Revisiting the maintenance of wakefulness test: from intra‐/inter‐scorer agreement to normative values in patients treated for obstructive sleep apnea

Pierre Tankéré, Jacques Taillard, Marc‐Antoine Armeni, Thierry Petitjean, Christian Berthomier, Mélanie Strauss, Laure Peter‐Derex
Journal of Sleep Research. 2023-06-07; :
DOI: 10.1111/jsr.13961

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Tankéré P(1)(2), Taillard J(3)(4), Armeni MA(2), Petitjean T(2), Berthomier C(5), Strauss M(6)(7), Peter-Derex L(2)(8)(9).

Author information:
(1)Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and
Intensive Care Unit, Dijon University Hospital, Dijon, France.
(2)Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital,
Hospices Civils de Lyon, Lyon, France.
(3)Sommeil, Addiction et Neuropsychiatrie, Université de Bordeaux, SANPSY, USR
3413, Bordeaux, France.
(4)CNRS, SANPSY, USR 3413, Bordeaux, France.
(5)Physip, Paris, France.
(6)Hôpital Universitaire de Bruxelles, Site Erasme, Services de Neurologie,
Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, Brussels,
(7)Neuropsychology and Functional Imaging Research Group (UR2NF), Center for
Research in Cognition and Neurosciences and ULB Neuroscience Institute,
Université Libre de Bruxelles, Brussels, Belgium.
(8)Lyon Neuroscience Research Center, PAM Team, INSERM U1028, CNRS UMR 5292,
Lyon, France.
(9)Claude Bernard Lyon 1 University, Lyon, France.

The Maintenance of Wakefulness Test is widely used to objectively assess
sleepiness and make safety-related decisions, but its interpretation is
subjective and normative values remain debated. Our work aimed to determine
normative thresholds in non-subjectively sleepy patients with well-treated
obstructive sleep apnea, and to assess intra- and inter-scorer variability. We
included maintenance of wakefulness tests of 141 consecutive patients with
treated obstructive sleep apnea (90% men, mean (SD) age 47.5 (9.2) years, mean
(SD) pre-treatment apnea-hypopnea index of 43.8 (20.3) events/h). Sleep onset
latencies were independently scored by two experts. Discordant scorings were
reviewed to reach a consensus and half of the cohort was double-scored by each
scorer. Intra- and inter-scorer variability was assessed using Cohen’s kappa for
40, 33, and 19 min mean sleep latency thresholds. Consensual mean sleep
latencies were compared between four groups according to subjective sleepiness
(Epworth Sleepiness Scale score < versus ≥11) and residual apnea-hypopnea index
(< versus ≥15 events/h). In well-treated non-sleepy patients (n = 76), the
consensual mean (SD) sleep latency was 38.4 (4.2) min (lower normal limit
[mean - 2SD] = 30 min), and 80% of them did not fall asleep. Intra-scorer
agreement on mean sleep latency was high but inter-scorer was only fair (Cohen’s
kappa 0.54 for 33-min threshold, 0.27 for 19-min threshold), resulting in
changes in latency category in 4%-12% of patients. A higher sleepiness score but
not the residual apnea-hypopnea index was significantly associated with a lower
mean sleep latency. Our findings suggest a higher than usually accepted
normative threshold (30 min) in this context and emphasise the need for more
reproducible scoring approaches.

© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd
on behalf of European Sleep Research Society.


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