Complex event-related potentials (P300 and CNV) and MSLT in the assessment of excessive daytime sleepiness in narcolepsy-cataplexy.

The P300 and contingent negative variation (CNV) evoked potential (EP) paradigms were performed by 12 untreated narcoleptics and controls immediately prior to each nap of the Multiple Sleep Latency Test (MSLT) in order to assess whether they might hold promise as rapid quantitative techniques to assess excessive daytime sleepiness. The Stanford Sleepiness Scale (SSS) was also completed across test days and immediately before and after both the evoked potential recordings and MSLT naps. MSLT findings confirmed shorter sleep latencies and frequent SOREMPs in narcoleptics and a strong mid-afternoon increase in sleepiness based upon pressure for NREM sleep in both groups. On SSS narcoleptics were sleepier and they showed greater increase in sleepiness induced by the EP tests and greater sleepiness reduction by the MSLT naps. In the P300 paradigm, narcoleptics showed smaller component P3 amplitudes and larger P1 amplitudes. In the CNV paradigm, N1 latencies were greater in narcoleptics to both S1 and S2 and the post-CNV negative component was larger: but no significant differences were seen for the main CNV measures of negativity amplitude in the first or second halves of the response. The P300 paradigm but not the CNV, therefore, appeared to be a sensitive EP measure of sleepiness. Finally, EP components in both the P300 and CNV paradigms showed time-of-day (circadian) differences between narcoleptics and controls.