Using a reaction-time test to measure alertness and sleep grogginess in people with central sleepiness disorders
Abstract
STUDY OBJECTIVES: The central disorders of hypersomnolence (CDH) manifest with daytime sleepiness, often accompanied by cognitive symptoms. Objective tests characterizing cognitive dysfunction may have diagnostic utility. Further, because some people with CDH report worsening cognition upon awakening, cognitive testing before and after napping may provide additional diagnostic information.
METHODS: Patients with CDH with idiopathic hypersomnia (n = 76), narcolepsy type 1 (n = 19), narcolepsy type 2 (n = 22), and self-reported excessive daytime sleepiness not meeting current diagnostic criteria (n = 76) and nonsleepy controls (n = 33) underwent testing with the Psychomotor Vigilance Test (PVT), a 10-minute reaction-time test. A subset of participants underwent repeat testing during a Multiple Sleep Latency Test, before and immediately after naps 2 and 4.
RESULTS: Most PVT metrics were significantly better in controls than in patients with CDH. Minimal group differences in PVT performance were observed by CDH diagnosis. PVT performance was weakly correlated to Epworth Sleepiness Scale and Multiple Sleep Latency Test mean sleep latency in the CDH group. Before and after naps, PVT metrics were minimally different for controls, while PVT performance generally worsened following naps in the CDH group, with significant worsening compared with controls for nap 2 mean, median, lapses, and fastest 10% of responses and nap 4 lapses and slowest 10% of responses. Change in performance did not differ based on CDH diagnostic group for any metric on either nap.
CONCLUSIONS: The PVT, at baseline and following a short nap, may provide adjunctive diagnostic utility in separating individuals with CDH from controls.
CITATION: Trotti LM, Saini P, Bremer E, et al. The Psychomotor Vigilance Test as a measure of alertness and sleep inertia in people with central disorders of hypersomnolence.. 2022;18(5):1395-1403. J Clin Sleep Med
Funding
Competing interests
All authors have seen and approved the manuscript. Work for this study was funded by the National Institutes of Health (R01 NS111280 to L.M.T. and R01 NS089719 to D.B.R.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency. Dr. Trotti is a member of the Board of the American Academy of Sleep Medicine (AASM). Views expressed are those of the authors and do not necessarily reflect those of the AASM. Dr. Bliwise has served as a consultant for Merck, Ferring, Eisai, and Huxley. The other authors report no conflicts of interest.
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