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We have presented the rationale, treatment implications, and recording and data reducing techniques of ambulatory PSG. We find the method well accepted by patients, the data of adequate quality, the scoring of tape-recorded data far easier than with paper recorded data, and the interpretations of value in the diagnosis and treatment of patients presenting with DIMS.
Fifteen normal volunteers were evaluated to assess the effect of a meal on sleep onset latency. The meal was administered in a counterbalanced design on 1 of 2 successive days. Subjects napped 20 min subsequent to the meal (or at the corresponding time on the no-meal day) and 1 h after the initiation of the first nap. Ten subjects completed the Stanford Sleepiness Scale (SSS) on arriving at the laboratory, and just prior to nap 1 and nap 2. Sleep onset latency after the meal was not significantly different from that obtained under the no-meal condition, but was significantly less on nap 1 as compared with nap 2 irrespective of day or meal. SSS did not reveal subjective differences in sleepiness between the initial estimate and the postmeal estimate. Only five subjects showed a decrease in sleep onset latency postprandially (1-11 min). Although group differences in postprandial sleepiness were not documented, the phenomenon was clearly exhibited by certain individuals. Thus, postprandial sleepiness is not an invariable consequence of meal ingestion; rather, it appears to be affected by numerous variables such as hunger, volume of the meal, and meal constituents.
Sleep architecture derived from long-term polysomnographic recordings during the first year of life is characterized by clear developmental trends against a backdrop of variability. Variability is due to differences in state definitions and data collection and analysis strategies but probably also to an intrinsic characteristic of the maturing central nervous system (functional plasticity). Changes in sleep and wakefulness probably constitute nonspecific responses to a variety of stimuli. The variability has frustrated efforts to use specific features of sleep architecture for diagnostic or prognostic purposes. At present, polysomnographic studies of sleep architecture independent from EEG and cardiorespiratory studies are not indicated for diagnosing specific medical conditions or prognoses of good/adverse outcomes. For accurate interpretation for cardio-respiratory data, however, studies of sleep and wakefulness are indispensable. Furthermore, the study of neonatal seizures, in particular the coherence of state-defining variables or the evolution of sleep morphology, may benefit from attention to sleep architecture. Initial findings from some laboratories suggest that the very feature of excessive instability, which can be measured by repetitive long-term polysomnographic monitoring, signals a poor prognosis. In addition, fragmented sleep and the evolving interrelationship between ultradian and circadian rhythms may contain useful information that has yet to be mined. The advent of computer technologies can make the clinical laboratory into a setting where both research and clinical studies contribute to an elucidation of risk for sudden infant death syndrome and sequelae of neonatal seizures.
The present study sought to investigate the meaning of subjectively good sleep, using a longitudinal and intraindividual design. Eight subjects slept in an isolation unit according to an irregular schedule of 6 h sleeps and 1 h naps, designed to give normal amounts of time in bed (1/3 of total), but variable sleep quality. Eight sleeps and eight naps were used for longitudinal simple and multiple regression analyses with standard polysomnographical sleep variables as predictors and subjective sleep quality as dependent variables. The results showed that subjective sleep quality (and related variables) was closely related to sleep efficiency, but not sleep stages. At least 87% efficiency was required for ratings of 'rather good' sleep. In addition, sleep quality ratings improved with closeness (of the awakening) to the circadian acrophase (17.00-21.00 hours) of the rectal temperature rhythm. The subjective ease of awakening differed from most other other variables in that it was related to low sleep efficiency. Objective and subjective homologues of sleep length and sleep latency showed high mean intraindividual correlations (r = 0.55 and 0.64, respectively). It was concluded that objective measures of sleep continuity were closely reflected in perceived sleep quality and that sleep quality essentially means sleep continuity.
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The all-night polysomnogram is used to assess the severity of sleep apnea by the quantitative analysis of a number of respiratory and sleep parameters. Because precise scoring of these parameters is a time-consuming process, we studied the effect of scoring varying percentages of polysomnograms on the accuracy of estimating sleep apnea severity. Twenty adult all-night polysomnograms with apnea-hypopnea (AH) indexes ranging from 1.0 to 67.8 were scored in the following manner: every 30-s epoch (100% scoring), every other epoch (50% scoring), every fourth epoch (25% scoring), every sixth epoch (16.7% scoring), every eighth epoch (12.5% scoring), and every tenth epoch (10% scoring). Each method was then compared with 100% scoring. For each parameter we established criteria for classifying studies as having a mild, moderate, or severe degree of abnormality. The number of studies correctly categorized for the following parameters was: (1) AH index, 20/20 for 50 and 25% scoring, 19/20 for 16.7 and 10% scoring, and 18/20 for 12.5% scoring; (2) AH time, 20/20 for 50, 25, and 16.7% scoring, 17/20 for 12.5% scoring, and 18/20 for 10% scoring; (3) mean AH duration, 20/20 for 50, 25, and 12.5% scoring, 18/20 for 16.7% scoring, and 15/20 for 10% scoring; (4) mean event percent O2 saturation, 20/20 for 50 and 25% scoring, 18/20 for 16.7 and 12.5% scoring, and 17/20 for 10% scoring; (5) longest AH, 19/20 for 50% scoring, 18/20 for 25% scoring, and 15/20 or less for 16.7, 12.5, and 10% scoring; (6) lowest percent O2 saturation, 19/20 for 50% scoring, 17/20 for 25% scoring, and 15/20 or less for 16.7, 12.5, and 10% scoring.(ABSTRACT TRUNCATED AT 250 WORDS)
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The authors report a case of Shy-Drager syndrome in a 53 year-old male patient. Autonomic failure was made evident by physical examination as well as laboratory tests. A sleep recording showed decreased percentage of REM sleep and apneas of the central type. The possible mechanisms for this sleep disorder are discussed.
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Survivors of an "apparent-life-threatening-event" subsequently more often die from sudden infant death syndrome than others. The aim of this study was to find out abnormal clinical symptoms and/or polysomnographic patterns in this group of patients. Between January 1989 and September 1990 122 infants (mean age 13.98 weeks) were examined after a life threatening event (mean age 9.3 weeks at the event). In total, 222 polysomnographic studies were performed. In 46 cases additional esophageal pH-metric measurements, and in 26 cases a Holter 24 hours monitoring were done. Seven infants were premature and had been ventilated, and 6 were siblings of sudden-infant-death-syndrome victims. Pulmonary problems were identified in 7 (6%), cardiac problems in 17 (14%), 18 (15%) had neurological problems, and 40 (33%) showed a gastroesophageal reflux. In 14 (11%) other diseases were found. Only 43 (35%) infants were without pathologic findings and were classified as having had an "idiopathic" event. The polysomnographic studies showed that obstructive apnea occurred significantly more often, the maximal duration of apnea was longer, and the number of sudden pO2 decreases was significantly higher than in a group of 188 normal infants. Thus, patients having had an "apparent-life-threatening-event" showed a broad spectrum of abnormal clinical symptoms and some respiration disturbances compared to a reference group of infants.
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Polysomnographic data recorded from a large sample of normal, healthy, adult volunteer subjects are reported. First and second night summary values are included. Results agree remarkably well with previously published findings and the age-related differences in sleep architecture that we found are described in detail. We also discuss some of the unique methodological problems associated with developing normative sleep values.