過眠症の診断基準（終夜睡眠ポリグラフ検査PSG＋反復睡眠潜時検査MSLT）の問題点についての引用文献
現在の過眠症の診断基準では健常者の約２２〜３０％（３〜５人に１人）が過眠症（特発性過眠症）が陽性になってしまう問題点などについて、引用文献のまとめを作成いたしました。
現在、特発性過眠症の診断に使用されている終夜睡眠ポリグラフ検査PSGや反復睡眠潜時検査MSLTなどの基準は健常者の一般人口でも約２２〜３０％が過眠症が陽性になるものです。
更に、それらの検査が過去に一度検査が陽性であった方でも４年以内の再検査で４０％以上が陰性になります。
これらの問題は下記に記載の多くの研究で取り上げられてきた事実であり、かつ反説を述べた文献が見当たりません。
現在、「過眠症の診断基準であるPSGやMSLTは様々な研究で有用性が支持されているので毎日８時間睡眠をとって検査をすれば誤診なんて起きない」とおっしゃられる方（時には医療関係者様）がいらっしゃることがありますが、下記の引用文献を呈して「具体的に何が支持をされているのでしょうか」とお伺いをすると回答が返せないような状態です。
MSLTは１９７６年、特発性過眠症の名前が歴史上初めて世間に発表された時に既に存在していた検査です。否定的な論文がこれだけ存在している中で肯定的な論文は発表されていません。
下記の文献の反説を述べた具体的な研究があるのであれば是非ご教授いただきたいと思います。
過眠症の診断の際に最も一般的に利用されている反復睡眠潜時検査（ＭＳＬＴ）の診断基準では一般人口の約２２％～３０％が特発性過眠症の診断基準を満たします。
“How many people do you think fall asleep faster than 8 mins if I just grab them off the street and put them on this test? Like 22%. Do they all have Idiopathic Hypersomnia?”
Hypersomnolence Australia - Dr Rye HF Conference 2018
https://www.hypersomnolenceaustralia.org.au/single-post/2018/11/06/dr-rye-hf-conference-2018
“This results in significant overlap between mean sleep latency values among healthy controls and populations with excessive sleepiness. Pooled data from normal subjects across all ages using the 4 or 5 nap MSLT with sleep onset defined as the latency to the first epoch of any sleep stage, give a mean sleep latency of 10.4 +/- 4.3 minutes and 11.6 +/- 5.2 minutes, respectively.”
Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test An American Academy of Sleep Medicine Report Standards of Practice Committee of the American Academy of Sleep Medicine （※American Academy of Sleep Medicine はICSDの出版元の団体です）
https://doi.org/10.1093/sleep/28.1.113
“To stay consistent with narcolepsy, a MSLT-SL ≤8 min was also extended to define objective EDS in IH, although this cut-off is likely neither sensible nor specific. Indeed, it can be found in ∼30% of the general population”
Daytime continuous polysomnography predicts MSLT results in hypersomnias of central origin
https://doi.org/10.1111/j.1365-2869.2012.01032.x
Littner, M. R., 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: 113–121.
Mignot, E., Lin, L., Finn, L. et al. Correlates of sleep-onset REM periods during the Multiple Sleep Latency Test in community adults. Brain, 2006, 129: 1609–1623.
Singh, M., Drake, C. L. and Roth, T.The prevalence of multiple sleep-onset REM periods in a population-based sample. Sleep, 2006, 29: 890–895.
“Using the MSL ≤ 8 minutes to define IH, according to studies in the general population, indicated that approximately 22% of the population meets this criteria,16–18 risking overdiagnosis of IH as well. ”
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
Singh M, Drake CL, Roth T. The prevalence of multiple sleep-onset REM periods in a population-based sample. Sleep. 2006;29(7):890–895.
Goldbart A, Peppard P, Finn L, et al. Narcolepsy and predictors of positive MSLTs in the Wisconsin Sleep Cohort. Sleep. 2014;37(6):1043–1051.
「正常人口の30%で、8 分以下の平均睡眠潜時が認められる。」
日本睡眠学会「ナルコレプシーの診断・治療ガイドライン」
http://www.jssr.jp/data/pdf/narcolepsy.pdf
過眠症の診断の際の反復睡眠潜時検査（ＭＳＬＴ）の検査前に１日８時間睡眠をとることで「睡眠不足を除外診断した」ということにしている睡眠クリニックが多く存在します。
しかし、その基準はだいぶ問題です。例えば、下記にMSLTの過眠症の診断基準を満たす方が１日８時間の睡眠時間をとってもMSLTの結果が陰性にならないという研究発表があります。一方で同一グループに長期間で１日１０時間よりも多い睡眠時間をとった場合にMSLTの入眠潜時が大きく改善し、MSLTの結果が陰性になるという研究があります。
Sleep Extension in Sleepy and Alert Normals.
https://doi.org/10.1093/sleep/12.5.449
ナルコレプシーの診断基準に関して、健常者の一般人口でも約〜１３％が入眠レム睡（SOREM）２回の診断基準を満たすという研究があります。
反復睡眠潜時検査（ＭＳＬＴ）平均入眠潜時８分以内と入眠レム睡眠（SOREM）２回以上というナルコレプシーの診断基準も一般人口で約２～４％が満たします。
“In one sample of 539 subjects, 3.9% had 2 or more SOREMPs, and 2.5% of subjects met MSLT criteria for narcolepsy with mean sleep latencies ≤ 8 minutes plus ≥ 2 SOREMPs. [2] These findings suggest that in the general population, SOREMPs are not uncommon, especially in subjects with EDS.
