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PubMed2001

Cisapride plasma levels and corrected QT interval in infants undergoing routine polysomnography.

BACKGROUND: Reported QTc prolongation associated with cardiac arrhythmia in a small number of children undergoing cisapride therapy and lack of pharmacokinetic correlation provided the impetus for this prospective study. The authors evaluated the relation between cisapride plasma concentrations, the electrocardiographic QT interval, and cardiac rhythm in infants undergoing routine 8-hour polysomnography. METHODS: A total of 211 infants were enrolled: 84 (17 born prematurely) undergoing cisapride therapy for at least 4 days for suspected gastroesophageal reflux and 127 controls (10 born prematurely), aged between 1 week and 13.5 months. Infants underwent continuous bipolar limb lead I recording during routine 8-hour polysomnography. QT intervals and heart rate were measured at hourly intervals. The morning after polysomnography, 12-lead electrocardiography was performed (1 hour after cisapride administration). Cisapride plasma concentrations were determined immediately before and 1 to 2 hours after administration. Serum electrolyte concentrations were measured. RESULTS: The administered cisapride dose ranged from 0.35 to 1.55 (mean, 0.81, median 0.79) mg. kg-1. d-1. Cisapride plasma concentrations were significantly higher in infants younger than 3 months of age. Cisapride-treated infants younger than 3 months of age had longer QTc intervals compared with age-matched controls. Heart rate was similar for cisapride-treated and control infants. No arrhythmia or atrioventricular conduction abnormalities were observed. CONCLUSIONS: At comparable doses of cisapride and comparable plasma concentrations, the QTc was significantly higher in infants younger than 3 months of age. This confirms age-dependent cisapride pharmacokinetics in the first 10 to 12 weeks strongly correlated with changes in body weight and may also suggest an altered ability of infants younger than 3 months of age to metabolize cisapride. The clinical significance and risk of the increased QTc interval is unclear. Cisapride should be judiciously prescribed in infants younger than the age of 3 months and electrocardiography should be performed before and during therapy.

Age Factors↗

PubMed1999

Polysomnography and home documented monitoring of cardiorespiratory pattern.

Polysomnographic findings were compared with data obtained subsequently from home documented monitoring in order to study the diagnostic value of both techniques. Polysomnography was performed in 1274 infants born prematurely and in 422 patients admitted because of apparent life threatening events (ALTEs). In 72 of the infants, home documented monitoring of the cardiorespiratory pattern, including QRS complexes, was performed. Subsequent documented episodes of heart rate < 50 beats/min were considered as "serious life threatening events". It was confirmed that polysomnographic findings correlated well with subsequent events as registered by home documented monitoring. Especially in the ALTE group where both infants with and without abnormal polysomnography were home monitored, the single polysomnography significantly predicted subsequent life threatening events. Home documented monitoring of the cardiorespiratory pattern has a distinctive advantage over simple cardiorespiratory monitoring as a means to identify and document life threatening events, in addition to its value as a rescue device.

Apnea↗

PubMed2002

Comparison of a cardiorespiratory device versus polysomnography for diagnosis of sleep apnoea.

This study assessed the accuracy of a cardiorespiratory monitoring device versus polysomnography for the diagnosis of suspected sleep apnoea/hypoponea syndrome (SAS). A total of 86 patients (89% male, mean age 52 yrs) that had been referred to a sleep laboratory with a clinical diagnosis of SAS underwent cardiorespiratory polygraphy in an unattended mode using an ambulatory device (MERLIN). Analysis was carried out both automatically and manually. Conventional overnight full-channel polysomnography was performed simultaneously. Valid polygraphical recordings were obtained from 79 patients. The mean+/-SD apnoea/hypopnoea index (AHI) was 34.4+/-29.2. The results obtained with manual scoring were superior to automatic scoring for all AHI thresholds. For an AHI of > or = 5, which is diagnostic SAS, the optimum cut-off value for the manual respiratory event index was 6.7 and the cardiorespiratory monitoring device had 97.1% sensitivity and 90.9% specificity. Correct classification according to the different cut-off points obtained via polysomnography and the corresponding cut-off points in the MERLIN manual index were confirmed in 90-96% of patients. The MERLIN device is a useful diagnostic approach for the initial assessment of adult patients with clinical suspicion of sleep apnoea/hypopnoea syndrome. Manual scoring is clearly better than automatic scoring in terms of agreement with the apnoea/hypopnoea index and to discern patients with sleep apnoea/hypopnoea syndrome.

