Validity of the Pupillographic Sleepiness Test for the diagnosis of daytime sleepiness in children and adolescents and its relationship to sleepiness-associated outcomes

6533b859fe1ef96bd12b798e

RESEARCH PRODUCT

Validity of the Pupillographic Sleepiness Test for the diagnosis of daytime sleepiness in children and adolescents and its relationship to sleepiness-associated outcomes

Tobias Peters Christian F. Poets Barbara Wilhelm Angelika Schlarb Hannah Von Lukowicz Michael S. Urschitz

subject

Male Multiple Sleep Latency Test medicine.medical_specialty Sleepiness Adolescent Excessive daytime sleepiness Disorders of Excessive Somnolence Audiology Daytime sleepiness Correlation 03 medical and health sciences 0302 clinical medicine Quality of life Humans Medicine Wakefulness Child Sleepiness testing Rank correlation Hypersomnia Central nervous Receiver operating characteristic medicine.diagnostic_test Pupillography business.industry Area under the curve General Medicine Alertness Cross-Sectional Studies 030228 respiratory system Quality of Life Pupillography activation Female medicine.symptom business 030217 neurology & neurosurgery

description

Objectives: To report validation data for the Pupillographic Sleepiness Test (PST) in children and adolescents, evaluate its applicability for diagnosing excessive daytime sleepiness and its relationship to sleepiness-associated outcomes. Methods: A cross-sectional diagnostic test accuracy study was performed. Patients underwent three PST at 9 a.m. (T1), 11 a.m. (T2) and 1 p.m. (T3) plus the Multiple Sleep Latency Test (MSLT) on a single day. Additionally, two neurocognitive tests were performed and three questionnaires about quality of life, sleep-related self-efficacy and behavioural aspects completed. Gender-stratified z-values of the natural logarithm of the Pupillary Unrest Index (z-lnPUI) were correlated to Sleep Latency (SL) and Mean Sleep Latency (MSL) and to variables of neurocognitive tests and questionnaires using Spearman's rank correlation. Cut-off values were determined by receiver operating characteristic (ROC) analysis. Results: 47 patients were recruited (median 10.6 years, range 6e18). Correlation between z-lnPUI and SL was r(T1) = -0.373 (p = 0.011); r(T2) = -0.320 (p = 0.028) and r(T3) = -0.336 (p = 0.022). Correlation between z-lnPUI and MSL was r(T1) = -0.338 (p = 0.020); r(T2) = -0.202 (p = 0.173); r(T3) = -0.117 (p = 0.433). ROC analysis showed an area under the curve of 90.7% and PUI cut-off values of 12.6 mm/min (boys) and 11.6 mm/min (girls). There were moderate correlations between z-lnPUI(T1) and reaction time and omission errors in neurocognitive tests (r = 0.394, p = 0.007 and 0.391, p = 0.008). Conclusions: We found satisfactory correlations between PST and MSLT results. The z-lnPUI(T1) was related to MSL and objective measures of attention ability. Given this accuracy, the PST may be used as a screening tool for evaluating daytime sleepiness in children and adolescents. Corresponding gender-related reference values are now available. (C) 2021 Elsevier B.V. All rights reserved.

year	journal	country	edition	language
2021-03-15	Sleep Medicine

https://doi.org/10.1016/j.sleep.2021.04.030