A separate cohort study of 556 subjects found a surprisingly high prevalence of positive MSLTs, especially in men [3]: 13.1% of men had ≥ 2 SOREMPs, and 4.1% met the criteria for narcolepsy with ≥ 2 SOREMPs, a mean sleep latency ≤ 8 minutes, and subjective sleepiness (Epworth Sleepiness Scale score > 10). These findings were especially common in shift workers. In contrast, 5.6% of women had ≥ 2 SOREMPs, but only 0.4% had positive MSLTs plus subjective sleepiness. It is possible that some of these subjects have Na-2, but none had cataplexy. A more likely explanation is that the MSLT can produce false-positive results, especially in shift workers.”
Challenges in Diagnosing Narcolepsy without Cataplexy: A Consensus Statement
https://doi.org/10.5665/sleep.3756
2. Singh M, Drake CL, Roth T. The prevalence of multiple sleep-onset REM periods in a population-based sample, Sleep, 2006, vol. 29 (pg. 890-5)
3. Mignot E, Lin L, Finn L, Lopes C, Pluff K, Sundstrom ML, Young T. Correlates of sleep-onset REM periods during the multiple sleep latency test in community adults, Brain, 2006, vol. 129 (pg. 1609-23
”However, studies as early as 1997 by Aldrich et al., [15] and later in population-based samples, [16–18] suggested that widespread administration of the MSLT was bound to generate an increased number of false positives, estimated at 2.5% to 4.7% in large case series, [15–19] due, in part, to the high frequency of sleep apnea diagnoses in patients presenting to sleep clinics. [19] Extended studies in large sets of population-based controls16–18 have also shown that the MSLT can also be confounded by shift work or circadian misalignment, and to a lesser extent by chronic sleep restriction. [18,20]“
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
15. Aldrich MS, Chervin RD, Malow BA. Value of the multiple sleep latency test (MSLT) for the diagnosis of narcolepsy. Sleep. 1997;20(8):620–629.
16. Singh M, Drake CL, Roth T. The prevalence of multiple sleep-onset REM periods in a population-based sample. Sleep. 2006;29(7):890–895.
17. Mignot E, Lin L, Finn L, et al. Correlates of sleep-onset REM periods during the Multiple Sleep Latency Test in community adults. Brain. 2006;129(Pt 6):1609–1623.
18. Goldbart A, Peppard P, Finn L, et al. Narcolepsy and predictors of positive MSLTs in the Wisconsin Sleep Cohort. Sleep. 2014;37(6):1043–1051.
19. 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;161(2 Pt 1):426–431.
20. Marti I, Valko PO, Khatami R, Bassetti CL, Baumann CR. Multiple sleep latency measures in narcolepsy and behaviourally induced insufficient sleep syndrome. Sleep Med. 2009;10(10):1146–1150.
“We report on the prevalence and correlates of SOREMPs in the community-based Wisconsin Sleep Cohort Study. MSLTs were conducted following nocturnal polysomnography (NPSG) and daily sleep diaries in 289 males and 267 females (age 35–70, 97% Caucasians). Multiple SOREMPs were observed in 13.1% of males and 5.6% of females. An MSLT mean sleep latency ≤8 min and ≥2 SOREMPs (diagnostic of narcolepsy) was observed in 5.9% (males) and 1.1% (females), all without cataplexy.”
“Our finding of high SOREMP prevalence in a representative sample also agrees with more recent, largely unpublished data in healthy individuals. Bishop et al. (1996) studied 139 healthy, drug-free volunteers without sleep-related symptoms, medical or psychiatric conditions. These volunteers were young (mean age = 33) subjects without habitual napping habits wanting to enter pharmacological protocols. NPSG indicated no sleep apnea and adequate TST. A surprisingly high prevalence of ≥2 SOREMPs (24 subjects, 17%) was observed. As in our study, subjects with multiple SOREMP were mostly male (75 versus 47%). Multiple SOREMP was found to be related to MSL during the MSLT but not to subjective reports of daytime sleepiness, as evaluated using the EPW scale. This report generated a considerable amount of controversy (Rye and Bliwise, 1997) and was largely ignored. Since then, however, two studies, published as abstracts, have also suggested a high prevalence of SOREMPs in normal individuals. In the first, Geisler et al. (1998) studied 100 normal volunteers aged 20–69 years old selected on the basis of an absence of any sleep problems and excessive daytime sleepiness, and found 11% with ≥1 SOREMPs and 3% with ≥2 SOREMPs. Most recently, Singh et al. (2005) studied 539 subjects, 333 of whom were randomly selected and 206 subjectively sleepy, and found that 3.9% had ≥2 SOREMPs. In this study, short sleep latency on the MSLT but not NPSG TST or EPW predicted ≥2 SOREMPs. Together with the present study, these preliminary reports indicate that the high prevalence of ≥2 SOREMP is not limited to patients with sleep disorders (e.g. sleep apnea), but extend to the general population.”
