Maintenance of Wakefulness Test and Multiple Sleep Latency Test: Measurement of Different Abilities in Patients With Sleep Disorders

doi:10.1378/chest.101.4.898

Chest

Volume 101, Issue 4, April 1992, Pages 898-902

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The multiple sleep latency test and the maintenance of wakefulness test were administered on the same day to 258 consecutive patients whose clinical presentation required evaluation for excessive sleepiness. While the MSLT is the standard test for assessing excessive daytime sleepiness, the MWT may have some clinical advantage over the MSLT when the assessment of daytime alertness is the primary goal. To explore further the relationship between alertness and sleepiness, we have conducted a thorough analysis of the similarities, differences, and correlations between MWT and MSLT. The results of this study show that the coefficient of correlation between MSLT and MWT (r = 0.41), although statistically significant, accounts for less than 17 percent of the variability between the two tests. Factor analysis suggests that two factors, alertness and sleepiness, account for 91 percent of all variance. Our data demonstrate that patients with diagnosable disorders of excessive somnolence may be discordant on the two tests (eg, having low sleep latency on MSLT but high sleep latency on MWT). Specifically, we found that some patients with abnormally low MSLT scores were able to stay awake when asked to do so on the MWT, and conversely, some patients who failed to stay awake when asked to do so on the MWT were unable to fall asleep quickly on the MSLT. We conclude that the MWT and MSLT measure different abilities and that the MWT may be a useful adjuvant daytime test in many clinical situations.

Section snippets

METHODS

We studied a total of 258 patients, 185 men and 73 women, whose mean age was 44.6 (standard deviation = 13.9). Our polysomnographic protocols require that, to the extent that it is medically feasible, all patients should be free, for a minimum of one week prior to sleep laboratory evaluation, of medications that significantly affect the central nervous system. We believe that at least 95 percent of the patients were free of such drugs at the time of study. All had symptoms of daytime sleepiness

RESULTS

Figure 1 shows box plots that summarize the distributions for the individual MWT trials, as well as the four-trial average for each patient. Box plots are useful ways to present truncated data sets such as those resulting when individual scores frequently reach a protocol-dependent maximum such as 20 min for the MSLT and 40 min for the MWT. Each box encompasses the middle 50 percent of the distribution and the horizontal line within the box represents the median. Note that the median for the

DISCUSSION

We have systematically explored the relationship between the MWT and the MSLT in 258 consecutive patients evaluated for excessive daytime sleepiness. Our results indicated a small but significant correlation between the MWT and the MSLT (r = 0.41). While this correlation is statistically significant, it is quite small. The statistical significance is due, of course, to the large number of subjects. In reality, the MWT variance only accounts for about 16 percent of the MSLT variance. This

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Maintenance of wakefulness test: a polysomnographic technique for evaluating treatment in patients with excessive somnolence
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MA Carskadon et al.
Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness
Sleep
(1986)
JS Poceta et al.
The maintenance of wakefulness test in obstructive sleep apnea syndrome
Sleep Res
(1990)

There are more references available in the full text version of this article.

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Primary funding and support for this project came from the Sleep Disorders Institute of Troy, Michigan.

Supported by PHS grants, R01 NS20459 and R03 AA08235 and by clinical research center grant RR00833 to Scripps Clinic and Research Foundation and by a grant from the American Narcolepsy Association.

Manuscript received May 17; revision accepted July 23.

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Clinical InvestigationsMaintenance of Wakefulness Test and Multiple Sleep Latency Test: Measurement of Different Abilities in Patients With Sleep Disorders

Section snippets

METHODS

RESULTS

DISCUSSION

Electroencephalogr Clin Neurophysiol

Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness

Sleep

The maintenance of wakefulness test in obstructive sleep apnea syndrome

Sleep Res

Clinical Investigations
Maintenance of Wakefulness Test and Multiple Sleep Latency Test: Measurement of Different Abilities in Patients With Sleep Disorders