特発性過眠症とナルコレプシーの診断にＭＳＬＴ検査は全く意味がない

反復睡眠潜時検査（通称：MSLT検査）は一般人口の約22〜30％が検査で陽性になり、検査結果は再現性にも乏しく、検査を受けた50%以上が４年以内の再検査で検査結果が陽性→陰性に変わってしまいます。

「特発性過眠症は検査で正確に診断できる」と主張される睡眠専門医の方が稀にいらっしゃるそうなのですが（※最近は流石にいなくなりました）、この検査でどのように過眠症を正確に診断できるのか是非教えていただきたいものです。

下記のリンクをご覧ください。

上記の他にも特発性過眠症とナルコレプシー２型の診断に反復睡眠潜時検査（ＭＳＬＴ）を利用することの妥当性に関して、多くの文献で疑問視されています。

下記に引用文献を載せていきます。

"There are however many other studies that also question the validity of the MSLT in diagnosing idiopathic hypersomnia and N2.”
 
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Anderson KN, Pilsworth S, Sharples LD, Smith IE, Shneerson JM, Idiopathic hypersomnia: a study of 77 cases, Sleep 2007, 30, pp. 1274-1281
 
Mignot E, Lin L, Finn L, Lopes C, Pluff K, Sundstrom ML, et al. Correlates of sleep-onset
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Singh M, Drake CL, Roth T, The prevalence of multiple sleep-onset REM periods in a population-based sample Sleep 2006, 29, pp. 890-895
 
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Chervin RD, Aldrich MS, Sleep onset REM periods during multiple sleep latency tests in patients evaluated for sleep apnea. Am J Respir Crit Care Med. 2000 Feb; 161(2 Pt 1): pp.426-31
 
Aldrich MS, Chervin RD, Malow BA, Value of the multiple sleep latency test (MSLT) for the diagnosis of narcolepsy, Sleep 1997 Aug; 20(8): pp.620-9
 
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Rye DB, Bliwise DL, Dihenia B, Gurecki P, FAST TRACK: daytime sleepiness in Parkinson's disease. J Sleep Res. 2000 Mar; 9(1): pp.63-9
 
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Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test, Sleep 2005, 28: pp.113–121
 
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“The current classification relies heavily on the MSLT result despite the test having low sensitivity and specificity for diagnostic purposes”
 
Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. https://doi.org/10.1016/j.smrv.2020.101306
 
E. Mignot, L. Lin, L. Finn, C. Lopes, K. Pluff, M.L. Sundstrom, et al.
Correlates of sleep-onset REM periods during the multiple sleep latency test in community adults
Brain, 129 (Pt 6) (2006), pp. 1609-1623
 
A. Goldbart, P. Peppard, L. Finn, C.M. Ruoff, J. Barnet, T. Young, et al.
Narcolepsy and predictors of positive MSLTs in the Wisconsin sleep cohort
Sleep, 37 (6) (2014), pp. 1043-1051
 
M. Singh, C.L. Drake, T. Roth
The prevalence of multiple sleep-onset REM periods in a population-based sample
Sleep, 29 (7) (2006), pp. 890-895
 
 
“A large number of clinicians and researchers have recently questioned the use of the MSLT as a diagnostic tool. The MSLT may be sensitive to sleep deprivation, sleep-disordered breathing, and circadian sleep disorders.”
 
A Study of the Diagnostic Utility of HLA Typing, CSF Hypocretin-1 Measurements, and MSLT Testing for the Diagnosis of Narcolepsy in 163 Korean Patients With Unexplained Excessive Daytime Sleepiness
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Littner MR, Kushida C, Wise M, et al. Practice parameters for clini- cal use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. Sleep 2005;28:113-21.
 
Bassetti C, Gugger M, Bischof M, et al. The narcoleptic borderland: a multimodal diagnostic approach including cerebrospinal fluid lev- els of hypocretin-1 (orexin A). Sleep Med 2003;4:7-12.
 
Aldrich MS, Chervin RD, Malow BA. Value of the multiple sleep latency test (MSLT) for the diagnosis of narcolepsy. Sleep 1997;20:620-9.
 
Moscovitch A, Partinen M, Guilleminault C. The positive diagnosis of narcolepsy and narcolepsy’s borderland. Neurology 1993;43:55- 60.
 
Mignot E, Lin L, Finn L, et al. Correlates of Sleep onset REM pe- riods during the Multiple Sleep Latency Test in community adults. Brain 2006:129:1609-23
 
Geisler P, Tracik F, Tajana AM, et al. The influence of age and sex on sleep latency in the MSLT-30—a normative study. Sleep 2006;29:687-92
 
Singh M, Drake C, Roth T. The prevalence of multiple sleep-onset REM periods in a population-based sample. Sleep 2006:29:890-5.
 
Chervin RD, Aldrich MS. Sleep onset REM periods during mul- tiple sleep latency tests in patients evaluated for sleep apnea. Am J Respir Crit Care Med 2000;161:426-31.
 
Punjabi NM, Bandeen-Roche K, Young T. Predictors of objective sleep tendency in the general population. Sleep. 2003;26:678-83.
 
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