Correlates of sleep-onset REM periods during the Multiple Sleep Latency Test in community adults
https://doi.org/10.1093/brain/awl079
Bishop C, Rosenthal L, Helmus T, Roehrs T, Roth T. The frequency of multiple sleep onset REM periods among subjects with no excessive daytime sleepiness, Sleep, 1996, vol. 19 (pg. 727-30)
Rye DB, Bliwise DL. Frequency of multiple sleep onset REM periods in ‘control’ subjects, Sleep, 1997, vol. 20 (pg. 813-4)
Geisler P, Cröhnlein T, Tracik F, Zulley J. MSLT: sleep latency in normals is age and sex related, J Sleep Res, 1998, vol. 7 Suppl 2pg. 99
Singh M, Drake C, Roehrs T, Koshorek G, Roth T, et al. The prevalence of SOREMPs in the general population, Sleep, 2005, vol. 28 pg. A221
反復睡眠潜時検査（ＭＳＬＴ）は再現性に乏しく、その検査で一度診断を受けた半数以上の症例が再度同じ検査を受けるだけで過眠症の診断結果の陰性／陽性が変わってしまいます。
“It is not uncommon for patients to have several polysomnography/MSLT in the pursuit of the ‘right’ diagnosis despite us knowing that “when the MSLT is repeated the diagnosis can change 50% of the time.”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
Trotti LM, Staab BA, Rye DB, Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia, J Clin Sleep Med 2013;9, pp.789–95
Voderholzer U, Backhaus J, Hornyak M, et al. A 19-h spontaneous sleep period in idiopathic central nervous system hypersomnia J Sleep Res, 19 (1998), pp. 219–223
“On repeat testing, only 17 patients (47%) retained the same diagnosis”
Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia
https://doi.org/10.5664/jcsm.2922
“Both MSLTs in unmedicated patients were positive for narcolepsy in 78%, 18%, and 7% of NT1, NT2, and controls, respectively. NT2 cases changed to idiopathic hypersomnia or to a negative MSLT 26% and 57% of the time, respectively.”
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study.
https://doi.org/10.5664/jcsm.6882
”A recent study, for example, found that 10 of 15 subjects in whom a diagnosis of NT2 was made on their first MSLT were reclassified as either normal (n = 7) or IH (n = 3) upon repeat testing.“
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
Trotti LM, Staab BA, Rye DB. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia. J Clin Sleep Med. 2013;9(8):789–795.
“These weaknesses result in low test-retest reliability of the MSLT. Among 18 individuals with Na-2 who had two MSLTs, fewer than half showed positive MSLT results on both studies.19 In addition, a recent study of 36 patients with Na-2 and other CNS hypersomnias showed that after a second MSLT, differences in mean sleep latencies and number of SOREMPs spurred a change in diagnosis in 53% of patients.21 “
Challenges in Diagnosing Narcolepsy without Cataplexy: A Consensus Statement
https://doi.org/10.5665/sleep.3756
19. Andlauer O, Moore H, Jouhier L, et al. Nocturnal REM sleep latency for identifying patients with narcolepsy/hypocretin deficiency, JAMA Neurol, 2013, vol. 70 (pg. 891-902)
21. Trotti LM, Staab BA, Rye DB. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia, J Clin Sleep Med, 2013, vol. 9 (pg. 789-95)
“The current classification relies heavily on the MSLT result despite the test having low sensitivity and specificity for diagnostic purposes. Moreover, more recently, the consistency of the MSLT result over time is suggested to be unreliable for several diagnoses”
Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. https://doi.org/10.1016/j.smrv.2020.101306
L.M. Trotti, B.A. Staab, D.B. Rye
Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia
J Clin Sleep Med, 9 (8) (2013), pp. 789-795
A. Cairns, L.M. Trotti, R. Bogan
Demographic and nap-related variance of the MSLT: results from 2,498 suspected hypersomnia patients: clinical MSLT variance
Sleep Med, 55 (2019), pp. 115-123
R. Lopez, A. Doukkali, L. Barateau, E. Evangelista, S. Chenini, I. Jaussent, et al.
Test-Retest reliability of the multiple sleep latency test in central disorders of hypersomnolence
Sleep, 40 (12) (2017)
過眠症の反復睡眠潜時検査（MSLT）の問題は再検査をすることにより、特発性過眠症であるかナルコレプシーであるかの両者の間で診断名が変わるだけではありません。
特発性過眠症やナルコレプシー２型の診断を受ける４０％以上の人が平均４年間の間に再検査で「過眠症かそうではないか」の閾値である「MSLT８分以内か以上か」の結果が変わってしまいます。
“MSLT-based diagnoses of narcolepsy without cataplexy and idiopathic hypersomnia demonstrated poor stability in clinical practice among patients evaluated in a tertiary clinic. Diagnoses changed in half of patients over an average of four years. This occurred because of changes in both sleepiness level (i.e., the MSL) and the propensity for REM sleep (i.e., SOREMs). Over 40% of patients had a change in MSL that crossed the conventional hypersomnia threshold of 8 minutes.”
Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia
https://doi.org/10.5664/jcsm.2922
反復睡眠潜時検査（ＭＳＬＴ）は偽陰性率も高く、本物のナルコレプシー１型の患者さんでも約７％がMSLT検査で陰性（＝過眠症ではないという結果）となります。
“In a recent study, Andlauer found that the MSLT was falsely negative in 7% of Na-1 patients.”
