Demographic and nap-related variance of the MSLT: results from 2,498 suspected hypersomnia patients: Clinical MSLT variance

Sleep Med. 2019 Mar;55:115-123. doi: 10.1016/j.sleep.2018.12.013. Epub 2018 Dec 30.


Objective: The purpose of this study was to enhance our understanding of clinical trends in sleep and rapid eye movement (REM) propensity on the multiple sleep latency test (MSLT). Demographic variables of interest included early childhood/advanced age, gender, race, and REM-suppressant use.

Methods: Nocturnal sleep studies and 5-nap MSLTs were retrieved from a large repository of deidentified studies from various US sleep clinics between 2007 and 2015. Studies were signal processed, human-edited, and underwent rigorous quality assurance for inclusion.

Results: The final sample consisted of N = 2498 MSLTs (24.2% Black; 34.2% Men; Age 4-89). In adults (age ≥ 21), sleep propensity modestly decreased across nap (90% at nap 1 to 80% at nap 5; p < 0.001). Children ≤12 years were least likely to fall asleep on any nap (∼55% at nap 5). REM propensity troughed at nap 4 (13%) and varied with age. Advanced age (≥60 years; OR: 0.28, p < 0.001), REM-suppressant use (OR:0.52, p < 0.001), and female sex (men OR: 1.48, p = 0.012) was associated with a decreased proportion of ≥2 REMs in adjusted logistic models. Children often demonstrated only 1 REM and generally had long sleep latencies, yielding a low proportion of MSLTs consistent with narcolepsy (11.0% vs. 19.2% and 16.8% in those between 13-20 and 21-59, respectively; p = 0.003).

Conclusions: MSLT outcomes vary greatly across age, gender, and use of psychotropic medication. Demographic variance should be considered when interpreting MSLT results. Robust age effect question the appropriateness of the MSLT as currently designed and implemented for children and older adults.

Keywords: Age; Gender; Hypersomnia; MSLT; Narcolepsy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Disorders of Excessive Somnolence / diagnosis*
  • Disorders of Excessive Somnolence / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Polysomnography / methods
  • Polysomnography / standards*
  • Reproducibility of Results
  • Sleep Latency / physiology*
  • Sleep, REM / physiology*
  • Young Adult