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PubMed2005

Polysomnography before and after weight loss in obese patients with severe sleep apnea.

OBJECTIVE: While obstructive sleep apnea (OSA) is strongly related to obesity, few studies have examined polysomnographic (PSG) changes with major weight loss. We examined the effect of weight loss following laparoscopic adjustable gastric banding (LAGB) on the PSG changes in patients with severe OSA. In addition, we studied daytime sleepiness, the metabolic syndrome and quality of life (QOL). METHODS: A prospective study was conducted of 25 severely obese patients (17 men, eight women) with paired diagnostic PSG, biochemical and questionnaire studies, the first prior to LAGB and the second at least 1 y later. Subjects with a baseline apnea-hypopnea index (AHI) >25/h were included. RESULTS: Subject baseline age was 44.7 y, weight 154 kg and body mass index 52.7 kg/m(2). The second PSG study was conducted 17.7+/-10 (range 12-42) months after surgery and mean percentage of excess loss and weight loss were 50.1+/-15% (range 24-80%) and 44.9+/-22 kg (range 18-103 kg), respectively. There was a significant fall in AHI from 61.6+/-34 to 13.4+/-13, improved sleep architecture with increased REM and stage III and IV sleep, daytime sleepiness, as measured by Epworth Sleepiness Scale, of 13+/-7.0 to 3.8+/-3.0, and fewer patients requiring nasal continuous positive airways pressure (CPAP). There were also major improvements in the metabolic syndrome, QOL, body image and fewer symptoms of depression (P<0.05 for all). CONCLUSION: Weight loss provides major improvement or resolution of OSA and CPAP requirements. It also reduces daytime sleepiness, and improves the metabolic syndrome and QOL. LAGB placement should be considered a broadly effective therapy for sleep apnea in the severely obese patient.

Adult↗
PubMed1998

Anaesthetic depth at induction. An evaluation using clinical eye signs and EEG polysomnography.

We describe the stages of non-REM sleep induced by anaesthesia with sevoflurane 8% in oxygen and relate these stages to clinical eye positions. We explored John Snow's observation (1847) that 'when voluntary movement ceases, with the eyes fixed in an upward gaze during the gas induction of anaesthesia, the patient is protected against the risk of mental suffering' (awareness). Unpremedicated ASA 1 patients undergoing elective tonsillectomy were studied using EEG polysomnographic principles and clinical eye movement tracking. The results expressed as median and range were: latency to stage 1 sleep 4.5 min [2.5-7.5], stage 2 sleep 5 min [3.5-8.5], stage 3 sleep 5.5 min [4-12] and stage 4 sleep 6 min [4.5-15.5]. Eye position 5, the point of no further eye movement, was reached after 9 min [5.5-18.5]. This was significantly longer than the time taken to reach the stage 4 sleep EEG, p < 0.01, supporting Snow's observation and encouraging investigation into eye movement tracking technology as a potential monitor of anaesthetic depth.

Adolescent↗
PubMed2003

Daytime testing after laboratory or home-based polysomnography: comparisons of middle-aged insomnia sufferers and normal sleepers.

Many studies have shown only modest differences between insomnia sufferers and matched, non-complaining normal controls in regard to their levels of daytime sleepiness and diurnal performances. The current study was conducted to determine whether such daytime comparisons might be affected by the setting (home vs. sleep lab) in which study participants sleep on the nights before such testing. The study used a counter-balanced, matched-group design in which participants underwent three consecutive nocturnal polysomnographs (PSG) conducted either in the sleep lab or in their homes prior to undergoing daytime multiple sleep latency test (MSLT) and computer-administered performance testing. The study participants were 35 (18 women and 17 men) middle-aged (40-59 years) non-complaining normal sleepers and 33 middle-aged insomnia sufferers (17 women and 16 men) who met structured interview criteria for persistent primary insomnia. Use of a hierarchical linear statistical model showed only insomnia sufferers who underwent nocturnal home PSG were more alert on the MSLT than were normal sleepers who underwent lab PSG. However, these insomnia sufferers showed a greater propensity toward attention lapses on selected reaction time tests than did either of the two normal control groups (i.e. either those who slept in the lab or those who slept at home). The results suggest the nocturnal sleep setting (home vs. lab) may affect subsequent MSLT and performance test comparisons of insomnia sufferers and normal sleepers.