Challenges in Diagnosing Narcolepsy without Cataplexy: A Consensus Statement
https://doi.org/10.5665/sleep.3756
Andlauer O, Moore H, Jouhier L, et al. Nocturnal REM sleep latency for identifying patients with narcolepsy/hypocretin deficiency, JAMA Neurol, 2013, vol. 70 (pg. 891-902
“In a recent study of 479 patients with narcolepsy with cataplexy and 509 controls, specificity and sensitivity were 98.6% and 92.9%, respectively”
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
Andlauer O, Moore H, Jouhier L, et al. Nocturnal rapid eye movement sleep latency for identifying patients with narcolepsy/hypocretin deficiency. JAMA Neurol. 2013;70(7):891–902.
反復睡眠潜時検査（ＭＳＬＴ）は長時間睡眠を伴う特発性過眠症（いわゆる「本物」と言われている形態の特発性過眠症）の約７０％以上に偽陰性を示します。
“MSLT requirements are especially problematic for patients with IH [25,26] because: (1) false-negative MSLT results have been reported in 71% of cases with IH with long sleep times [27]; ”
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
25. Ozaki A, Inoue Y, Hayashida K, et al. Quality of life in patients with narcolepsy with cataplexy, narcolepsy without cataplexy, and idiopathic hypersomnia without long sleep time: comparison between patients on psychostimulants, drug-naive patients and the general Japanese population. Sleep Med. 2012;13(2):200–206.
26. Dauvilliers Y, Paquereau J, Bastuji H, Drouot X, Weil JS, Viot-Blanc V. Psychological health in central hypersomnias: the French Harmony study. J Neurol Neurosurg Psychiatry. 2009;80(6):636–641.
27. Vernet C, Arnulf I. Idiopathic hypersomnia with and without long sleep time: a controlled series of 75 patients. Sleep. 2009;32(6):753–759.
“An 8-minute MSL threshold, for example, fails to capture 22% to 39% of patients who otherwise meet clinical criteria for a CNS hypersomnia. [9,12] Consistent with this, an average MSL of 8.3 minutes has been reported for patients with idiopathic hypersomnia. [13] Type I error may also be problematic, as MSL < 8 was reported in 25% of one population-based sample. [14] Collectively, these studies and our data call into question the appropriateness of an 8-minute threshold in capturing the complaint of sleepiness expressed by patients with nonhypocretin deficient CNS hypersomnias, and differentiating it from asymptomatic controls.”
Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia
https://doi.org/10.5664/jcsm.2922
9. Vernet C, Arnulf I. Idiopathic hypersomnia with and without long sleep time: a controlled series of 75 patients. Sleep. 2009;32:753–9.
12. Pizza F, Vandi S, Detto S, et al. Different sleep onset criteria at the multiple sleep latency test (MSLT): an additional marker to differentiate central nervous system (CNS) hypersomnias. J Sleep Res. 2011;20:250–6.
13. Anderson KN, Pilsworth S, Sharples LD, Smith IE, Shneerson JM. Idiopathic hypersomnia: a study of 77 cases. Sleep. 2007;30:1274–81.
14. Mignot E, Lin L, Finn L, et al. Correlates of sleep-onset REM periods during the Multiple Sleep Latency Test in community adults. Brain. 2006;129:1609–23.
反復睡眠潜時検査（MSLT）では長時間睡眠を伴う特発性過眠症の半数以上の患者さんの検査結果が１０分以上です。このことに関しては世界で一番大きな特発性過眠症（過眠症）の研究啓発機関からも発表されています。
“Spontaneous sleep periods of up to 19 hours have been reported in idiopathic hypersomnia, despite a normal MSL (11 mins). [47] With regards to the MSLT and 24-hr continuous ad libitum sleep polysomnography Billiard said in his paper, Idiopathic Hypersomnia [39];”
“Perhaps the most significant difference between the two groups is that while all the patients without long sleep had MSL <8 min, “71% of patients with long sleep time have normal MSL (MSL > 8 min) during MSLT, reinforcing the idea that the latter test is poorly sensitive for diagnosing hypersomnia”. [2] In fact, more than half of the patients with long sleep time had MSL > 10 min. ‘These results support the idea that hypersomniacs would not fall asleep as quickly as narcoleptic patients (i.e., without rapid shift from wakefulness to sleep). In contrast, they would have difficulty waking spontaneously after sleep (i.e., difficulty shifting from sleep to wake), which could result in severe cases in sleep drunkenness.’ [2]”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review.
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
47. Voderholzer U, Backhaus J, Hornyak M, et al. A 19-h spontaneous sleep period in idiopathic central nervous system hypersomnia J Sleep Res, 19 (1998), pp. 219–223
39. Billiard M, Idiopathic hypersomnia, Neurologic Clinics, 1996; 14: pp.573–582
2. Vernet C, Arnulf I, Idiopathic hypersomnia with and without long sleep time: a controlled series of 75 patients, Sleep 2009 Jun; 32(6): pp.753-9
長時間睡眠を伴う特発性過眠症の患者さんの約７０％以上が反復睡眠潜時検査（ＭＳＬＴ）の８分以内の結果が陰性になってしまうことに関して、世界で一番大きな過眠症のカンファレンスを開いているアメリカの団体からも同様の発表があります。
同発表では一般人口の約８％が約９時間の睡眠を取っていることを示唆する研究についても取り上げられています。
“Some surveys suggest around 8% of people sleep for more than 9 hours per day, and 1.6% of people report sleepiness intruding on their waking activities. One of the tests we commonly use, the MSLT, whilst helpful, can be negative in people with all the other symptoms of IH. In one study, 71% of people with long sleep times and other symptoms of IH had a mean sleep latency of > 8 minutes. “
Hypersomnia Foundation - What’s New in the Diagnosis and Treatment of Hypersomnia in 2016?
