Maintenance wakefulness test

While correlation may not be the optimal measure of the usefulness of the Epworth scale for discrimination or prediction (32), there also appears to be no categorical association between ESS score and sleep latency (30,33,34). Thus, although the ESS may be predictive of other variables such as general health status (16) or respiratory disturbance index (12), most of the evidence suggests that its association with sleep latency is tenuous. Similar results emerge from studies comparing ESS with the other (newer) objective measure of EDS, the maintenance of wakefulness test (MWT). In a large narcolepsy sample, the correlation between ESS and MWT was weak (r = -0.29, p <. 001) (35). 

Sangal RB, Mitler MM, Sangal JM. Subjective sleepiness ratings (Epworth Sleepiness Scale) do not reflect the same parameter of sleepiness as objective sleepiness (maintenance of wakefulness test) in patients with narcolepsy. Clin Neurophysiol 1999 110 2131-2135. 

The Maintenance of Wakefulness Test (MWT) was developed as an alternative, physiologically based test of sleepiness (1). The test was designed for use with patients whose sleepiness during the day might adversely affect performance or safety. Reasoning on the basis of face validity, a person who has little difficulty with falling asleep inappropriately should be able to stay awake in a quiet, sedentary situation such as during MWT trails. Beyond the procedure s face validity, there are other rationales for the use of the MWT, as discussed below. 

Table 1 Maintenance of Wakefulness Test (MWT) Sleep Latency Norms...

Mitler MM, Gujavarty KS, Browman CP. Maintenance of wakefulness test a polysomnographic technique for evaluation treatment efficacy in patients with excessive somnolence. Electroencephalogr Clin Neurophysiol 1982 53 658-661. 

Sangal RB, Thomas L, Mitler MM. Maintenance of wakefulness test and Multiple Sleep Latency Test measurement of different abilities in patients with sleep disorders [see comments]. Chest 1992 101 898-902. 

Doghramji K, Mitler MM, Sangal RB, et al. A normative study of the maintenance of wakefulness test (MWT). Electroencephalogr Clin Neurophysiol 1997 103 554-562. 

Mitler MM, Doghramji K, Shapiro C. The Maintenance of Wakefulness Test normative data by age. J Psychosom Res 2000 49 363-365. 

Subjective (e.g., Epworth Sleepiness Scale) and objective [e.g., Multiple Sleep Latency Test (MSLT)] daytime somnolence quantification does not seem to provide valuable information on patients risks. This could be explained by the fact that sleep-related accidents occur at certain times when behavioral and chronobiological factors play an important role. Medical and legal issues could nevertheless require an objective test, such as the Maintenance of Wakefulness Test (MWT), to confirm that treated apneic patients present a normal level of vigilance. 

Browman CP, Gujavarty KS, Sampson MG (1983) REM sleep episodes during the maintenance of wakefulness tests in patients with sleep apnea syndrome and patients with narcolepsy. Sleep 6 23-28... 

Armodafinil was initially evaluated in healthy volunteers undergoing acute sleep loss using the maintenance of wakefulness test (MWT) and psychomoter vigilance testing (PVT).25 In this single-dose, double-blind, parallel group trial,... 

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