Discuss The Diagnostic Value Of The Multiple Sleep Latency Test?HLA-DQB1*0602 In Youth Narcolepsy Type 1

Objective:The multiple sleep latency test(MSLT)is one of the diagnostic criteria for narcolepsy,but many other diseases and healthy people can also show positive MSLT.These false positives can lead to false diagnoses.By comparing the differences of MSLT,HLA-DQB 1*0602 forecast parameters in the diagnosis of narcolepsy,find out the relatively high value of the diagnosis of narcolepsy,to guide clinical early detection,early diagnosis and early treatment.Method:Collected 171 cases of type 1 narcolepsy(NT1)patients and 57 with normal age matched healthy volunteers,ranging in age from 19 to 24 years old.The 3rd edition of the International Classification of Sleep Disorders(ICSD-3)as the gold standard in the diagnosis of narcolepsy.All participants were collected the basic information,related questionnaire,nPSG and MSLT HLA-DQB 1*0602 test results.Analysis of the differences between each other and related indicators for the diagnostic value of narcolepsy.Results:In 171 cases of NT1 patients,all have excessive daytime sleepiness(EDS)and cataplexy symptom,school record affected(performance decline or even drop out of school),dreaminess and nightmares,personality change(irritable,grumpy),sleep paralysis and weight gain can reach more than 50%.The visual and auditory hallucination,snoring and urinary incontinence rate below 50%.Among the 171 patients with narcolepsy,71.3 percent were males,28.7 percent were females,and the ratio of men to women is 2.5:1.Compared to male and female patients with onset age,P>0.05.Compared with women,men have higher BMI,MSL time shorter,SOREMPS more,MSLT positive rate is higher,the difference was statistically significant(P<0.05),while DQB 1*0602 has no obvious difference between male and female of narcolepsy patients(P>0.05).The narcolepsy group has significant difference in BMI,MSL,SOREMPS,MSLT+ and DQB1*0602 compared with the healthy control group,P<0.05.There was no difference in total sleep time between the healthy group and the narcolepsy groups,but the narcolepsy groups showed sleep efficiency decreased,the sleep latency period and REM sleep latency period shorten,the proportion of sleep in N1 period increased,while the proportion of sleep was decreased in N2,N3 and REM,P<0.05.The sensitivity,specificity,positive predictive value(PPV)and Youden index of MSLT for the diagnosis of narcolepsy were 91.2%,96.5%,98.7%and 0.877,respectively.HLA-DQB 1*0602 was 94.2%,75.4%,92%,0.696,respectively.When the value of MSL in MSLT decreased,its specificity and positive predictive value increased,and the sensitivity and Youden index decreased.The sensitivity,specificity,positive predictive value and Youden index of MSLT combined with DQB1*0602 predicted narcolepsy were 88.3%,100%,100%,and 0.883,respectively.When MSLT*combined with DQB1*0602,the specificity and positive predictive value increased,but the sensitivity and Youden index decreased significantly.Conclusion:The sensitivity,specificity,positive predictive value and Youden index of MSLT combined with HLA-DQB 1*0602 for the diagnosis of narcolepsy is higher.Clinically,MSLT can be used to combine HLA-DQB 1*0602 as a tool for the diagnosis of narcolepsy,to improve the diagnosis rate and to reduce the misdiagnosis rate.