https://www.hypersomniafoundation.org/hypersomnia2016/
長時間睡眠を伴う完全型の形態の特発性過眠症は遺伝要素が強く、夜間の睡眠が長時間に及ぶことや起床困難などのその他一連の諸症状が一貫しています。このような理由で長時間睡眠を伴う完全型の形態のみが本物の特発性過眠症であるという説が支持を得ています。
“Polygraphically we found a significantly longer duration of night sleep in the complete form when the subjects were allowed to sleep at will. According to the characteristic difficulty waking up, it could be that the complete form is the only genuine idiopathic hypersomnia and that the incomplete form awaits further study. [39]”
“Another interesting point in Billiard’s study is that a marked family pattern has been evidenced by different authors and that their ‘results are similar and emphasize the very strong genetic component of idiopathic hypersomnia’. Bassetti and Dauvilliers have stated that Idiopathic Hypersomnia can present in families, although these individuals are more likely to have long sleep time. [46]“
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
39. Billiard M, Idiopathic hypersomnia, Neurologic Clinics, 1996; 14: pp.573–582
46. Dauvilliers Y, Bassetti CL, Principles and Practice of Sleep Medicine (Sixth Edition) 2017, e.4, c.91 Idiopathic Hypersomnia, pp.883–891
“Idiopathic hypersomnia with long sleep seems an independent clinical entity with a strong genetic predisposition”
- S. Nevsimalova （2017 World Sleep Society Congress in Prague）
“Nevsimalova who is a student of Bedrich Roth who first coined the term idiopathic hypersomnia,
I think made an insightful comment, which I think several many of us are starting to agree with, is that idiopathic hypersomnia, particularly the type with long sleep is a clinical entity with a strong genetic predisposition. “
Dr. David Rye from 2018 Hypersomnia Foundation Conference
https://www.youtube.com/watch?v=xTiUAPgsTXY 03:40-04:02
研究者から「ナルコレプシー２型がナルコレプシーなのは名前だけではないか?ナルコレプシー２型がナルコレプシーなのは反復睡眠潜時検査（ＭＳＬＴ）という検査がその結果を示すということのみによってのみではないか?」という疑問が上がっています。
“Since hypocretin/orexin deficiency has been found to be unique in N1 and the knowledge that there is no test that can confidently diagnosis N2 and no biomarkers that can identify it, it has been asked, is N2 actually narcolepsy, or more specifically ‘does N2 only exist because of the existence of the MSLT and the at-time controversial results it yields?’ Is N2, narcolepsy in name only? “
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
Mayer G, Lammers G, The MSLT: More Objections than Benefits as a Diagnostic Gold Standard? Sleep 2014 Jun 1; 37(6): pp.1027–1028
世界的に有名な研究者の方々もナルコレプシー２型はナルコレプシー１型と名前が同じだけであり、ナルコレプシー２型と１型は全く別の疾患であるという認識をしています。
“Khan and Trotti noted that N1 and N2 have ‘now been recognized to be quite different entities despite their similar nomenclature’.”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
Trotti, LM, Answers Questions on Diagnostics Relating to Hypersomnia, Hypersomnia Foundation, June 20, 2017
ナルコレプシー２型は不完全型の特発性過眠症と同一疾患であるという説が支持を得ています。
“The concept of narcolepsy type 2 is becoming more and more meaningless”
- E Mignot 2017 World Sleep Society Congress in Prague.
“I believe idiopathic hypersomnia & Narcolepsy Type 2 to be the same disease”
-M. Partinen 2017 World Sleep Society Congress in Prague.
“the present study gives credit to those in favour of merging the former IH w/o LST and narcolepsy type 2 into a single condition, combining monosymptomatic hypersomnia/narcolepsy type 2, and considering polysymptomatic hypersomnia (formerly IH with LST) as a unique form of idiopathic hypersomnia.”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
Šonka K, Susta M, Billiard M, Narcolepsy with and without cataplexy, idiopathic hypersomnia with and without long sleep time: a cluster analysis. Sleep Medicine February 2015;16 (2), pp.225–231
“Our results suggest that continued adherence to the 8-minute MSL threshold in defining hypersomnia syndromes in clinical practice is problematic. The distinction between narcolepsy without cataplexy and idiopathic hypersomnia based on MSLT testing alone also does not appear justified. “
Test-Retest Reliability of the Multiple Sleep Latency Test in Narcolepsy without Cataplexy and Idiopathic Hypersomnia
https://doi.org/10.5664/jcsm.2922
世界で一番歴史のある特発性過眠症の研究啓発団体が「エプワース眠気尺度と反復睡眠潜時検査（ＭＳＬＴ）は有用な検査ではないことが判明している」と発表しており「これらの検査の結果を持って特発性過眠症の長時間睡眠を伴う型と伴わない型とが同一のカテゴリーにされているというのは皮肉です」という見解を発表しています。
“It is therefore ironic that the ICSD3 “now pools both conditions (with and without long sleep time) into one heterogeneous condition because researchers were unable to objectively separate both forms of the disease based on the length of nocturnal sleep; patients above the cut-off of 10 hours of sleep showed no significant differences in daytime sleepiness assessed by the Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT)..” [46] considering that neither the ESS or the MSLT have been found to be reliable objective tests.”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review.