Adult↗
PubMed2004

Polysomnography during withdrawal with clomethiazole or placebo in alcohol dependent patients--a double-blind and randomized study.

INTRODUCTION: The present study was designed to assess if the routine application of clomethiazole to ameliorate withdrawal symptoms in chronic alcohol dependent patients perpetuates sleep disturbances. METHODS: Twenty inpatients with alcohol dependence according to DSM-IV criteria received clomethiazole or placebo in a double-blind, randomized design upon admission. 11 patients were randomized to the clomethiazole group and 9 patients to the placebo group. During the first 5 days of treatment the patients received either clomethiazole (1st day: 3 x 384 mg, 2nd day: 4 x 384 mg, 3rd day: 3 x 384 mg, 4th day: 2 x 384 mg and 5th day: 1 x 384 mg) or placebo capsules at constant intervals. The patients spent two consecutive nights in the sleep laboratory at each of three assessment times: the first time at the beginning of abstinence (night 1 and 2, T0), the second time 6 days later (i. e. after 5 days of treatment and one day of discontinuation of clomethiazole or placebo: nights 6 and 7, T1) and the third time after 13 days (nights 13 and 14, T2). The first night at each of the three assessment times was an adaptation night. RESULTS: During the first two weeks of abstinence, the analysis of variance demonstrated a significant variation of Rapid Eye Movement (REM) sleep variables in the clomethiazole group. The placebo group showed no such variation. Clomethiazole evidently had a pronounced REM sleep suppressing effect, whereas the discontinuation of clomethiazole led to a REM sleep rebound. Furthermore, analysis of sleep continuity and sleep architecture variables showed that the clomethiazole group had significantly disturbed sleep at T1 in comparison to the placebo group. Simultaneous statistical testing with alcohol intake as covariate reduced the test power so that contrasts between the groups became nonsignificant. CONCLUSIONS: The REM sleep results are in line with earlier findings that REM sleep disinhibition in primary alcohol dependency is partly due to a REM sleep rebound after withdrawal from medication. Differences in the polysomnographic variables of sleep continuitiy and sleep architecture at T0 and T1 found between the clomethiazole and the placebo patients correspond to rebound insomnia following discontinuation of clomethiazole. Our findings indicate that drugs enforcing GABAergic neurotransmission may perpetuate the neuroadaptative effects caused by chronic alcohol consumption.

Adult↗
PubMed1996

Nocturnal polysomnography with and without continuous pharyngeal and esophageal pressure measurements.

PSG with simultaneous pharyngeal and esophageal pressure measurements of the upper airway may interfere with sleep architecture and cause a bias. The aim of this study was to evaluate the degree of disturbance to sleep caused by inclusion of pressure measurements of the airway, and whether this would reduce the validity of the PSG. Thirty-two consecutive patients referred for PSG for possible obstructive sleep apnea syndrome (OSAS) were included. For pressure recordings, a 6-F silicone tube, 1.9 mm in diameter, containing six pressure transducers, was introduced through one nostril into the pharynx and esophagus. Each patient had two nocturnal PSGs, one of which included airway pressure measurements. There were no statistically significant differences between PSGs performed with and without simultaneous pressure recordings for the following sleep quality parameters: total sleep time, number of sleep-stage shifts, sleep efficiency, arousal during sleep (= intrasleep wakefulness), percent REM sleep, and number of microarousals. We did not find any statistically significant differences for respiratory parameters such as type, duration, and index of different respiratory events and snoring. However, there was a slight tendency for reduced sleep quality and oxygen saturation when pressure measurements were included. The only significant change seen was in the duration of non-REM sleep with oxygen saturation below 90%. The multisensor airway pressure probe demonstrated that proximal obstructions were more common than distal obstructions, and obstruction in one or two segments was far more frequent than obstruction in more than two.

