MSLT検査は再検査で半数以上の症例の診断結果が変わってしまう。

反復睡眠潜時検査（ＭＳＬＴ）は再現性に乏しく、その検査で一度ナルコレプシーもしくは特発性過眠症の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診断結果の陰性／陽性が変わってしまいます。

下記に論拠となる引用文献の一覧を載せます。

 
“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.“
 
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うのです。
 
“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

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