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PubMed1995

Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients.

Technology for conducting ambulatory polysomnography (APSG) has been available for more than a decade, but relatively few studies have used this technology to study the sleep of subjects in their usual home sleeping environments. Herein we suggest the usefulness of this technology for the study of normal sleepers and insomniacs, and we report our APSG findings with a large cohort (n = 117) of drug-free insomnia outpatients. All patients completed a sleep-history questionnaire, a clinical interview with a sleep-disorders clinician, and one night of APSG in their homes. Most sleep parameters derived were consistent with previously reported laboratory PSG findings for insomniacs, except that values of rapid-eye-movement sleep latencies were generally shorter than typically found in laboratory studies. Moreover, results showed that APSG served to differentiate major age groups and diagnostic subtypes within our larger sample, and patient tolerance for APSG was within acceptable limits. We conclude that APSG is a useful technique for evaluating insomnia complaints.

Adult↗

PubMed1998

Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep Heart Health Research Group.

This paper reviews the data collection, processing, and analysis approaches developed to obtain comprehensive unattended polysomnographic data for the Sleep Heart Health Study, a multicenter study of the cardiovascular consequences of sleep-disordered breathing. Protocols were developed and implemented to standardize in-home data collection procedures and to perform centralized sleep scoring. Of 7027 studies performed on 6697 participants, 5534 studies were determined to be technically acceptable (failure rate 5.3%). Quality grades varied over time, reflecting the influences of variable technician experience, and equipment aging and modifications. Eighty-seven percent of studies were judged to be of "good" quality or better, and 75% were judged to be of sufficient quality to provide reliable sleep staging and arousal data. Poor submental EMG (electromyogram) accounted for the largest proportion of poor signal grades (9% of studies had <2 hours artifact free EMG signal). These data suggest that with rigorous training and clear protocols for data collection and processing, good-quality multichannel polysomnography data can be obtained for a majority of unattended studies performed in a research setting. Data most susceptible to poor signal quality are sleep staging and arousal data that require clear EEG (electroencephalograph) and EMG signals.

Electroencephalography↗

PubMed1999

[Comparison of AutoSet with polysomnography in the diagnosis of sleep apnea syndrome].

OBJECTIVE: To evaluate the validation of the AutoSet system in the diagnosis of sleep apnea syndrome(SAS). METHODS: One hundred and twenty patients were studied simultaneously performed both with the AutoSet and the polysomnography(PSG). The apnea index(AI) and apneas + hypopneas index (AHI) were compared between the two methods by Bland and Altmen method. RESULTS: A significant correlation was found between the AHI assessed by the AutoSet and by the PSG (r = 0.92, P < 0.001). The respiratory irregularity index (RII) of the AutoSet was well correlated with the arousal index (Ai) from the PSG (r = 0.72, P < 0.001). The sensitivity and specificity of the AutoSet in diagnosing sleep apnea were 94% and 80% for AHI > or = 5/hour, 92% and 85% for AHI > or = 10/hour, 91% and 92% for AHI > or = 15/hour, 91% and 91% for AHI > or = 20/hour. CONCLUSIONS: The AutoSet system is a sensitive and valuable tool for identifying patients with sleep apnea and can make a diagnosis of sleep apnea for these patients with AHI > or = 30/hour, but has some limits especially for mild to moderate sleep apnea.

Adolescent↗

PubMed2002

[Combined use of melatonin and low-dose flunitrazepam for treatment of sleep disturbance in a child with spastic quadriplegia: evaluation using polysomnography].

