights the importance of sleepiness assessment in patients suffering from these disorders [5,6,7,8].
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