Female↗

PubMed2000

[Comparative study of actigraphy and ambulatory polysomnography in the assessment of adaptation to night shift work in nurses].

Night shift work is common in hospitals to assure continuous care. This practice, however, induces difficulties due to changes in the sleep/awake cycle of hospital workers. The aims of the present study were to validate actigraphy in comparison with polysomnography for sleep evaluation and to assess nurses' adaptation to sleep/wake cycles when on a permanent night shift schedule. Actigraphy and ambulatory polysomnography were performed in fifteen night shift nurses employed in hospital on a full time basis, during their work and their rest periods. Our first findings showed that actigraphy gave reliable results compared with polysomnography in evaluation of total sleep time. In addition, it was found that seven of the nurses exhibited, during their work periods, an approximately five-hour delay in the acrophase of their rest/activity rhythm compared with their rest periods. In contrast, five other nurses whose acrophase did not change between work and rest periods, exhibited sleep episodes of more than 100 minutes duration at work. These results confirm data in the literature and show that some nurses cannot adjust the circadian rhythm of their inner biological clock to their nocturnal schedules. Actigraphy seems to be an efficient, low cost and easy method for measuring total sleep time as well as for assessing the inability of nurses to adapt to permanent night shift work.

Adaptation, Physiological↗

PubMed2000

Obstructive sleep apnea, polysomnography, and split-night studies: consensus statement of the Connecticut Thoracic Society and the Connecticut Neurological Society.

Obstructive sleep apnea is a state-dependent syndrome. It is characterized by repeated collapse of the upper airway as the result of the loss of waking neuromuscular drive as the brain changes from wakefulness to sleep. This produces a state-dependent decrease in muscle tone, which, together with other predisposing factors such as obesity and anatomical narrowing of the upper airway, results in the spectrum of sleep disordered breathing. Sleep-disordered breathing describes the continuum from simple snoring (pharyngeal vibration), to flow limitation (hypopnea), to complete cessation of breathing (apnea). Obstructive sleep apnea (OSA) is the common description of what is now appreciated as the sleep apnea/hypopnea syndrome. The cardinal symptoms are snoring, observed apneas, and excessive daytime sleepiness. The immediate physical consequences are hypoxia, repeated sympathetic discharges, increased cardiac load, and repeated brain arousals. The repetitive arousals are required to restore airway patency, resulting in severely fragmented sleep and consequent sleep deprivation. The syndrome, untreated, produces significant cognitive and cardiorespiratory morbidity, and potential mortality. Compared to matched controls, patients with undiagnosed sleep apnea use twice the health resources and spend double the health-care dollars in the 10 years prior to diagnosis. Both trends are reversed by successful treatment. It is by definition a sleep-related illness and can be observed and evaluated only when the patient is asleep. Polysomnography is the laboratory procedure to study sleep and its protean dysfunctions. Multiple physiologic parameters are required to document the various types of sleep disorders as well as to establish the origin of pathologic sleep fragmentation. Complete polysomnography includes (but is not limited to) electroencephalogram (EEG), electrooculogram ((EOG), electromyogram (EMG), electrocardiogram (ECG), respiratory effort, air flow, and oxygen saturation. Treatment options for obstructive sleep apnea include continuous positive airway pressure (CPAP), oral appliances, uvulopalatal and/or maxillomandibular surgery, positional control, and weight loss. The efficacy of each depends on the individual anatomy and the severity of the sleep-disordered breathing. CPAP is accepted as the most reliable treatment regardless of anatomy and severity. It is currently the only treatment modality which can be titrated during sleep and requires simultaneous polysomnography.

Connecticut↗

PubMed2002

Short-term variability of respiration and sleep during unattended nonlaboratory polysomnography--the Sleep Heart Health Study. [corrected].

