Box 3.

MWT clinical guidance and patient preparation before testing.

1. In preparation, the clinician and the patient should define goals for adequate sleep with regard to timing and duration. Adequate sleep should be documented by sleep diary and, whenever possible, actigraphy for 2 weeks before testing.

2. The MWT should be conducted when a patient is clinically stable and when treatments of any known sleep disorders are well-established and effective.

3. In patients with sleep-disordered breathing who are being evaluated for the effectiveness of therapy, the clinician should ensure effectiveness (efficacy and adherence) based on a review of downloaded data or self-reported use for non-PAP before testing. If adequate effectiveness is suboptimal, then the clinician should determine if the anticipated impact on the test results warrants rescheduling. The patient should use PAP/non-PAP therapy on the night before the MWT.

4. The clinician should develop a plan regarding the use of prescription medications, OTC agents, herbal remedies, and other substances. If the patient is chronically taking medications with alerting or sedating properties, then they should be continued at a stable dose. Changes in medications should be avoided for 2 weeks before testing. The patient should be instructed to consult with the clinician before starting a prescription or OTC medication before the test.

5. The ordering clinician in consultation with the patient should clarify acceptable caffeine consumption before the MWT.

MWT = Maintenance of Wakefulness Test, OTC = over the counter, PAP = positive airway pressure.