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学科主题: 临床医学
题名:
Nocturnal Rapid Eye Movement Sleep Latency for Identifying Patients With Narcolepsy/Hypocretin Deficiency
作者: Andlauer, Olivier1,2,4,5,6; Moore, Hyatt1,2; Jouhier, Laura7; Drake, Christopher8; Peppard, Paul E.9; Han, Fang10; Hong, Seung-Chul11; Poli, Francesca12,13; Plazzi, Giuseppe12,13; O′ Hara, Ruth1,2,3; Haffen, Emmanuel4,5,6; Roth, Thomas8; Young, Terry9; Mignot, Emmanuel1,2
刊名: JAMA NEUROLOGY
发表日期: 2013-07-01
DOI: 10.1001/jamaneurol.2013.1589
卷: 70, 期:7, 页:891-902
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Clinical Neurology
研究领域[WOS]: Neurosciences & Neurology
关键词[WOS]: HYPOCRETIN OREXIN DEFICIENCY ; ONSET REM PERIODS ; NARCOLEPSY-CATAPLEXY ; PRACTICE PARAMETERS ; DAYTIME SLEEPINESS ; CLINICAL-USE ; TEST MSLT ; MULTIPLE ; RELIABILITY ; HLA
英文摘要:

IMPORTANCE Narcolepsy, a disorder associated with HLA-DQB1*06:02 and caused by hypocretin (orexin) deficiency, is diagnosed using the Multiple Sleep Latency Test (MSLT) following nocturnal polysomnography (NPSG). In many patients, a short rapid eye movement sleep latency (REML) during the NPSG is also observed but not used diagnostically.

OBJECTIVE To determine diagnostic accuracy and clinical utility of nocturnal REML measures in narcolepsy/hypocretin deficiency.

DESIGN, SETTING, AND PARTICIPANTS Observational study using receiver operating characteristic curves for NPSG REML and MSLT findings (sleep studies performed between May 1976 and September 2011 at university medical centers in the United States, China, Korea, and Europe) to determine optimal diagnostic cutoffs for narcolepsy/hypocretin deficiency compared with different samples: controls, patients with other sleep disorders, patients with other hypersomnias, and patients with narcolepsy with normal hypocretin levels. Increasingly stringent comparisons were made. In a first comparison, 516 age-and sex-matched patients with narcolepsy/hypocretin deficiency were selected from 1749 patients and compared with 516 controls. In a second comparison, 749 successive patients undergoing sleep evaluation for any sleep disorders (low pretest probability for narcolepsy) were compared within groups by final diagnosis of narcolepsy/hypocretin deficiency. In the third comparison, 254 patients with a high pretest probability of having narcolepsy were compared within group by their final diagnosis. Finally, 118 patients with narcolepsy/hypocretin deficiency were compared with 118 age- and sex-matched patients with a diagnosis of narcolepsy but with normal hypocretin levels.

MAIN OUTCOME AND MEASURES Sensitivity and specificity of NPSG REML and MSLT as diagnostic tests for narcolepsy/hypocretin deficiency. This diagnosis was defined as narcolepsy associated with cataplexy plus HLA-DQB1*06: 02 positivity (no cerebrospinal fluid hypocretin-1 results available) or narcolepsy with documented low (<= 110 pg/mL) cerebrospinal fluid hypocretin-1 level.

RESULTS Short REML (<= 15 minutes) during NPSG was highly specific (99.2%[95% CI, 98.5%-100.0%] of 516 and 99.6%[95% CI, 99.1%-100.0%] of 735) but not sensitive (50.6%[95% CI, 46.3%-54.9%] of 516 and 35.7%[95% CI, 10.6%-60.8%] of 14) for patients with narcolepsy/hypocretin deficiency vs population-based controls or all patients with sleep disorders undergoing a nocturnal sleep study (area under the curve, 0.799 [95% CI, 0.771-0.826] and 0.704 [95% CI, 0.524-0.907], respectively). In patients with central hypersomnia and thus a high pretest probability for narcolepsy, short REML remained highly specific (95.4%[95% CI, 90.4%-98.3%] of 132) and similarly sensitive (57.4%[95% CI, 48.1%-66.3%] of 122) for narcolepsy/hypocretin deficiency (area under the curve, 0.765 [95% CI, 0.707-0.831]). Positive predictive value in this high pretest probability sample was 92.1% (95% CI, 83.6%-97.0%).

CONCLUSIONS AND RELEVANCE Among patients being evaluated for possible narcolepsy, short REML (<= 15 minutes) at NPSG had high specificity and positive predictive value and may be considered diagnostic without the use of an MSLT; absence of short REML, however, requires a subsequent MSLT.

语种: 英语
所属项目编号: R01HL62252 ; 1UL1RR025011 ; NS23724
项目资助者: Fondation Servier ; National Institutes of Health
WOS记录号: WOS:000323563000012
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/56632
Appears in Collections:北京大学第二临床医学院_呼吸内科_期刊论文

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作者单位: 1.Dept Vet Affairs Hlth Care Syst, Palo Alto, CA USA
2.Stanford Univ, Sch Med, Ctr Sleep Sci & Med, Palo Alto, CA 94304 USA
3.Stanford Univ, Sch Med, Dept Psychiat & Behav Sci, Palo Alto, CA 94304 USA
4.Univ Hosp Besancon, Dept Clin Psychiat, Besancon, France
5.Technol Innovat Clin Invest Ctr, INSERM, CIC IT 808, Besancon, France
6.Univ Franche Comte, Lab Neurosci, EA 481, F-25030 Besancon, France
7.Univ Paris 05, Fac Med, Paris, France
8.Henry Ford Sleep Disorders Ctr, Detroit, MI USA
9.Univ Wisconsin, Dept Populat Hlth Sci, Madison, WI 53706 USA
10.Beijing Univ, Peoples Hosp, Dept Pulm Med, Beijing 100871, Peoples R China
11.Catholic Univ Korea, St Vincents Hosp, Dept Neuropsychiat, Suwon, South Korea
12.Univ Bologna, Dept Biomed & Neuromotor Sci, Sleep Disorders Ctr, Bologna, Italy
13.IRCCS Ist Sci Neurol, Bologna, Italy

Recommended Citation:
Andlauer, Olivier,Moore, Hyatt,Jouhier, Laura,et al. Nocturnal Rapid Eye Movement Sleep Latency for Identifying Patients With Narcolepsy/Hypocretin Deficiency[J]. JAMA NEUROLOGY,2013,70(7):891-902.
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