so tell me: 4 or 5 nap MSLT?

Moderators: TexasSleepguy, labman2, respbarb

how many naps in the majority of your MSLT's

4
27
52%
5
25
48%
 
Total votes : 52

so tell me: 4 or 5 nap MSLT?

Postby labman2 » Mon Jul 16, 2007 3:30 am

i am curious as to if most folks run 4 naps or 5 for the majority of mslt's.
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Thanks for the responses so far

Postby labman2 » Mon Jul 16, 2007 3:41 pm

Has anyone heard that an AASM accredited Center MUST run 5 naps each time?

Thanks

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Postby oldsleeper » Mon Jul 16, 2007 3:52 pm

The practice parameters as presented on the aasm web site make no mention of that.

http://www.aasmnet.org/Resources/Practi ... SLTMWT.pdf

Doesn't mean it isn't a new thing coming down the pike tho.... :wink:
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Postby endymion » Mon Jul 16, 2007 10:08 pm

I once worked at a lab where the Medical Director was adament that the lab should run 5 naps on every patient, every time.

His thinking was, that the physician might disagree with the technician's assessment of whether REM had occurred, so using 5 naps would eliminate the risk of having to completely re-do the PSG+MSLT.

I didn't buy the argument. Afer all, the physician could also disagree with the tech's assessement of onset, in which case the nap would be a wildly improper length. The only way to assure that the naps wouldn't need to be redone based on doctor-tech disagreement would be to have the physician running each nap until REM onset, which of course isn't ever going to occur in most labs.

At my current lab, most MSLTs have four naps -- either there issn't any REM at all, rendering a fifth nap useless, or there are already multiple REMs by nap 4. We tell the patient there will be five naps, though, to avoid that "last nap" effect.
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Postby somnonaut » Mon Jul 16, 2007 10:11 pm

oldsleeper wrote:The practice parameters as presented on the aasm web site make no mention of that.

http://www.aasmnet.org/Resources/Practi ... SLTMWT.pdf

Doesn't mean it isn't a new thing coming down the pike tho.... :wink:


AHEM:
"The MSLT consists of five nap opportunities performed at two hour intervals. The initial nap opportunity begins 1.5 to 3 hours after termination of the nocturnal recording. A shorter four-nap test may be performed but this test is not reliable for the diagnosis of narcolepsy unless at least two sleep onset REM periods have occurred."

And this means what?
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Postby endymion » Mon Jul 16, 2007 10:43 pm

Am I being dense? It says that you can stop at four if you already have multiple REMs.

It doesn't say you can stop at 4 if you have no REMs, but we currently do that here (just emailed the Md Dir to see if he wants to change it, though!) I don't see how a fifth nap could be helpful in that situation myself, but I'll jump through the AASM's hoop if they so command....
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Postby oldsleeper » Tue Jul 17, 2007 2:26 am

Has anyone heard that an AASM accredited Center MUST run 5 naps each time?


So, anybody heard anything about a change in the current practice parameters - which would no longer allow the 4 nap exception and require 5 nappies each and every time no matter what? :?:
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i misspoke

Postby labman2 » Tue Jul 17, 2007 3:19 am

oldsleep

I really DIDNT mean EVERYTIME- but I believe that they feel the bulk of the naps should be of the 5 pack variety.

Sorry if I mislead with my previous statement.

just citing the parameter that said an MSLT consist of 5 naps yada yada...

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Postby oldsleeper » Tue Jul 17, 2007 3:33 am

Ha...you're just trying to addle what's left of my brain 8-[

Guess I was just feeling a little literal....... :lol: :lol:
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Postby Vix » Tue Jul 17, 2007 11:41 pm

somnonaut wrote:
AHEM:
"The MSLT consists of five nap opportunities performed at two hour intervals. The initial nap opportunity begins 1.5 to 3 hours after termination of the nocturnal recording. A shorter four-nap test may be performed but this test is not reliable for the diagnosis of narcolepsy unless at least two sleep onset REM periods have occurred."


We just had our AASM site visit - that's what we have in our P&P, and that's what the AASM is looking for. You are supposed to run 5 naps unless you have at least 2 SOREMs.
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Postby oldsleeper » Tue Jul 17, 2007 11:54 pm

and that's the end of that..... :wink:
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Postby Rick » Wed Jul 18, 2007 7:21 pm

Here is what I remember:
Two naps with Sleep Onset REM are diagnostic for Narcolepsy.
If you have two of those by the fourth nap, you are done.
If you have one SOREMP by the fourth nap, a fifth nap must be done.
If you have none, you are done after the fourth nap because one episode of SOREMP is not diagnostic and that is all you will get with one more nap.
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I concur with Rick

Postby labman2 » Wed Jul 18, 2007 8:16 pm

Rick

That was my opinion ( As I write this I am running a fifth nap for a pateint that had 1 SOREMP earlier while the another MSLT patient is long gone due to no REM in 4 naps:D )

Anybody else that wants to weigh in to this take on 4 or 5 naps?

Is Rick's take accurate?

If not why Not?

Thanks Rick!
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Think I got it!

Postby labman2 » Wed Jul 18, 2007 9:39 pm

I just received the AASM protocol and procedure reference manual book that I purchased and they seem to want 5 naps based on this paragraph.. on page 40 of Accreditation reference Manual for Policies, Procedures, Documentation and Reporting
"a shorter 4- nap test can be performed if after 4 naps there are at least 2 SOREMPS. Five opportunities must be performed for mean sleep latency if no SOREMPS or one SOREMP occured in the first four naps. The definition of pathological sleep latency was based on MSLTs done with 5 naps. (bold lettering by me) A shorter four nap MSLT in which no SOREMPS or only one SOREMP occur may provide an inaccurate estimate of sleep latency..

so folks- it appears 5 is the answer-

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Postby oldsleeper » Thu Jul 19, 2007 12:19 am

Clear as mud :lol: :lol:
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