Adult↗
PubMed2000

The impact of split-night polysomnography for diagnosis and positive pressure therapy titration on treatment acceptance and adherence in sleep apnea/hypopnea.

STUDY OBJECTIVES: The time and resource intensive nature of the traditional two-night paradigm for diagnosing and titrating positive pressure therapy for Obstructive Sleep Apnea/Hypopnea (OSA/H) contributes to patient care cost and limitation of service availability. Although split night polysomography (PSG(SN)) algorithms can establish a diagnosis of OSA/H and establish a positive pressure prescription for many patients, there has been only limited evidence that this strategy does not impair acceptance and adherence to treatment. The objective of this study was to test the null hypothesis that PSG(SN) does not adversely impact acceptance and adherence to positive pressure therapy for OSA/H compared with a standard two-night PSG strategy (PSG(TN)). DESIGN: Retrospective case-controlled study. SETTING: University-based sleep disorders program PATIENTS: Both PSG(SN) and PSG(TN) (control) patients were selected on the basis of having an initial medical/sleep evaluation by a full-time physician member of the University of Pittsburgh Sleep Disorders Program, must not have had prior diagnostic PSG or treatment for sleep-disordered breathing, and must have been followed by the Sleep Program team. Selection of PSG(SN) patients required the ability to be matched with a control patient. Both groups underwent evaluation during the same time period. Of 146 patients who underwent PSG(SN) between October 1995 and September 1997, 51 had their initial evaluation and subsequent follow-up by physician-staff members of our Program. Of these, 15 were excluded from analysis because of a previous diagnostic PSG's or prior OSA/H therapy. Also, matches were unavailable for 5 patients. Seven patients refusal to use positive pressure at home and were not available for assessment of adherence, but were included in analysis of therapeutic acceptance. Thus, analysis of the impact of PSG(SN) on adherence to positive pressure therapy was based on a data set of 24 patients in whom a PSG(SN) was performed and 24 patients who had PSG(TN). The two groups were matched for age, Apnea+Hypopnea Index (AHI) and gender. MEASUREMENT AND RESULTS: There were no significant differences between the PSG(SN) and PSG(TN) groups with respect to age, body mass index (BMI), Desaturation Event Frequency (DEF), Arousal Index (ArI) or the Epworth Sleepiness Score (ESS). The nadir of oxyhemoglobin saturation (SpO2) during sleep was lower in the PSG(TN) than PSG(SN) group (69.3+/-15 vs. 79.8+/-9, mean+/-SD, p=0.012). During positive pressure titration, the time spent at the final pressure which was prescribed for the patients were comparable in both groups (123.4+/-64 vs. 161+/-96 minutes, PSG(SN) and PSG(TN), respectively, p=0.17). Adherence to therapy was objectively assessed by the average daily run-time of the positive pressure device at the first meter-read following initiation of treatment (55.1+/-44 vs. 40.8+/-16 days following home set-up, PSG(SN) and PSG(TN), respectively, p=0.14). Depending whether or not patients with previous exposure to positive pressure therapy were included in the analysis, 84-86% of patients undergoing PSG(SN) accepted therapy. There was no difference between the groups with respect to adherence (5.1+/-4 vs. 4.6+/-3 hours, PSG(SN) and PSG(TN), respectively, p=0.64). CONCLUSIONS: In a population of predominantly moderate-to-severe OSA/H patients, PSG(SN) strategy does not adversely impact on adherence to positive pressure therapy over the first six weeks of treatment. Acceptance of therapy is comparable to that reported in the literature following PSG(TN).

Adult↗
PubMed2002

Digital tools in polysomnography.

Recent advances in the computing power and storage devices have made computer-based recording of polysomnograms (PSGs) very attractive. Digital PSGs offer the possibility of automating many tedious and time-consuming tasks of identifying sleep related events. Automation not only alleviates these laborious tasks, but also introduces a measure of objectivity in the scoring of various discrete events. In this paper we briefly review some automatic methods that have been previously developed by the authors. Automatic sleep staging methods is emphasized with some illustrative results on inter-scorer variations. We also discuss the leg movement event, respiratory event, sleep spindle and rapid-eye-movement detection methods.

