Eyelid Closure Behavior of Patients with Idiopathic and Nonorganic Hypersomnia, Narcolepsy-Cataplexy, and Healthy Controls in the Maintenance of Wakefulness Test

Annelies Santschi; David R Schreier; Anneke Hertig-Godeschalk; Samuel E J Knobel; Uli S Herrmann; Jelena Skorucak; Wolfgang J Schmitt; Johannes Mathis

doi:10.2147/NSS.S408318

Eyelid Closure Behavior of Patients with Idiopathic and Nonorganic Hypersomnia, Narcolepsy-Cataplexy, and Healthy Controls in the Maintenance of Wakefulness Test

Nat Sci Sleep. 2023 Aug 18:15:677-690. doi: 10.2147/NSS.S408318. eCollection 2023.

Authors

Annelies Santschi^#¹, David R Schreier^#¹, Anneke Hertig-Godeschalk¹, Samuel E J Knobel¹, Uli S Herrmann¹, Jelena Skorucak², Wolfgang J Schmitt³, Johannes Mathis^{1

4}

Affiliations

¹ Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² University Children's Hospital Zurich, Zurich, Switzerland.
³ University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
⁴ Sleep Medicine, Neurozentrum Bern, Bern, Switzerland.

^# Contributed equally.

Abstract

Purpose: 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: central disorders of hypersomnolence; excessive daytime sleepiness; hypersomnia; hypersomnia associated with psychiatric disorders; microsleep; vigilance test.

Grants and funding

This work was supported by the Swiss National Science Foundation (grant 32003B_176323 and P500PM_210834), the Swiss Innovation Agency/Innosuisse (grant 17864.1 PFLS-LS), and the Department of Neurology, Inselspital, Bern University Hospital.