STUDY OBJECTIVES: To determine the short-term variability of indices of disturbed respiration and sleep during 2 nights of unattended nonlaboratory polysomnography conducted several months apart. DESIGN: Participants were randomly selected using a block design with stratification on preliminary estimates of 2 criteria: respiratory disturbance index [RDI3% (apnea or hypopnea events associated with > or = 3% O2 desaturation): < 15/hour total sleep time, > or = 15/hour total sleep time] and sleep efficiency (SEff: < 85% and > or = 85%). The RDI and sleep data from initial and repeated polysomnography were compared. SETTING: NA. PARTICIPANTS: A subset of 99 participants in the Sleep Heart Health Study who agreed to have a repeat polysomnogram within 4 months of their original study. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Acceptable repeat polysomnograms were obtained in 91 subjects (mean study interval: 77 +/- 18 [sd] days; range: 31-112 days). There was no significant bias in RDI between study nights using several different RDI definitions including RDI3% and RDI4% (apnea or hypopnea events associated with > or = 4% O2 desaturation). Variability between studies estimated using intraclass correlations (ICC) ranged from 0.77 to 0.81. For subjects with a RDI3% < 15, variability increased as a function of increasing RDI, but for those with a RDI3% > or = 15, variability was constant. Body mass index, SEff, gender, or age did not directly predict RDI variability. Using RDI4% cutpoints of < or = 5, < or = 10 and < or = 15 events per hour of sleep demonstrated that 79.1%, 85.7%, and 87.9% of subjects, respectively, had the same classification of SDB status on both nights of study. There also was no significant bias in sleep staging, sleep efficiency, or arousal index between studies. However, variability was greater with ICC values ranging from 0.37 (% time in REM) to 0.76 (arousal index). CONCLUSION: In the Sleep Heart Health Study, accurate estimates of the severity of sleep-disordered breathing and the quality of sleep were obtained from a single night of unattended nonlaboratory polysomnography. These findings may be applicable to other large epidemiologic studies provided that similar recording techniques and quality-assurance procedures are followed.

Adult↗

PubMed2006

[Assessment of sleep with polysomnography in patients with interstitial lung disease].

In our study we aimed to examine the sleep structure, oxygenation and breathing pattern in interstitial lung disease (ILD) patients. We also aimed to determine whether relevance between the advanced disease and the sleep disorders exists and whether polysomnography is necessary in those patients. A total of 37 patients were examined in the study and whole night standard polysomnography was performed to all. Polysomnography results revealed that, total sleep time, time spent in NREM sleep stage III and IV, and in REM sleep were decreased. The patients had poor sleep efficiency and they spent more time as wake after sleep onset (WASO). Severe oxygen desaturations were detected during sleep and statistically significant positive correlations were found between mean awake O2 saturation and mean and lowest sleep O2 saturations. Clinical, Radiological and Physiological (CRP) scoring system was used to assess the disease stage, whether advanced or not, and statistically significant negative correlations were found between CRP score and awake and sleep O2 saturations. Obstructive sleep apnea syndrome (OSAS) was diagnosed in 24 (64.9%) patients. In those patients it was found that not the apneas but the hypopneas predominate. No difference was found among body mass indices (BMI) between the patients with and without OSAS. As a result it was concluded that a sleep study should be considered as part of the overall assessment in managing patients with ILD, and is especially indicated if there is incipient pulmonary hypertension, cor pulmonale and nocturnal arrhythmia despite normal awake blood gas tensions and symptoms as snoring and excessive day time sleepiness.

Adult↗

PubMed1996

Standards for polysomnography in Canada. The Standards Committees of the Canadian Sleep Society and the Canadian Thoracic Society.

OBJECTIVE: To develop standards for polysomnography in Canada in order to assist in the uniform provision of diagnostic and therapeutic services related to sleep disorders. OPTIONS: Uniform testing versus no current Canadian standards. OUTCOMES: Uniform delivery of health care; reduction in number of repeat studies and their attendant costs. EVIDENCE: Availability of diagnostic laboratories and services, and survey responses (written and oral) from directors of sleep laboratories; the American Thoracic Society statement on indications and standards for cardiopulmonary sleep studies was used as a template. VALUES: Acceptable standards of practice were based on consensus opinion of the standards committees of the Canadian Sleep Society and the Canadian Thoracic Society. The committees comprised specialists in neurology, psychiatry, psychology, respirology and polysomnographic technology; family practitioners and otolaryngologists were also consulted. BENEFITS, HARMS, COSTS: Improved level of care and reduction in duplicate or unnecessary testing; establishment, with available resources, of diagnostic sleep laboratories by appropriately qualified physicians in areas where polysomnography is unavailable. RECOMMENDATIONS: Health care practitioners involved in the diagnosis and treatment of sleep disorders should possess a minimum amount of training (both clinical and research) in sleep disorders medicine. The variables recorded and findings entered in a patient's report must be relevant to the sleep disorder under investigation. The recording equipment must provide reliable, accurate and reproducible data and lend itself to appropriate calibration and quality-control procedures. Facilities for sleep studies must meet patient care safety standards, with provisions for emergency or resuscitative measures when necessary; all personnel must be trained in basic cardiopulmonary resuscitation. VALIDATION: No previous standards concerning polysomnography in Canada exist. The recommended standards were reviewed by all members of the Canadian Sleep Society and a revised document was approved by the Standards Committee of the Canadian Sleep Society and by the Standards and Executive committees of the Canadian Thoracic Society. SPONSORS: These standards are endorsed by the Canadian Sleep Society and the Canadian Thoracic Society. The cost of preparing this statement was borne by the individual members of the standards committees; no external funding was provided.

