Characteristics of Maintenance of Wakefulness Test (MWT) in drug-naïve patients with narcolepsy type 1 and type 2, and relationship with other measures of sleepiness
We aimed to describe the characteristics of standard maintenance of wakefulness test (MWT), outside of clinical trials, in a sample of drug-naïve patients with narcolepsy type 1 (NT1) and type 2 (NT2). Consecutive drug-naïve patients with narcolepsy underwent two days of continuous PSG recording, th...
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25.06.2025
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| Abstract | We aimed to describe the characteristics of standard maintenance of wakefulness test (MWT), outside of clinical trials, in a sample of drug-naïve patients with narcolepsy type 1 (NT1) and type 2 (NT2).
Consecutive drug-naïve patients with narcolepsy underwent two days of continuous PSG recording, the multiple sleep latency test (MSLT), then night-PSG and, on the following day, MWT. MWT results were correlated with MSLT and Epworth Sleepiness Scale (ESS). Patients in the two lower tertiles of MWT mean sleep latency (mSL) were compared to those in the upper tertile.
Seventy-eight NT1 (30.6 ± 11.4 years, 35 males) and 19 NT2 (31.0 ± 9.9 years, 12 males) were included. MWT results showed a bimodal distribution with a large peak with reduced mSL and a small peak with values towards 40 minutes. MWT mSL was lower in NT1 than in NT2 (10.7 ± 10.8 min vs 23.9 ± 11.5 min, p<.001). In the entire sample, lower MWT mSL was moderately correlated with lower MSLT mSL (Rho = 0.347, p=.001) and higher ESS (Rho = -0.398, p<.001). Patients with NT1 with MWT mSL in the two lower tertiles (≤11.2 min) had higher ESS than those in the upper tertile, without any difference in other clinical or neurophysiological features. In NT2, no significant correlations emerged between MWT, MSLT, and ESS.
MWT mSL is reduced in drug-naive narcolepsy, more severely in NT1 than in NT2. However, a minority of patients show normal MWT results. MSLT, MWT, and ESS measure different aspects of sleepiness in narcolepsy, and none can be considered a comprehensive measure of its severity. |
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| AbstractList | We aimed to describe the characteristics of standard maintenance of wakefulness test (MWT), outside of clinical trials, in a sample of drug-naïve patients with narcolepsy type 1 (NT1) and type 2 (NT2).
Consecutive drug-naïve patients with narcolepsy underwent two days of continuous PSG recording, the multiple sleep latency test (MSLT), then night-PSG and, on the following day, MWT. MWT results were correlated with MSLT and Epworth Sleepiness Scale (ESS). Patients in the two lower tertiles of MWT mean sleep latency (mSL) were compared to those in the upper tertile.
Seventy-eight NT1 (30.6 ± 11.4 years, 35 males) and 19 NT2 (31.0 ± 9.9 years, 12 males) were included. MWT results showed a bimodal distribution with a large peak with reduced mSL and a small peak with values towards 40 minutes. MWT mSL was lower in NT1 than in NT2 (10.7 ± 10.8 min vs 23.9 ± 11.5 min, p<.001). In the entire sample, lower MWT mSL was moderately correlated with lower MSLT mSL (Rho = 0.347, p=.001) and higher ESS (Rho = -0.398, p<.001). Patients with NT1 with MWT mSL in the two lower tertiles (≤11.2 min) had higher ESS than those in the upper tertile, without any difference in other clinical or neurophysiological features. In NT2, no significant correlations emerged between MWT, MSLT, and ESS.