A 14-year-old boy born at 39 gestational weeks with the birth weight of 3,250 g, had severe mental retardation and spastic quadriplegia of unknown etiology from early childhood. At 7 years of age, disturbance of night sleep appeared with several awakenings. Combined treatment with melatonin (MLT; 0.04 mg/kg) and flunitrazepam (FNZ; 0.025 mg/kg) was more effective than monotherapy with FNZ for the sleep disturbance. Difference of the effects of the combined therapy and the monotherapy for the sleep disturbance were assessed by polysomnographies (PSGs), consisted of EEG (C3, C4), bipolar EOG and surface EMG on the mentalis muscle. The PSGs were performed twice at 13 years 6 months old, and at 14 years 1 month old. In both trials, the number of awakening was fewer, total sleep time was longer, percent (%) stage I and II were lower and %REM sleep was larger in combined MLT and FNZ therapy than in FNZ monotherapy. The present study suggests that the combined MLT and FNZ therapy not only reduces awakening during sleep but also normalizes sleep architecture. This therapy is valuable because normalization of sleep is important for the developing brain as it reflects the normal functioning of the aminergic neurons of the midbrain and the brainstem which have important roles for morphological and functional development of the brain in immature brain.

Adolescent↗

PubMed2004

Hypnic headache: a case report with polysomnography.

We report on a case of nocturnal headache attacks fulfilling the criteria for hypnic headache syndrome. Using an overnight polysomnography, one nocturnal headache attack was captured during the REM phase of sleep. Quality of sleep was poor with desaturation episodes. However, the hypnic headache attack was not associated with oxygen desaturation. This additional case supports the view of a relationship between the hypnic headache syndrome and the REM sleep stage. Lithium therapy decreased the intensity and frequency of headache attacks.

Diagnosis, Differential↗

PubMed2004

Hypnic headache syndrome: excessive periodic limb movements in polysomnography.

We report a patient with hypnic headache syndrome associated with excessive periodic limb movements in sleep, which is a unique finding for this syndrome recorded in polysomnography. She had had daily hypnic headache attacks history for 10 years. Her headache attacks ceased immediately after lithium carbonate therapy and she has been headache-free for 5 months.

Diagnosis, Differential↗

PubMed2005

[Polysomnography analysis in children].

OBJECTIVE: To analyze the characteristics of Polysomnography (PSG) in children with obstructive sleep apnea-hypopnea syndrome(OSAHS). METHOD: Forty-five children with sleep breathing disorder were studied with 32 guide PSG and analyzed by Polysmith. PSG results of OSAHS children were compared with primary snore group. RESULT: The mean age of OSAHS children was(7.3 +/- 3.8) years and the mean body weight was (40.1 +/- 19.7) kg. The mean value of NREM stage 1, stage 2, stage 3+4 and REM stage was(21.4 +/- 13.2)%, (43.1 +/- 13.7)%, (26.1 +/- 14.0) % and (9.4 +/- 6.0) % respectively. The sleep structure between OSAHS group and primary snore group was not significant (P > 0.05). The mean value of AHI of OSAHS children was(12.8 +/- 8.1) h. AI was (6.7 +/-6.6)h, HI was(6.1 +/- 5.1)h. CONCLUSION: The sleep structure of children is prefect and mild effected by OSAHS.

Adolescent↗

PubMed2005

Sleep measurement in flight crew: comparing actigraphic and subjective estimates to polysomnography.

INTRODUCTION: Flight crew sleep is recognized as critical to alertness and safety, but few studies have compared the reliability of the different types of sleep monitoring that are commonly used. The present study compared actigraphic and subjective estimates of sleep to the gold standard, polysomnography (PSG). METHODS: In-flight (25 episodes) and layover sleep (21 episodes) of 21 flight crew were measured with PSG and actigraphy. Subjective reports were made 30 min after in-flight sleep episodes. Actigraphy data were analyzed at low, medium, and high activity thresholds. RESULTS: Actigraphic and subjective estimates of sleep duration correlated highly with PSG (range 0.84-0.95), regardless of sleep location or activity threshold. Mean differences were relatively small (-36-20 min), but the 95% confidence intervals of the differences were wide (+/- 71- +/- 103 min), particularly for subjective estimates (+/- 112 min). Actigraphic estimates of sleep efficiency and latency showed moderate to poor correlation with PSG values. Epoch-by-epoch comparisons showed the actigraph was sensitive to sleep (83-95%), but not very specific (34-62%). Kappa values indicated only weak agreement (< 0.4). DISCUSSION: For estimating mean sleep duration, both actigraphic and subjective estimates are sufficiently close to PSG values, but the amount of random error must be considered. Any single estimate may vary by more than 1 h from the mean difference. Neither actigraphy nor subjective estimates are suitable for estimating sleep efficiency and latency. Findings indicate that the performance of the actigraph is not altered in flight, other than the predictable effects associated with shorter, more disturbed sleep.

