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Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine
Open accessAbstract
This article updates the American Academy of Sleep Medicine protocols for the administration of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. The American Academy of Sleep Medicine commissioned a task force of clinical experts in sleep medicine to review published literature on the performance of these tests since the publication of the 2005 American Academy of Sleep Medicine practice parameter paper. Although no evidence-based changes to the protocols were warranted, the task force made several changes based on consensus. These changes included guidance on patient preparation, medication and substance use, sleep before testing, test scheduling, optimum test conditions, and documentation. This article provides guidance to providers who order and administer the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test. Krahn LE, Arand DL, Avidan AY, et al. Recommended protocols for the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine. J Clin Sleep Med. 2021;17(12):2489–2498.
Overview
CoChat Summary
TL;DR
This AASM guidance updates protocols for the Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT) in adults. The task force found no evidence-based protocol changes were warranted but made several consensus changes on patient preparation, medications/substances, sleep before testing, scheduling, test conditions, and documentation.
Key findings
- The task force adopted consensus changes including frontal EEG electrodes for consistency with current sleep staging, stopping stimulating activities/electronic devices 30 minutes before each trial, and added guidance on sleep duration, OSA treatment, and shared patient-clinician decisions about medications and caffeine.
- For MSLT: perform after attended PSG with minimum 7 hours time in bed and at least 6 hours sleep; use 5 nap trials, initial trial 1.5–3 hours after PSG, each subsequent trial 2 hours after prior start; terminate at 20 minutes if no sleep or continue 15 minutes after sleep onset; a 4-nap test is allowed only when results are clearly diagnostic (mean sleep latency ≤8 minutes and ≥2 SOREMPs). Medication washout is generally 2 weeks, up to 6 weeks for long half-life agents.
- For MWT: use four 40-minute wake trials, initial trial 1.5–3 hours after sleep, subsequent trials 2 hours after prior start; PSG before MWT is optional. Published normal control MWT mean sleep latency is 30.4 ± 11.20 minutes, with a modal MSL of 40 minutes indicating a ceiling effect.
- Drug screening findings cited: up to 33% of adult MSLT patients had a positive drug screen, and one study found 81% had not reported the detected substance; in MWT, 6 of 26 patients (16%) had a positive screen for amphetamine, cannabis, or benzodiazepine. Neither MSLT nor MWT should be the sole criterion for determining excessive sleepiness, certifying a diagnosis, or proving treatment response.
Methods
- The American Academy of Sleep Medicine commissioned a task force of clinical experts in sleep medicine to review published literature on MSLT and MWT performance since the 2005 AASM practice parameter paper.
- Guidance applies to adults aged 18 years and older; normative data and clinical indications are not addressed in detail.
- Main analysis was literature review and expert consensus; no evidence-based changes to the protocols were warranted.
Limitations
- The paper states future research is needed on the effect of protocol modifications on sleep latency and test operational characteristics, the impact of medications, OSA treatments, and sleep-wake cycles, large normative and validation studies, age-specific diagnostic criteria, and MWT relationships to driving and workplace safety.
- The paper states no evidence-based changes were warranted, so recommendations are consensus-based; it also notes limited or no data for several areas, including central/complex sleep apnea, sitting in bed vs chair for MWT, fifth wake trial utility, and nighttime MSLT/MWT for shift workers.
- Evident from the text: this is a consensus guidance update rather than a systematic review with evidence grading or meta-analysis.
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Claims the paper makes
0 Valid · 4 Not valid · 38 Not checked · 21 Own results and interpretations
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although no evidence-based changes to the protocols were warranted, the task force made several changes based on consensus.”
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The exact duration of time that medications should be discontinued to avoid medication or rebound effects on the MSLT has not been extensively studied, but a 2-week duration is considered likely sufficient in most patients.”
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > Planning before the MSLT
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although no studies have been found addressing the potential impact of PAP usage on sleep latency during the MSLT, the task force recommended that most patients accustomed to nighttime PAP/non-PAP therapies should use these interventions to reduce sleep disruption during the daytime nap trials.”
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > Planning before the MSLT
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The available evidence suggests that up to 33% of adult patients undergoing MSLTs have a positive drug screen.”
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > Planning before the MSLT
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper states — it cites no source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because the task force found no evidence concerning the impact of sitting in a bed vs a chair”
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > Environmental factors:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
26 more claims
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Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“6 out of 26 patients (16%) undergoing an MWT had a positive drug screen”
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > Comorbid sleep disorders:
Reported 16 · recomputed 23.076923
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > General testing and data acquisition
“Therefore, the total duration of each nap trial can vary from 20-35 minutes.”
§ Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine > General testing and data acquisition
“Each nap trial should be terminated 15 minutes after an epoch of sleep or after 20 minutes if no epoch of sleep is identified.”
