Objective evaluation of excessive daytime sleepiness

Jacques Taillard, Jean Arthur Micoulaud-Franchi, Vincent P. Martin, Laure Peter-Derex, Marie Françoise Vecchierini
Neurophysiologie Clinique. 2024-04-01; 54(2): 102938
DOI: 10.1016/j.neucli.2023.102938

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Taillard J(1), Micoulaud-Franchi JA(2), Martin VP(3), Peter-Derex L(4), Vecchierini MF(5).

Author information:
(1)Univ. Bordeaux, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France. Electronic
address: .
(2)Univ. Bordeaux, CNRS, SANPSY, UMR 6033, F-33000 Bordeaux, France; Service
Universitaire de Médecine du Sommeil, CHU de Bordeaux, Place Amélie Raba-Leon,
33 076 Bordeaux, France.
(3)Deep Digital Phenotyping Research Unit, Department of Precision Health,
Luxembourg Institute of Health, Strassen, Luxembourg.
(4)Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France;
Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital,
Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
(5)AP-HP, Hôtel Dieu, Centre de référence Narcolepsies et Hypersomnies rares,
centre du sommeil et de la vigilance, 1 place du parvis Notre Dame, 75181 Paris
cedex 04, France.

Excessive daytime sleepiness (EDS) is multifactorial. It combines, among other
things, an excessive propensity to fall asleep (« physiological sleepiness ») and
a continuous non-imperative sleepiness (or drowsiness/hypo-arousal) leading to
difficulties remaining awake and maintaining sustained attention and vigilance
over the long term (« manifest sleepiness »). There is no stand-alone biological
measure of EDS. EDS measures can either capture the severity of physiological
sleepiness, which corresponds to the propensity to fall asleep, or the severity
of manifest sleepiness, which corresponds to behavioral consequences of
sleepiness and reduced vigilance. Neuropsychological tests (The psychomotor
vigilance task (PVT), Oxford Sleep Resistance Test (OSLeR), Sustained Attention
to Response Task (SART)) explore manifest sleepiness through several sustained
attention tests but the lack of normative values and standardized protocols make
the results difficult to interpret and use in clinical practice.
Neurophysiological tests explore the two main aspects of EDS, i.e. the
propensity to fall asleep (Multiple sleep latency test, MSLT) and the capacity
to remain awake (Maintenance of wakefulness test, MWT). The MSLT and the MWT are
widely used in clinical practice. The MSLT is recognized as the « gold standard »
test for measuring the severity of the propensity to fall asleep and it is a
diagnostic criterion for narcolepsy. The MWT measures the ability to stay awake.
The MWT is not a diagnostic test as it is recommended only to evaluate the
evolution of EDS and efficacy of EDS treatment. Even if some efforts to
standardize the protocols for administration of these tests have been ongoing,
MSLT and MWT have numerous limitations: age effect, floor or ceiling effects,
binding protocol, no normal or cutoff value (or determined in small samples),
and no or low test-retest values in some pathologies. Moreover, the recommended
electrophysiological set-up and the determination of sleep onset using the
30‑sec epochs scoring rule show some limitations. New, more precise
neurophysiological techniques should aim to detect very brief periods of
physiological sleepiness and, in the future, the brain local phenomenon of
sleepiness likely to underpin drowsiness, which could be called « physiological
drowsiness ».

Copyright © 2023 Elsevier Masson SAS. All rights reserved.

DOI: 10.1016/j.neucli.2023.102938
PMID: 38401239

Conflict of interest statement: Declaration of Competing Interest No conflicts
of interest were reported for this study.

Auteurs Bordeaux Neurocampus