Adult↗

PubMed2005

Clinical screening of school children for polysomnography to detect sleep-disordered breathing--the Tucson Children's Assessment of Sleep Apnea study (TuCASA).

STUDY OBJECTIVES: This report describes the associations, specificities, sensitivities, and positive likelihood ratios of clinical symptoms to a finding of sleep-disordered breathing (SDB) on polysomnography in children. METHODS: Four hundred eighty unattended home polysomnograms were completed in a community-based cohort of children 6 to 11 years of age (50% boys, 42.3% Hispanic, and 52.9% between the ages of 6 and 8 years). SDB was present if the child had a respiratory disturbance index of > or = 1 event per hour. MEASUREMENTS AND RESULTS: Boys were twice as likely as girls to have SDB (p < .01); however, witnessed apnea, ethnicity, age, obesity, and airway size (based on clinical evaluation) were not significantly different between those with SDB and without SDB. The sensitivity of any individual or combined clinical symptoms was poor, with male sex (60%) and snoring (29.5%) having the greatest proportion of SDB children. However, high specificities for snoring (89.5%), excessive daytime sleepiness (86.3%), and learning problems (95.9%) were noted. Combinations of symptoms such as snoring+male sex (95.1%), snoring+excessive daytime sleepiness (97.0%), and snoring+learning problems (98.9%) had specificities approaching 1. Positive likelihood ratios for snoring (2.8), learning (2.8), and symptoms combined with snoring such as snoring+male sex (3.9), snoring+learning problems (4.0), and snoring+excessive daytime sleepiness (2.9) were observed. CONCLUSIONS: Snoring, excessive daytime sleepiness, and learning problems are each highly specific, but not sensitive, for SDB in 6- to 11-year old children. However, specificities and positive likelihood ratios for the combination of some of these symptoms is sufficiently high to suggest that some children may not require a polysomnogram for the diagnosis of SDB.

Child↗

PubMed2006

[Usefulness of polysomnography at an early stage of amyotrophic lateral sclerosis].

A 47-year-old man who presented moderate muscle weakness in the neck and all the extremities was diagnosed as having early stage of amyotrophic lateral sclerosis (ALS). He did not have bulbar dysfunction and respiratory distress. His pulmonary function tests and arterial blood gas analysis showed no abnormalities, but polysomnography (PSG) revealed sleep-disordered breathing requiring mechanical support ventilation. Bi-level positive airway pressure treatment was started only at night, which improved both sleep-disordered breathing and daytime activity. PSG should be considered in ALS patients at an early clinical stage in order to predict mild respiratory dysfunction.

Amyotrophic Lateral Sclerosis↗

PubMed2006

[Effects of risperidone on polysomnography in patients with first-episode schizophrenia].

