Journal Article

0613 Multimodal Hypersomnolence Assessment Substantially Increases Objective Identification of Hypersomnolence in Patients Referred for Multiple Sleep Latency Testing

D T Plante, J D Cook and M L Prairie


Published on behalf of American Academy of Sleep Medicine

Volume 41, issue suppl_1, pages A227-A228
ISSN: 0161-8105
Published online April 2018 | e-ISSN: 1550-9109 | DOI:

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  • Neurology
  • Sleep Medicine
  • Clinical Neuroscience
  • Neuroscience


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Objective measurement of hypersomnolence plays a key role in the practice of sleep medicine. The multiple sleep latency test (MSLT) is the current gold standard for quantifying daytime sleepiness and measures the ability to fall asleep under soporific conditions. Since hypersomnolence is a multifaceted construct that includes other aspects such as excessive sleep duration, drowsiness, and impaired psychomotor vigilance, the goal of this investigation was to evaluate whether additional ancillary measures would affect the proportion of patients identified as having objective hypersomnolence during clinical sleep testing.


A multimodal hypersomnolence assessment (MHA) was performed in 100 clinical patients referred for polysomnography (PSG) and MSLT. MHA included ad libitum overnight PSG, as well as infrared pupillometry and the psychomotor vigilance test (PVT) conducted twice between MSLT naps. Objective hypersomnolence on the MHA was defined as at least one of the following: MSLT mean sleep latency ≤8 minutes, mean pupillary unrest index (PUI) ≥9.8, mean PVT lapses≥4.8, or total sleep duration (ad libitum PSG plus MSLT naps) ≥ 11 hours. Proportion of patients identified as objectively hypersomnolent using MHA versus standard-of-care defined sleepiness (MSLT sleep latency ≤8 minutes) was compared using McNemar’s Test.


Standard MSLT identified 26 patients as objectively sleepy. MHA identified an additional 36 patients as hypersomnolent, resulting in a highly significant increase in objective identification of hypersomnlence (62% vs. 26% of the sample; p<0.0001). When assessed separately, each component of the MHA significantly increased the proportion of patients identified as hypersomnolent relative to MSLT alone [(PUI; 42%, p<0.0001); (PVT lapses; 43%, p<0.0001); (excessive sleep duration; 35%; p=0.003)].


The use of MHA in patients referred for PSG/MSLT more than doubles the proportion of patients identified as having objective hypersomnolence. These results demonstrate clinical assessment of hypersomnolence should expand beyond the MSLT.

Support (If Any)

This research was supported by a Strategic Research Award from the American Sleep Medicine Foundation.

Journal Article.  0 words. 

Subjects: Neurology ; Sleep Medicine ; Clinical Neuroscience ; Neuroscience

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