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
46. Dauvilliers Y, Bassetti CL, Principles and Practice of Sleep Medicine (Sixth Edition) 2017, e.4, c.91 Idiopathic Hypersomnia, pp.883–891
反復睡眠潜時検査（ＭＳＬＴ）は数々の研究者から酷評を受けており、睡眠障害国際分類（ICSD）の診断基準改定に関する公式会議や特発性過眠症の専門学会でも検査基準としての廃止発表・廃止案の発表がありました。
Dr. David Rye from 2018 Hypersomnia Foundation Conference
(世界で一番大きな特発性過眠症・過眠症の専門学会の発表)
https://www.youtube.com/watch?v=xTiUAPgsTXY 0:30~0:45
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
（世界で一番大きな特発性過眠症専門研究啓発機関の発表）
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. （ICSD−３の改訂に関する会議）
https://doi.org/10.1016/j.smrv.2020.101306
睡眠障害国際分類第３班（ICSD-3）は自らが自らの結論に対する矛盾したデータを引用しているのです。
“There is an assumption that if it (diagnostic criteria, treatment etc) works well for narcolepsy then it will work well for idiopathic hypersomnia despite the authors of the ICSD-2 citing data that actually contradicts their decision. [42]”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
42. Trotti, LM, Answers Questions on Diagnostics Relating to Hypersomnia, Hypersomnia Foundation, June 20, 2017
睡眠障害国際分類（ICSD）という診断基準はそもそも研究者から支持を得ていないものです。
“I have spoken to a number of clinician-scientists experienced in idiopathic hypersomnia and narcolepsy since the release of the ICSD-3 and there isn’t a lot of confidence in it. Some question whether it is sufficiently justified by data.”
Hypersomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
Rye D, 2013 Narcolepsy Network conference, What’s in a Name? Understanding the Origins of the Terminologies for the Family of Hypersomnias
Correspondence with Prof D Rye, 9 May 2015 and 3 August 2017
Correspondence with Prof Karel Šonka, 17 August 2015 and 7 August 2017
“The current ICSD classification, published in 2014, inevitably has important shortcomings, largely reflecting the lack of knowledge about the precise neurobiological mechanisms underlying the majority of sleep disorders we currently delineate. “
Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. https://doi.org/10.1016/j.smrv.2020.101306
“These results expand upon data reported by Trotti et al. suggesting a single positive MSLT as defined by ICSD-3 has little diagnostic value as currently defined. “
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
Trotti LM, Staab BA, Rye DB. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia. J Clin Sleep Med. 2013;9(8):789–795.
“This results in significant overlap between mean sleep latency values among healthy controls and populations with excessive sleepiness. Pooled data from normal subjects across all ages using the 4 or 5 nap MSLT with sleep onset defined as the latency to the first epoch of any sleep stage, give a mean sleep latency of 10.4 +/- 4.3 minutes and 11.6 +/- 5.2 minutes, respectively.”
“These papers report a total of 92 patients with idiopathic hypersomnia with a weighted mean sleep latency of 6.2 +/-3.0 minutes. This value is intermediate between those reported for patients with narcolepsy and normal control subjects [6.2.3]. These values suggest that differentiation of sleepiness due to idiopathic hypersomnia from the sleepiness seen in normal controls may be difficult.”
Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test An American Academy of Sleep Medicine Report Standards of Practice Committee of the American Academy of Sleep Medicine （※American Academy of Sleep Medicine はICSDの出版元の団体です）
https://doi.org/10.1093/sleep/28.1.113
6. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, van het Loo M, McDonnell J, Vader JP, Kahan JP. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: Rand Corporation, 2001.
2. Lavie P. Sleep habits and sleep disturbances in industrial workers in Israel: main findings and some characteristics of workers com- plaining of excessive daytime sleepiness. Sleep 1981; 4:147-158.
3. Mitler MM, Carskadon MA, Czeisler CA, Dement WC, Dinges DF, Graeber RC. Catastrophes, sleep, and public policy: consensus report. Sleep 1988;11:100-109.
現在、睡眠科で過眠症の診断に広く使用されている反復睡眠潜時検査（ＭＳＬＴ）は「健常者の睡眠不足症候群の重症度判定にのみ有効性が認められている」と発表されています。
“The ability of the MSLT to quantify sleepiness has only been validated in healthy volunteers with different degrees of sleep deprivation.”
Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. https://doi.org/10.1016/j.smrv.2020.101306
G.J. Lammers, J.G. van Dijk
The multiple sleep latency test: a paradoxical test?
Clin Neurol Neurosurg, 94 (Suppl) (1992), pp. S108-S110
M.A. Carskadon, W.C. Dement
Effects of total sleep loss on sleep tendency
Percept Mot Skills, 48 (2) (1979), pp. 495-506
K.M. Hartse, T. Roth, F.J. Zorick
Daytime sleepiness and daytime wakefulness: the effect of instruction
Sleep, 5 (Suppl 2) (1982), pp. S107-S118
T. Roth, T. Roehrs, F. Zorick
Sleepiness: its measurement and determinants
Sleep, 5 (Suppl 2) (1982), pp. S128-S134
そもそも、元来、反復睡眠潜時検査（ＭＳＬＴ）は過眠症ではなく睡眠不足の眠気計測のために開発された検査でした。
“The Multiple Sleep Latency Test (MSLT) was first established to document and quantify the intensity of sleepiness in the context of sleep deprivation”
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep. 1986;9(4):519–524.