OBJECTIVE: To investigate the effects of risperidone on the polysomnography (PSG) in the patients with first-episode schizophrenia. METHODS: Twenty-five patients with first-episode schizophrenia, 13 males and 12 females, aged 29 +/- 8, underwent polysomnographic recording for 4 consecutive nights, the first night being used for acclimatization, and on the 3 rd and 4 th nights risperidone in the dose of 1.2 mg was administered before going to bed. Forty-four healthy persons, 23 males and 21 females, aged 28 +/- 8, underwent polysomnographic recording for 2 consecutive nights, the first night being used for acclimatization. RESULTS: The baseline PSG recording showed that in comparison with the normal control group the total sleep time of the schizophrenia patients was shorter (378 min +/- 30 min vs 462 min +/- 21 min), sleep latency was longer (30 min +/- 14 min vs 18 min +/- 8 min), rapid eye movement (REM) sleep latency was shorter (59 min +/- 20 min vs 88 min +/- 10 min), REM sleep time was shorter (61 min +/- 17 min vs 84 min +/- 12 min), awakening time was longer (34 min +/- 17 min vs 15 min +/- 5 min), stage 1 (S1) time was longer (22% +/- 10% vs 9.0% +/- 1.7%), S3 time and S4 time were shorter, and the sleep efficacy was lower (86% +/- 10%) (P < 0.05 approximately P < 0.01); however, there was no significant difference in the S2 time between these 2 groups (54% +/- 16% vs 56% +/- 4%, P > 0.05). In the schizophrenia group, in comparison with the baseline levels in the third and fourth nights the total sleep times were significantly increased (406 min +/- 34 min and 428 min +/- 31 min respectively), the awakening times were significantly decreased (23 min +/- 15 min and 19 min +/- 8 min respectively), and S1 times were significantly decreased (14 min +/- 9 min and 10 min +/- 9 min respectively), with such changes time-dependently; and in the 4 th night the REM sleep time was significantly increased (87 min +/- 20 min) and the sleep efficacy was significantly improved (93% +/- 12%) (P < 0.05 approximately P < 0.01), however, there were no significant differences in the sleep latency and slow wave sleep (both P > 0.05). CONCLUSION: Risperidone significantly improves the quality of sleep.

Adult↗

PubMed1993

[Polysomnography: useful or superfluous?].

The sleep apnea/hypopnea syndrome is a common disorder. Medical and social complications are frequent. When the condition is untreated, life expectancy is reduced. The standard technique for diagnosing sleep apnea and establishing effective long-term treatment is overnight polysomnography. Limited diagnostic investigations and screening methods are currently being investigated.

Diagnosis, Differential↗

PubMed1995

Interaction between sleep and growth hormone. Evaluated by manual polysomnography and automatic power spectrum analysis.

The relation between nightly growth hormone (GH) secretion and sleep is poorly understood. To examine whether disturbances in GH secretion are reflected in abnormal sleep patterns 8 subjects with isolated GH deficiency and 9 subjects with excess of GH (acromegalics) underwent all night sleep studies, polysomnography. Moreover, the effect of correcting GH concentration on sleep patterns were examined in the same subjects. The results showed that all subjects with GH disturbances had abnormal REM and delta sleep and normalization of GH concentration was followed by correction of the sleep stages. By power spectrum analysis of the sleep EEG it was showed that during low GH concentration the sleep energy was low, and high GH concentration was associated with high sleep energy, and correction of abnormal plasma GH levels resulted in normalization of REM and delta sleep energy per time unit.

Adult↗

PubMed1996

Polysomnography: addressing the need for standards.

The field of sleep disorders medicine is facing enormous challenges as it strives to gain recognition from the medical profession, the public and government. One of these challenges is to ensure that limited resources for diagnosis are used wisely. The authors argue that the standards for polysomnography developed by the Canadian Sleep Society and the Canadian Thoracic Society (see pages 1673 to 1678 of this issue) will go a long way toward ensuring that this expensive resource is used prudently. In the mean-time, more research is needed to determine valid measures of the impact of sleep disorders and to establish the reliability of different diagnostic methods.

Canada↗

PubMed1997

A comparison of sleep detection by wrist actigraphy, behavioral response, and polysomnography.

Two alternative methods for detecting sleep, wrist actigraphy (ACT) and behavioral response monitoring (BRM), were compared to polysomnography (PSG). In the BRM paradigm, a threshold intensity visual or auditory stimulus generated by a palm-top computer was presented about once per minute, and subjects pressed a microswitch if the stimulus was detected. A response within 5 seconds of the stimulus was scored as "wake" and a failure to respond as "sleep." Four males and four females underwent two nights of simultaneous in-home PSG, BRM, and ACT. Each night, subjects underwent a protocol designed to generate five sleep latency trials. Subjects were awakened by alarm clocks at approximately 1-hour intervals and remained awake for 10 minutes before returning to bed for another sleep onset latency (SOL) trial. Minute-by-minute comparisons were made for PSG versus ACT and BRM. All measures were fairly sensitive in detecting sleep, but BRM was more accurate in determining SOL and subsequent wakefulness. Behavioral response monitoring using a tone resulted in more responses and arousals prior to and during light stages of sleep than BRM using a light. It is concluded that BRM has some important advantages as a simple, minimally invasive method for monitoring sleep.