MWT mSL is reduced in drug-naive narcolepsy, more severely in NT1 than in NT2. However, a minority of patients show normal MWT results. MSLT, MWT, and ESS measure different aspects of sleepiness in narcolepsy, and none can be considered a comprehensive measure of its severity. We aimed to describe the characteristics of standard maintenance of wakefulness test (MWT), outside of clinical trials, in a sample of drug-naïve patients with narcolepsy type 1 (NT1) and type 2 (NT2).STUDY OBJECTIVESWe aimed to describe the characteristics of standard maintenance of wakefulness test (MWT), outside of clinical trials, in a sample of drug-naïve patients with narcolepsy type 1 (NT1) and type 2 (NT2).Consecutive drug-naïve patients with narcolepsy underwent two days of continuous PSG recording, the multiple sleep latency test (MSLT), then night-PSG and, on the following day, MWT. MWT results were correlated with MSLT and Epworth Sleepiness Scale (ESS). Patients in the two lower tertiles of MWT mean sleep latency (mSL) were compared to those in the upper tertile.METHODSConsecutive drug-naïve patients with narcolepsy underwent two days of continuous PSG recording, the multiple sleep latency test (MSLT), then night-PSG and, on the following day, MWT. MWT results were correlated with MSLT and Epworth Sleepiness Scale (ESS). Patients in the two lower tertiles of MWT mean sleep latency (mSL) were compared to those in the upper tertile.Seventy-eight NT1 (30.6 ± 11.4 years, 35 males) and 19 NT2 (31.0 ± 9.9 years, 12 males) were included. MWT results showed a bimodal distribution with a large peak with reduced mSL and a small peak with values towards 40 minutes. MWT mSL was lower in NT1 than in NT2 (10.7 ± 10.8 min vs 23.9 ± 11.5 min, p<.001). In the entire sample, lower MWT mSL was moderately correlated with lower MSLT mSL (Rho = 0.347, p=.001) and higher ESS (Rho = -0.398, p<.001). Patients with NT1 with MWT mSL in the two lower tertiles (≤11.2 min) had higher ESS than those in the upper tertile, without any difference in other clinical or neurophysiological features. In NT2, no significant correlations emerged between MWT, MSLT, and ESS.RESULTSSeventy-eight NT1 (30.6 ± 11.4 years, 35 males) and 19 NT2 (31.0 ± 9.9 years, 12 males) were included. MWT results showed a bimodal distribution with a large peak with reduced mSL and a small peak with values towards 40 minutes. MWT mSL was lower in NT1 than in NT2 (10.7 ± 10.8 min vs 23.9 ± 11.5 min, p<.001). In the entire sample, lower MWT mSL was moderately correlated with lower MSLT mSL (Rho = 0.347, p=.001) and higher ESS (Rho = -0.398, p<.001). Patients with NT1 with MWT mSL in the two lower tertiles (≤11.2 min) had higher ESS than those in the upper tertile, without any difference in other clinical or neurophysiological features. In NT2, no significant correlations emerged between MWT, MSLT, and ESS.MWT mSL is reduced in drug-naive narcolepsy, more severely in NT1 than in NT2. However, a minority of patients show normal MWT results. MSLT, MWT, and ESS measure different aspects of sleepiness in narcolepsy, and none can be considered a comprehensive measure of its severity.CONCLUSIONSMWT mSL is reduced in drug-naive narcolepsy, more severely in NT1 than in NT2. However, a minority of patients show normal MWT results. MSLT, MWT, and ESS measure different aspects of sleepiness in narcolepsy, and none can be considered a comprehensive measure of its severity. |
| Author | Dauvilliers, Yves Pizza, Fabio Vandi, Stefano Mazzoni, Alice Barateau, Lucie Biscarini, Francesco Mignot, Emmanuel Plazzi, Giuseppe |
| Author_xml | – sequence: 1 givenname: Francesco orcidid: 0000-0001-9756-6470 surname: Biscarini fullname: Biscarini, Francesco organization: UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy – sequence: 2 givenname: Fabio surname: Pizza fullname: Pizza, Fabio organization: UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy – sequence: 3 givenname: Stefano surname: Vandi fullname: Vandi, Stefano organization: UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy – sequence: 4 givenname: Alice surname: Mazzoni fullname: Mazzoni, Alice organization: UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy – sequence: 5 givenname: Lucie orcidid: 0000-0002-6620-5127 surname: Barateau fullname: Barateau, Lucie organization: Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France – sequence: 6 givenname: Emmanuel orcidid: 0000-0002-6928-5310 surname: Mignot fullname: Mignot, Emmanuel organization: Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA – sequence: 7 givenname: Yves orcidid: 0000-0003-0683-6506 surname: Dauvilliers fullname: Dauvilliers, Yves organization: Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France – sequence: 8 givenname: Giuseppe surname: Plazzi fullname: Plazzi, Giuseppe organization: Department of Biomedical, Metabolic and Neuroscience, University of Modena and Reggio Emilia, Italy |
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| Keywords | multiple sleep latency test, Epworth sleepiness scale central disorders of hypersomnolence sleepiness narcolepsy disease severity maintenance of wakefulness test |
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