Maintenance of Wakefulness Test (MWT) Interpretation Report

[Preliminary—pending [pending item(s)]]

(Only include the above banner if key data are pending; otherwise omit and begin with header fields below.)

Patient name: [Patient name]

DOB: [Date of birth]

MRN: [Medical record number]

Test date: [Test date]

Facility/lab: [Facility or sleep lab name]

Ordering clinician: [Ordering clinician name and credentials]

Interpreting clinician: [Interpreting clinician name and credentials]

Scoring technologist: [Scoring technologist name and credentials]

Indication: [treatment-response evaluation / safety-sensitive occupation/fitness-for-duty / driving risk counseling / other: specify]

(When information for any field is not provided, include the field with "Not available" rather than omitting it.)

Reason for Test

[Clinical question and context] (Summarize in 3–5 sentences the clinical question the MWT is intended to inform, the relevant diagnoses motivating testing, and relevant operational context when applicable. Include standard language that MWT results supplement, not replace, clinical history, symptom burden, and treatment adherence data.)

Pre-Test Clinical Context

Sleep-wake schedule: [Summary of diary/actigraphy findings, date range, typical bed/wake times, estimated total sleep time, shift work or circadian misalignment] (If not provided, state "Not available".)

Night prior to MWT: [Whether in-lab PSG was performed the prior night, whether it was a titration night, or where/how major sleep period occurred; brief summary of sleep obtained] (If not provided, state "Not available".)

Treatment status: [Therapy used night prior, objective adherence data if available, stability of wake-promoting or sedating medication regimens, timing of last doses] (If not provided, state "Not available".)

Substances and medications (24-hour and day-of-test): [Prescription medications; OTC/herbal agents with alerting or sedating effects; caffeine type, amount, and timing; nicotine timing; alcohol, cannabis, or other substances] (If any item is not provided, state "Not available" for that item.)

Urine drug screening: [Performed / Not performed / Pending] (If performed, include date/time and results.)

Interpretation-impacting factors: [List identified validity threats or state "None identified"]

Test Protocol

Protocol: [Number of trials × duration]; [inter-trial interval]; [start time relative to awakening]; [patient posture]; [environmental conditions]; [monitoring montage]

Patient instructions: [Standardized instruction given at trial start]

Scoring rules: [Sleep latency definition]; [trial termination criteria]

Deviations: [Log of protocol deviations with timestamps, or state "None observed"]

Results

Trial	Scheduled start	Actual lights out	Sleep latency (min)	Sleep occurred	Sleep onset stage	Early termination reason	Comments
1	[Time]	[Time]	[Latency or full trial duration if no sleep]	[Y / N]	[Stage / N/A]	[Reason / N/A]	[Comments]
2	[Time]	[Time]	[Latency]	[Y / N]	[Stage / N/A]	[Reason / N/A]	[Comments]
3	[Time]	[Time]	[Latency]	[Y / N]	[Stage / N/A]	[Reason / N/A]	[Comments]
4	[Time]	[Time]	[Latency]	[Y / N]	[Stage / N/A]	[Reason / N/A]	[Comments]

(Add or remove rows to match the number of scheduled trials.)

Mean sleep latency: [Mean latency in minutes] (State calculation method; use full trial duration for trials without sleep.)

Summary: [Number of trials with sleep onset; pattern across the day; notable behavioral observations such as head nods or prolonged eye closure not meeting EEG sleep onset criteria]

(If fewer than expected trials are valid, state how many were completed, why trials were invalid, and how mean latency was calculated.)

Interpretation

Summary: [Statement that MWT measures ability to maintain wakefulness in a controlled, non-stimulating setting; characterization of findings as reduced ability to maintain wakefulness, within expected limits, or limited by ceiling effects; comment on consistency across trials]

Clinical context: [Integration of treatment adherence and efficacy, medication or substance confounding, sleep schedule adequacy, and any discordance between subjective report and objective performance]

Limitations: [Acknowledge single-day snapshot nature; potential motivation effects; absence of validated universal cutoffs for real-world crash prediction; any study-specific validity concerns]

Driving and Safety-Sensitive Duty Assessment

(Include this section only if the indication involves occupational fitness-for-duty or driving risk evaluation; otherwise omit entirely.)

Scope: [Medical counseling only / Formal fitness-for-duty opinion]; [Role or tasks under consideration]

Driving symptom history: [Sleepiness while driving, near-miss or crash history, countermeasures used, high-risk conditions; use direct patient quotes for high-stakes disclosures] (If not assessed, state "Not assessed".)

Risk characterization: [Functional language translating findings without pass/fail statements]

Restrictions: [Recommended restrictions, timeframe, objective clearance criteria, and rationale] (If none, state "None recommended".)

Recommendations

• Safety counseling: [Counseling provided regarding drowsy driving avoidance and warning sign recognition] (Owner: [Patient / Sleep clinic / Referring clinician])
• Treatment optimization: [PAP adherence, medication review, sleep extension, circadian stabilization as applicable] (Owner: [Patient / Sleep clinic / Referring clinician])
• Follow-up testing: [Repeat MWT timing, consideration of MSLT or repeat PSG if indicated] (Owner: [Sleep clinic / Referring clinician])
• Communication plan: [Recipients to be informed and method] (Owner: [Sleep clinic / Referring clinician]) (Include only if external communication is required.)

Attestation

Interpreting clinician: [Name, credentials, signature]

Date/time: [Date and time of attestation]

Distribution: [Referring clinician; Ordering clinician; Patient portal; Occupational medicine if applicable]