Adult↗

PubMed1997

Infant polysomnography: reliability. Collaborative Home Infant Monitoring Evaluation (CHIME) Steering Committee.

Infant polysomnography (IPSG) is an increasingly important procedure for studying infants with sleep and breathing disorders. Since analyses of these IPSG data are subjective, an equally important issue is the reliability or strength of agreement among scorers (especially among experienced clinicians) of sleep parameters (SP) and sleep states (SS). One basic issue of this problem was examined by proposing and testing the hypothesis that infant SP and SS ratings can be reliably scored at substantial levels of agreement, that is, kappa (kappa) > or = 0.61. In light of the importance of IPSG reliability in the collaborative home infant monitoring evaluation (CHIME) study, a reliability training and evaluation process was developed and implemented. The bases for training on SP and SS scoring were CHIME criteria that were modifications and supplements to Anders, Emde, and Parmelee (10). The kappa statistic was adopted as the method for evaluating reliability between and among scorers. Scorers were three experienced investigators and four trainees. Inter- and intrarater reliabilities for SP codes and SSs were calculated for 408 randomly selected 30-second epochs of nocturnal IPSG recorded at five CHIME clinical sites from healthy full term (n = 5), preterm (n = 4), apnea of infancy (n = 2), and siblings of the sudden infant death syndrome (SIDS) (n = 4) enrolled subjects. Infant PSG data set 1 was scored by both experienced investigators and trained scorers and was used to assess initial interrater reliability. Infant PSG data set 2 was scored twice by the trained scorers and was used to reassess inter-rater reliability and to assess intrarater reliability. The kappa s for SS ranged from 0.45 to 0.58 for data set 1 and represented a moderate level of agreement. Therefore, rater disagreements were reviewed, and the scoring criteria were modified to clarify ambiguities. The kappa s and confidence intervals (CIs) computed for data set 2 yielded substantial inter-rater and intrarater agreements for the four trained scorers; for SS, the kappa = 0.68 and for SP the kappa s ranged from 0.62 to 0.76. Acceptance of the hypothesis supports the conclusion that the IPSG is a reliable source of clinical and research data when supported by significant kappa s and CIs. Reliability can be maximized with strictly detailed scoring guidelines and training.

Humans↗

PubMed1997

Obstructive sleep apnea syndrome in Thai children diagnosed by polysomnography.

Overnight polysomnography was conducted in 39 Thai children with clinically suspected obstructive sleep apnea syndrome (OSAS) during the years 1994 to 1996. Eighty-five percent of these children met the polysomnographic criteria of pediatric OSAS, 42.4% among whom had severe OSAS. Male : female ratio of children with OSAS was 4.5:1. The peak age at the time of diagnosis was 3 to 4 years. The most common predisposing factor was adenoidal and tonsillar hypertrophy. Adenoidectomy and/or tonsillectomy was the most effective therapeutic option. Recovery of symptoms was observed following surgery and nasal continuous positive airway pressure.

Adenoidectomy↗

PubMed1998

[Polysomnography and other methods for the assessment of sleep disorders].

Polysomnography is an essential tool in the assessment of sleep disorders. However, PSG alone not always sufficient to evaluate various sleep disorders patients. For instance, in patients with suspected inadequate sleep hygiene, sleep logs or questionnaires on sleep habits may, be helpful in making the diagnosis. Patients who complain of excessive daytime sleepiness as a result of insomnia should be evaluated with the Epworth sleepiness scale and/or polysomnographic nap studies such as the multiple sleep latency test. In patients with suspected circadian rhythm sleep disorder, continuous temperature monitoring together with sleep log and actigraphy may establish the phase relationship between sleep-wake rhythms and other biological rhythms. Because polysomnographic measurements are cumbersome and expensive, it is necessary to select the suitable methods for the assessment of sleep disorders by the careful examination of the patients' complain.

Circadian Rhythm↗