From the Research
An overnight polysomnogram (PSG) should be performed the night immediately preceding the Multiple Sleep Latency Test (MSLT), with a minimum of 7 hours of sleep and an 8-hour recording time, as recommended by the American Academy of Sleep Medicine (AASM) 1. This sequential timing is essential for proper interpretation of the MSLT results. The PSG should be conducted to ensure adequate sleep time before the MSLT begins, ideally meeting age-based needs. The preceding PSG serves several critical purposes: it rules out other sleep disorders that might cause excessive daytime sleepiness (such as obstructive sleep apnea), documents adequate sleep duration (to prevent false positive results from sleep deprivation), and establishes the patient's baseline sleep architecture. Additionally, the PSG helps confirm that the patient hasn't experienced REM sleep rebound, which could affect MSLT results. Some key considerations for the PSG and MSLT include:
- Patient preparation, including maintaining a regular sleep schedule for at least one week before testing
- Evaluation of medication and substance use, with consideration for discontinuing REM-suppressing medications for at least two weeks prior to the test when possible
- Scheduling considerations, including the timing of the PSG and MSLT to minimize the effects of sleep inertia
- Optimal test conditions for youth, including the use of clinical judgment to guide the need for sleep-disordered breathing treatments before polysomnography-MSLT testing
- Documentation, including shared patient-health care provider decision-making regarding modifications in the protocol for children and adolescents with neurodevelopmental/neurological disorders, young age, and/or delayed sleep phase. It is also important to note that the AASM provides guidance based on pediatric expert consensus and evidence-based data when available, and that the MSLT protocol may need to be modified for certain patient populations, such as children and adolescents with neurodevelopmental/neurological disorders 1.