Polysomnography (PSG) and Multiple Sleep Latency Test (MSLT)
The PSG continuously records normal and abnormal physiologic activity during an entire night. A typical PSG montage includes an electroencephalogram (EEG), electrooculogram, electromyogram, electrocardiogram, and continuous pulse oximetry and includes measurement of airflow, respiratory effort, and leg movements. It documents the adequacy of sleep, including the frequency, duration, and total amounts of stages 1, 2, 3 and 4 (slow-wave sleep), and REM sleep. It also identifies whether other sleep pathologies, such as obstructive sleep apnea, are present.
The MSLT is the primary test for the diagnosis of narcolepsy. This test assesses 2 major components of narcolepsy: hypersomnolence and SOREMPs (Sleep Onset Rapid Eye Movement Periods), which occur in narcolepsy but are otherwise uncommon. The mean sleep latency, or time to sleep onset, provides evidence for hypersomnolence. The test uses an EEG to record sleep onset during normal waking hours. It consists of 4 or 5 20-minute nap opportunities at 2-hour intervals. Normally, sleep latency is greater than 10 minutes and REM sleep does not occur at sleep onset. Patients with narcolepsy typically fall asleep in 5 minutes or less and will display SOREMPs during at least 2 of the 5 daytime nap periods.
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