Citations
Cites
The International Classification of Sleep Disorders: Diagnostic and Coding Manual
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Littner, M. R., Kushida, C., Wise, M., G. Davila, D., Morgenthaler, T., Lee-Chiong, T., Hirshkowitz, M., Loube, D. L., Bailey, D., Berry, R. B., et al. (2005) · Sleep · doi:10.1093/sleep/28.1.113 · Cited by 1,142
Self-citationEvaluation of Positive Airway Pressure Treatment for Sleep Related Breathing Disorders in Adults
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Effects of Antidepressants on Sleep
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24-Hour Metabolic Rate in Insomniacs and Matched Normal Sleepers
Bonnet, M. H., & Arand, D. L. (1995) · Sleep · doi:10.1093/sleep/18.7.581 · Cited by 557
Self-citationMitler, M. M., Gujavarty, K. S., & Browman, C. P. (1982) · Electroencephalography and Clinical Neurophysiology · doi:10.1016/0013-4694(82)90142-0 · Cited by 522
Cannabis, Cannabinoids, and Sleep: a Review of the Literature
Babson, K. A., Sottile, J., & Morabito, D. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0775-9 · Cited by 484
Smith, M. T., McCrae, C. S., Cheung, J., Martin, J. L., Harrod, C. G., Heald, J. L., & Carden, K. A. (2018) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7230 · Cited by 483
Self-citationThe Clinical Use of the MSLT and MWT
Arand, D., Bonnet, M., Hurwitz, T., Mitler, M., Rosa, R., & Sangal, R. B. (2005) · Sleep · doi:10.1093/sleep/28.1.123 · Cited by 389
Self-citationSleep Fragmentation and Daytime Sleepiness
Stepanski, E., Lamphere, J., Badia, P., Zorick, F., & Roth, T. (1984) · Sleep · doi:10.1093/sleep/7.1.18 · Cited by 346
Research works printed but not linked: 3
- American Academy of Sleep Medicine . International Classification of Sleep Disorders. 3rd ed. Darien, IL : American Academy of Sleep Medicine ; 2014 .
- Berry RB, Quan SF, Abreu AR, et al ; for the American Academy of Sleep Medicine . The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.6. Darien, IL : American Academy of Sleep Medicine ; 2020 .
- Hartse KM, Roth T, Zorick F, Zammit G . The effect of instruction upon sleep latency during multiple daytime naps of normal subjects . Sleep Res. 1980 ; 9 ( 123):S72.
Cited by
Mental health in elite athletes: International Olympic Committee consensus statement (2019)
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., et al. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-100715 · Cited by 1,277
Barateau, L., Pizza, F., Plazzi, G., & Dauvilliers, Y. A. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13631 · Cited by 89
Clinical considerations for the diagnosis of idiopathic hypersomnia
Dauvilliers, Y. A., Bogan, R., Arnulf, I., Scammell, T. E., Louis, E. K. S., & Thorpy, M. J. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101709 · Cited by 78
The orexin story, sleep and sleep disturbances
Pizza, F., Barateau, L., Dauvilliers, Y. A., & Plazzi, G. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13665 · Cited by 77
Wang, W., Yuan, R. K., Mitchell, J. F., Zitting, K., Hilaire, M. A. S., Wyatt, J. K., Scheer, F. A. J. L., Wright, K. P., Brown, E. N., Ronda, J. M., et al. (2022) · Nature Protocols · doi:10.1038/s41596-022-00746-y · Cited by 46
Metadata
- Authors
- Krahn, L. E., Arand, D. L., Avidan, A. Y., Davila, D. G., DeBassio, W. A., Ruoff, C. M., & Harrod, C. G.
- Affiliations
- Mayo Clinic in Arizona (US)
- Wright State University (US)
- University of California, Los Angeles (US)
- Central Arkansas Veterans Healthcare System (US)
- Boston University (US)
- American Academy of Sleep Medicine (US)
- Corresponding author
- Krahn, Lois E.
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2021-12
- Volume
- 17
- Issue
- 12
- Pages
- 2489-2498
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC8726366
- OpenAlex
- W3196270389
- Cited by
- 177
- References
- 60
- Citations by year
- 2026: 42 · 2025: 40 · 2024: 33 · 2023: 37 · 2022: 23
- FWCI
- 16.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American Academy of Sleep Medicine
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- multiple sleep latency test, maintenance of wakefulness test, sleepiness assessment, patient preparation, test scheduling, experimental conditions, documentation, daytime sleepiness
- MeSH terms
- Academies and Institutes, Sleep Latency, Adult, Humans, Sleep, United States, Wakefulness, Polysomnography
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- CoChat. (2026). Citation check: Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine. https://app.cochat.ai/papers/10.5664/jcsm.9620
- The paper
- Krahn, L. E., Arand, D. L., Avidan, A. Y., Davila, D. G., DeBassio, W. A., Ruoff, C. M., & Harrod, C. G. (2021). Recommended protocols for the Multiple Sleep Latency Test and Maintenance of Wakefulness Test in adults: guidance from the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine. https://doi.org/10.5664/jcsm.9620
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