Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: Failure of the MSLT as a gold standard
Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: Failure of the MSLT as a gold standard
复制标题
DOI：
10.1046/j.1365-2869.2000.00177.x
复制
发表时间：
2000-03-01
影响因子：
4.4
通讯作者：
Johns, MW
中科院分区：
文献类型：
--
作者：
Johns, MW
白天过度嗜睡（EDS）是一种需要量化的重要症状，但对于实现这一目标的最佳方法存在困惑。三种最常用的测试：多次睡眠潜伏期测试（MSTH）、清醒维持测试（MWT）和埃普沃思嗜睡量表（ESS），其结果在统计学意义上显著相关，但并不密切相关。这次调查的目的是帮助澄清这个问题。使用先前发表的几项研究的数据计算每项试验的正常值参考范围，定义为平均值+/- 2 SD或2.5和97.5 ± SD。许多人用来解释MPEG4结果的“经验法则”在这里被证明是误导的。以前发表的每项测试的结果也适用于当时没有药物的发作性睡病患者，并且根据定义患有EDS。这使得三种测试的灵敏度和特异性首次得以比较，它们能够区分发作性睡病的EDS和正常受试者的白天嗜睡。受试者操作特征曲线清楚地表明，ESS是最具鉴别力的测试，MWT是其次最好的，而MST是最不具鉴别力的测试。MECHANISM不再被认为是此类测试的黄金标准。
Excessive daytime sleepiness (EDS) is an important symptom that needs to be quantified, but there is confusion over the best way to do this. Three of the most commonly used tests: the multiple sleep latency test (MSLT), the maintenance of wakefulness test (MWT) and the Epworth sleepiness scale (ESS) give results that are significantly correlated in a statistical sense, but are not closely related. The purpose of this investigation was to help clarify this problem. Previously published data from several investigations were used to calculate the reference range of normal values for each test, defined by the mean +/- 2 SD or by the 2.5 and 97.5 percentiles. The 'rule of thumb' that many people rely on to interpret MSLT results is shown here to be misleading. Previously published results from each test were also available for narcoleptic patients who were drug-free at the time and who by definition had EDS. This enabled the sensitivity and specificity of the three tests to be compared for the first time, in their ability to distinguish the EDS of narcolepsy from the daytime sleepiness of normal subjects. The receiver operator characteristic curves clearly showed that the ESS is the most discriminating test, the MWT is next best and the MSLT the least discriminating test of daytime sleepiness. The MSLT can no longer be considered the gold standard for such tests.