Computers↗
PubMed2002

Infant polysomnography: reliability and validity of infant arousal assessment.

Infant arousal scoring based on the Atlas Task Force definition of transient EEG arousal was evaluated to determine (1). whether transient arousals can be identified and assessed reliably in infants and (2). whether arousal and no-arousal epochs scored previously by trained raters can be validated reliably by independent sleep experts. Phase I for inter- and intrarater reliability scoring was based on two datasets of sleep epochs selected randomly from nocturnal polysomnograms of healthy full-term, preterm, idiopathic apparent life-threatening event cases, and siblings of Sudden Infant Death Syndrome infants of 35 to 64 weeks postconceptional age. After training, test set 1 reliability was assessed and discrepancies identified. After retraining, test set 2 was scored by the same raters to determine interrater reliability. Later, three raters from the trained group rescored test set 2 to assess inter- and intrarater reliabilities. Interrater and intrarater reliability kappa's, with 95% confidence intervals, ranged from substantial to almost perfect levels of agreement. Interrater reliabilities for spontaneous arousals were initially moderate and then substantial. During the validation phase, 315 previously scored epochs were presented to four sleep experts to rate as containing arousal or no-arousal events. Interrater expert agreements were diverse and considered as noninterpretable. Concordance in sleep experts' agreements, based on identification of the previously sampled arousal and no-arousal epochs, was used as a secondary evaluative technique. Results showed agreement by two or more experts on 86% of the Collaborative Home Infant Monitoring Evaluation Study arousal scored events. Conversely, only 1% of the Collaborative Home Infant Monitoring Evaluation Study-scored no-arousal epochs were rated as an arousal. In summary, this study presents an empirically tested model with procedures and criteria for attaining improved reliability in transient EEG arousal assessments in infants using the modified Atlas Task Force standards. With training based on specific criteria, substantial inter- and intrarater agreement in identifying infant arousals was demonstrated. Corroborative validation results were too disparate for meaningful interpretation. Alternate evaluation based on concordance agreements supports reliance on infant EEG criteria for assessment. Results mandate additional confirmatory validation studies with specific training on infant EEG arousal assessment criteria.

Arousal↗
PubMed1997

Reliability of scoring EMG orofacial events: polysomnography compared with ambulatory recordings.

The study of sleep bruxism is usually based on clinical history, signs and symptoms. The recording of electromyographic signals with either ambulatory portable home recorders or with polysomnographic techniques in the laboratory environment allows collection of objective data. The present study showed a 100% agreement with clinical evaluation in the recognition of bruxism episodes from the masseter electromyogram recorded with portable recorders and using the polysomnographic technique. On the contrary, scorers had difficulties in discriminating between different types of episodes (phasic, tonic and mixed), the between-scorers agreement varied between 62% and 63% and the kappa-values between 0.43 and 0.33. The ideal time base at which electromyographic signals should be integrated to allow for a good discrimination of bruxism patterns is 0.06 s. The results indicate that portable electromyography recorders are a valuable complement to polysomnographic recordings of orofacial motor activities as they provide a very good recognition rate with adequate time base data collection.

Adult↗
PubMed1998

Efficacy of L-846 in patients with insomnia: evaluation by polysomnography.

The effects of L-846, an ultra-short-acting pyrazolopyrimidine hypnotic, on sleep were studied in nine insomniacs and two neurotic patients with insomnia. The patients were randomly assigned to receive 5 mg (n=6) or 10 mg (n=5) L-846. The study schedule comprised of one adaptation night, two baseline nights, three drug nights, and two withdrawal nights. Sleep latency and slow wave sleep (SWS) latency was largely shortened and %SWS increased in the early phase of sleep. No clear evidence of rebound insomnia was noted.

Acetamides↗