Nature and Science of Sleep (Aug 2023)
Eyelid Closure Behavior of Patients with Idiopathic and Nonorganic Hypersomnia, Narcolepsy-Cataplexy, and Healthy Controls in the Maintenance of Wakefulness Test
Abstract
Annelies Santschi,1,* David R Schreier,1,* Anneke Hertig-Godeschalk,1 Samuel EJ Knobel,1 Uli S Herrmann,1 Jelena Skorucak,2 Wolfgang J Schmitt,3 Johannes Mathis1,4 1Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 2University Children’s Hospital Zurich, Zurich, Switzerland; 3University Hospital of Psychiatry, University of Bern, Bern, Switzerland; 4Sleep Medicine, Neurozentrum Bern, Bern, Switzerland*These authors contributed equally to this workCorrespondence: David R Schreier, Department of Neurology, Inselspital, Bern University Hospital, Freiburgstrasse 16, Bern, CH-3010, Switzerland, Tel +41 31 632 21 11, Email [email protected]: Differential diagnosis of central disorders of hypersomnolence remains challenging, particularly between idiopathic (IH) and nonorganic hypersomnia (NOH). We hypothesized that eyelid closure behavior in the maintenance of wakefulness test (MWT) could be a valuable biomarker.Patients and Methods: MWT recordings of patients with IH, NOH, narcolepsy-cataplexy (NC), and healthy sleep-deprived controls (H) were retrospectively analyzed (15 individuals per group). For each MWT trial, visual scoring of face videography for partial (50– 80%) and full eyelid closure (≥ 80%) was performed from “lights off” to the first microsleep episode (≥ 3 s).Results: In all groups, the frequency and cumulative duration of periods with partial and full eyelid closure gradually increased toward the first microsleep episode. On the group level, significant differences occurred for the latency to the first microsleep episode (IH 21 min (18– 33), NOH 23 min (17– 35), NC 11 min (7– 19), H 10 min (6– 25); p = 0.009), the ratio between partial and full eyelid closure duration (IH 2.2 (0.9– 3.1), NOH 0.5 (0– 1.2), NC 2.8 (1.1– 5), H 0.7 (0.4– 3.3); p = 0.004), and the difference between full and partial eyelid closure duration in the five minutes prior to the first microsleep episode (∆full – partial eyelid closure duration: IH − 16 s (− 35 to 28); NOH 46 s (9– 82); NC − 6 s (− 26 to 5); H 10 s (− 4 to 18); p = 0.007). IH and NOH significantly differed comparing the ratio between partial and full eyelid closure (p = 0.005) and the difference between ∆full – partial eyelid closure duration in the five minutes prior to the first microsleep episode (p = 0.006).Conclusion: In the MWT, eyelid closure behavior (∆full – partial) in the period prior to the first microsleep episode could be of value for discriminating NOH from other etiologies of excessive daytime sleepiness, particularly IH.Keywords: hypersomnia, hypersomnia associated with psychiatric disorders, excessive daytime sleepiness, vigilance test, central disorders of hypersomnolence, microsleep