Calibration↗

PubMed1997

Comparison of ResMed AutoSet (version 3.03) with polysomnography in the diagnosis of the sleep apnoea/hypopnoea syndrome.

In patients with the sleep apnoea/hypopnoea syndrome (SAHS), accurate and timely diagnostic evaluation and initiation of effective treatment is important. Therefore, an increasing number of limited sleep studies are now performed nowadays diagnosing the SAHS in typical patients. It was the aim of the present study to evaluate the diagnostic accuracy of one such system, the updated ResMed Sullivan AutoSet, against polysomnography. Sixty seven patients underwent full overnight polysomnography and simultaneous data acquisition with the AutoSet. Up to now, the AutoSet was designed for apnoea detection only. The new AutoSet, with software version 3.03, detects apnoeas if ventilation drops to <25%, and apnoeas+hypopnoeas if ventilation drops to <50%, compared with the recent average (100 s), using two independent detectors. A two page report with graphically displayed information on oximetry, snoring and breathing parameters, and an apnoea+hypopnoea index (AHI) and an apnoea index (AI) are provided at the end of each study night. There was a correlation between the AHI assessed by the AutoSet (AHI-AutoSet) and by polysomnography (AHI-PSG; r=0.95). The mean difference between the AHI-AutoSet minus the AHI-PSG was 4.2 (SD 7.2) respiratory events x h(-1) (p<0.001). The AutoSet identified patients with an AHI-PSG >20 events x h(-1) (a level of respiratory disturbance that would warrant consideration for treatment in most centres for sleep disorders), with a sensitivity of 97% and a specificity of 77%. The AutoSet was superior to oximetry alone. As event counting was similar between the two methods, the AHI-AutoSet may provide a reasonable indicator of the respiratory disturbance at night, especially when taking the patients graphic study report into consideration. In conjunction with full clinical information on the patients under investigation, the AutoSet might become a useful device in diagnosing the sleep apnoea/hypopnoea syndrome.

Body Mass Index↗

PubMed1998

[Diagnosis of nocturnal respiratory disorders. Review of portable monitoring devices. Analysis and evaluation of different polysomnography signals].

Polysomnography in an attended hospital laboratory setting is the gold standard for the diagnosis of sleep-related breathing disorders. However, this method is expensive and waiting lists are long. Portable recording devices that can be used at home have been recently developed to improve upon the problems of polysomnography. We review the recent portable devices validated by polysomnography and discuss their precise role in the assessment of sleep-related respiratory disorders.

Equipment Design↗

PubMed1984

Evaluation of sleep-disordered breathing. Is polysomnography necessary?

To determine whether polysomnography is necessary to assess the presence and severity of sleep-disordered breathing, bedside observations by physicians were compared with the results of polysomnography in 37 patients with clinically suspected obstructive sleep apnea. Physician observations correlated with objective findings from polysomnography in detecting the presence of obstructive apnea (p less than 0.01), and had a high specificity and positive predictive value. The 20 patients correctly identified by clinical observation had a longer duration of apneic episodes (p = 0.02), increased severity of snoring (p = 0.02), resuscitative snoring (p less than 0.02), and paradoxic thoracoabdominal movement (p less than 0.05). However, 11 other patients with sleep-disordered breathing were not identified clinically; therefore, the sensitivity (64.5 percent) and diagnostic accuracy (70.3 percent) of brief clinical observation were low. Furthermore, the physicians' determinations of the severity of the condition on the basis of bedside estimates of disordered breathing rate, duration of episodes, and the degree of associated hemoglobin oxygen desaturation did not correlate with objective measurements. These findings suggest that a single, brief clinical observation alone is an ineffective screening procedure for detecting obstructive sleep apnea.

Adult↗

PubMed1992

Clinical value of polysomnography.