現在の睡眠科の医療制度上で日中の眠気の客観的な指標として使用されている反復睡眠潜時検査（ＭＳＬＴ）は睡眠時間が短ければ陽性率が上がり、睡眠時間が長ければ長いほど陰性率が上がります。反復睡眠潜時検査（ＭＳＬＴ）の過眠症の診断基準を満たす方に長期間の睡眠時間の延長をすると検査結果が陰性になるという研究も多く存在します。
Sleep Extension in Sleepy and Alert Normals.
https://doi.org/10.1093/sleep/12.5.449
A Two-Week Sleep Extension in Sleepy Normals.
https://doi.org/10.1093/sleep/19.7.576
Sleep Deprivation Can Affect the MSLT for Days.
https://doi.org/10.5664/jcsm.1488
False‐positive cases in multiple sleep latency test by accumulated sleep debt.
https://doi.org/10.1002/npr2.12169
日中の眠気において短期間の睡眠時間の延長は逆効果（余計に眠くなってしまう）であることを示唆する研究もあります。しかし、長期間での睡眠時間の延長を行うことにより反復睡眠潜時検査（MSLT）の結果は改善していくという研究発表があります。
“Some studies of sleep extension suggest it is detrimental. These studies show increases in subjective measures of daytime sleepiness and reduced performance efficiency on vigilance and complex psychomotor tasks in healthy young adults who extended bedtimes from the usual 8 to 10 or 11 h for 1-2 nights (4-7). However, studies that have used the Multiple Sleep Latency Test (MSLT) to assess the effects of sleep extension found improvements in daytime sleepiness/alertness after bedtime was increased to 10 h for 4 consecutive nights (8,9).”
Sleep Extension in Sleepy and Alert Normals.
https://doi.org/10.1093/sleep/12.5.449
4. Taub JM, Berger RJ. Extended sleep and performance: the Rip Van Winkle effect. Psychon Sci
1969;16:204-5.
5. Taub JM, Globus GG, Phoebus E, Drury R. Extended sleep and performance. Nature 1971;233:142-3.
6. Taub JM, Berger RJ. The effects of changing the phase and duration of sleep. J Exp Psychol [Hum
Percept] 1976;2:30-41.
7. Taub 1M. Effects of ad lib extended-delayed sleep on sensorimotor performance, memory and sleepiness
in the young adult. Physiol Behav 1980;25:77--87.
8. Carskadon MA, Dement WC. Sleep tendency during extension of nocturnal sleep. Sleep Res 1979;8: 147.
9. Carskadon MA, Dement WC. Nocturnal determinants of daytime sleepiness. Sleep 1982;5:S73-81.
１日あたり８時間の睡眠では反復睡眠潜時検査（MSLT）の結果に大きな改善は見られないという研究発表があります。
“Further, several studies have shown there is little change in MSLT scores over consecutive days with a constant 8-h sleep schedule each night (8,13). “
Sleep Extension in Sleepy and Alert Normals.
https://doi.org/10.1093/sleep/12.5.449
8. Carskadon MA, Dement WC. Sleep tendency during extension of nocturnal sleep. Sleep Res 1979;8: 147.
13. Lipschutz L, Roehrs T, Spielman A, Zwyghuizen-Doorenbos A, Lamphere J, Roth T. Caffeine's alerting
effects in sleepy normals. Sleep Res 1988;17:49.
特発性過眠症は過去に様々な別の研究グループが独自で定めた別の診断基準を使いその疾患を診断、定義してきたものであり、一部では行動誘発性睡眠不足症候群や軽度の無呼吸症候群や精神疾患に伴う過眠が除外されていなかったこともあると発表されています。
“Different research groups have historically used different diagnostic criteria, making comparisons across studies difficult. This is particularly true of case series that did not exclude mild forms of sleep-disordered breathing, behaviourally induced insufficient sleep syndrome, and hypersomnia associated with psychiatric disorders. ”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
特発性過眠症は医療関係者にすら勘違いを受けている疾患であることが世界で一番歴史のある特発性過眠症の研究啓発団体から発表されています
。
“Idiopathic Hypersomnia is one of the most misunderstood and under-researched sleep disorders. Some people (including doctors) incorrectly think it refers to any case of excessive daytime sleepiness (EDS) that cannot be explained by another preexisting medical condition, sleep disorder or by lifestyle or behaviour. This is not correct. Idiopathic Hypersomnia is characterised by a number of symptoms and clinical features. Daytime sleepiness is just one of them.”
Hypersoomnolence Australia https://www.hypersomnolenceaustralia.org.au/what-is-idiopathic-hypersomnia https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
特発性過眠症の有病率に関して、過去に各医療機関の特発性過眠症とナルコレプシーの有病率を調査し、ナルコレプシーの人口比率と比較することにより特発性過眠症の一般の有病率を推測しようとした研究がいくつかあります。しかし、全ての医療機関でその有病率の推定結果が大きな差のあるものとなっており、特発性過眠症の有病率に関する発表は特発性過眠症の診断基準に問題提起をしているものとなっています。
“In a large series published in 2007, patients with idiopathic hyper- somnia represented 1% of 6000 patients seen at a single respiratory sleep center. Because idiopathic hypersomnia is 60% as prevalent as narcolepsy, questions about the diagnostic accuracy arise.”
Idiopathic Hypersomnia: A Study of 77 Cases
https://doi.org/10.1093/sleep/30.10.1274
反復睡眠潜時検査（ＭＳＬＴ）は睡眠不足症候群とナルコレプシー１型の診断基準としてはある程度有用なものです。しかし、この検査はそれ以外の過眠の症状を診断するには不適切です。
“Although the MSLT is sensitive to sleep deprivation and a clinically useful objective tool for NT1, it may not be the best test for other pathologies of excessive daytime sleepiness according to ICSD-3 criteria.”
”test-retest reliability of the MSLT outside the context of NT1 appears poor. [24]“
The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study
https://doi.org/10.5664/jcsm.6882
24. Trotti LM, Staab BA, Rye DB. Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia. J Clin Sleep Med. 2013;9(8):789–795.
今の過眠症の制度（診断、治療とその治療に対する結果）はナルコレプシーを主軸として作られているものです。しかし、それらの制度は特発性過眠症には当てはまらないと言われています。
“It is the view of some clinician-scientists that ‘narcolepsy is the prism that sleepiness is always viewed and therefore defines how diagnosis, treatments and outcome measures are framed however this framing is not appropriate for idiopathic hypersomnia not least of all because narcolepsy and idiopathic hypersomnia are not the same disorder’. [54]”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
54.Correspondence with Prof D Rye, 9 May 2015 and 3 August 2017
そもそも過眠症(特に特発性過眠症)の診断に反復睡眠潜時検査（ＭＳＬＴ）という診断基準を使用すること自体が研究者から支持をされていません
。
“Education of physicians, but also of sleep specialists is important. Because many of them still rely on the MSLT to diagnose this disorder. While long term monitoring (evaluating how much sleep the patient can produce during 24h in a sleep lab, which is greater than 11hr in most of them, if not 14-15h) is much more sensitive.”
- Isabelle Arnulf Phd. MD. （Bedřich Roth, His Life’s Work and the 35th anniversary of the book “Narcolepsy and Hypersomnia” Hypersomnolence Australia Idiopathic Awareness Week 2015）
“The MSLT has lead us astray in the study of hypersomnia”
- E. Mignot (2017 World Sleep Society Congress in Prague)
“The MSLT is not the way to capture the phenotype of these (idiopathic hypersomnia) patients”
- I. Arnulf (2017 World Sleep Society Congress in Prague)
“one might argue that the current polysomnography/MSLT alone has next to no diagnostic value.”
“There is an overwhelming amount of research that suggests “The MSLT can no longer be considered the gold standard” for diagnosing idiopathic hypersomnia and N2.”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
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）を利用することの有効性、妥当性に関して、多くの文献で疑問視され問題提起をされています。
“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
https://doi.org/10.1093/sleep/29.11.1429
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.
Punjabi NM, O’Hearn D J, Neubauer DN, et al. Modeling hyper- somnolence in sleep-disordered breathing. A novel approach using survival analysis. Am J Respir Crit Care Med. 1999;159:1703-9.
“There are however many other studies that also question the validity of the MSLT in diagnosing idiopathic hypersomnia and N2.”
Hypersoomnolence Australia, Idiopathic Hypersomnia - A Comprehensive Review
https://www.hypersomnolenceaustralia.org.au/single-post/2017/12/29/idiopathic-hypersomnia-a-comprehensive-review
Trotti LM, Staab BA, Rye DB, Test-retest reliability of the multiple sleep latency test in narcolepsy without cataplexy and idiopathic hypersomnia, J Clin Sleep Med 2013;9, pp.789–95
Vernet C, Arnulf I, Idiopathic hypersomnia with and without long sleep time: a controlled series of 75 patients, Sleep 2009 Jun; 32(6): pp.753-9
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
REM periods during the multiple sleep latency test in community adults, Brain 2006,
129, pp. 1609-1623.
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
Baumann C, Mignot E, Lammers G, Overeem S, Arnulf I, Rye D, Dauvilliers Y, Honda M, Owens J, Plazzi G, Scammell T, Challenges in Diagnosing Narcolepsy without Cataplexy: A Consensus Statement, Sleep 2014 Jun 1; 37(6): pp.1035–1042
Goldbart A, Peppard P, Finn L, Ruoff C, Barnet J, Young T, Mignot E, Narcolepsy and Predictors of Positive MSLTs in the Wisconsin Sleep Cohort, Sleep 2014 Jun 1; 37(6): pp.1043–1051
Mayer G, Lammers G, The MSLT: More Objections than Benefits as a Diagnostic Gold Standard?, Sleep 2014 Jun 1; 37(6): pp.1027–1028
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
Aldrich MS, The clinical spectrum of narcolepsy and idiopathic hypersomnia, Neurology 1996, 46, pp.393–401
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
Dauvilliers YA, Laberge L. Myotonic dystrophy type 1, daytime sleepiness and REM sleep dysregulation, Sleep Med Rev 2012, vol. 16, pp. 539-45
Andlauer O, Moore H, Jouhier L, Drake C, Peppard PE, Han F, Hong SC, Poli F, Plazzi G, O'Hara R, Haffen E, Roth T, Young T, Mignot E, Nocturnal rapid eye movement sleep latency for identifying patients with narcolepsy/hypocretin deficiency, JAMA Neurol. 2013 Jul; 70(7): pp.891-902
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