Polysomnography is used increasingly to investigate patients with possible sleep apnoea/hypopnoea syndrome (SAHS), but it has not been assessed critically. We thus examined prospectively the value of electrophysiological and respiratory monitoring in 200 consecutive adults (163 men, 37 women; mean [SD] age 50 [13] years) having polysomnography. At polysomnography, 91 patients had SAHS (greater than 15 apnoeas + hypopnoeas [A + H] per h asleep) and 11 had periodic limb-movement disorder. Recording sleep electrophysiologically was of no diagnostic value and SAHS could be as accurately defined by A + H per time in bed as by A + H per time asleep. 66% of patients with SAHS could be diagnosed with oximetry alone, but many of the undiagnosed patients had moderately severe SAHS and benefited from treatment. Neurophysiological sleep recording is unnecessary and oximetry alone is of limited value in the overnight investigation of patients suspected of having SAHS.

Electroencephalography↗

PubMed2002

Scoring variability between polysomnography technologists in different sleep laboratories.

OBJECTIVE: Examine the variability of polysomnography technologists from different sleep laboratories regarding scoring of polysomnograms. BACKGROUND: Polysomnography is the gold standard to diagnose obstructive sleep apnea-hypopnea syndrome. There are criteria to score sleep stages and respiratory events. We sought to determine how different technologists would score the same tests using their laboratory's criteria. METHODS: Eleven technologists in nine different sleep laboratories which used the Oxford Medilog SAC system scored eleven sleep studies performed in the Medical University of South Carolina Sleep Disorders Laboratory utilizing their respective laboratory's scoring rules. All sleep studies were performed for evaluation of obstructive sleep apnea-hypopnea syndrome (OSAHS). The scored studies were returned and analyzed for variability. RESULTS: Significant variability was present in scoring of both sleep and respiratory events with more variability demonstrated in respiratory event scoring. In four of the studies, diagnoses based on apnea-hypopnea indices (AHI) varied from none to moderate OSAHS depending on which technologist scored the study and in one study the diagnosis varied from none to severe OSAHS. CONCLUSIONS: Clinicians should be aware that there is tremendous variability among polysomnography technologists regarding the scoring of polysomnograms. These differences are likely due to different rules used to score events as well as differences in the technologist's interpretation of the rules.

Journal Article↗

PubMed1991

Diagnostic value of video-EEG polysomnography.

To investigate the diagnostic value of video-EEG polysomnography (VPSG), we reviewed our experience in 122 patients with suspected parasomnias who underwent one or two nights of VPSG. Of 86 patients without known epilepsy, VPSG provided useful diagnostic information for 41 (69%) of those with a history of prominent motor activity during sleep and for 11 (41%) of those with a history of minor motor activity during sleep. Two children and one adult with clinical histories suggestive of sleep terrors had unequivocal partial seizures during VPSG. Of 36 patients with known epilepsy, VPSG was useful diagnostically in 28 (78%). VPSG is superior to standard polysomnography for the evaluation of parasomnias because of the increased capability to identify and localize EEG abnormalities and to correlate behavior with EEG and polysomnography. VPSG may also be a suitable alternative to intensive inpatient monitoring for some patients with known or suspected epilepsy who have frequent undiagnosed nocturnal spells.

Electroencephalography↗

PubMed1996

Evaluation of pulmonary function and polysomnography in obese children and adolescents.

Obese adults have an increased prevalence of pulmonary disorders. Although childhood obesity is a common problem, few studies have evaluated the pulmonary complications of obesity in the pediatric population. We, therefore, performed pulmonary function tests (PFTs), polysomnography, and multiple sleep latency tests (MSLTs) in 22 obese children and adolescents [mean age, 10 +/- 5 (SD) years; 73 percent female; 184 +/- 36 percent ideal body weight], none of whom presented because of sleep or respiratory complaints. PFTs were normal in all but two subjects. Ten (46 percent) subjects had abnormal polysomnograms. There was a positive correlation between the degree of obesity and the apnea index (r = 0.47, P < 0.05), and an inverse correlation between the degree of obesity and the Sa0(2) nadir (r = -0.60, P < 0.01). The degree of sleepiness on MSLT correlated with the degree of obesity (r = -0.50, P < 0.05). We conclude that obese children and adolescents have a high prevalence of sleep-disordered breathing, although in many cases it is mild. Obstructive sleep apnea syndrome (OSAS) improved following tonsillectomy and adenoidectomy. We recommend that pediatricians have a high index of suspicion for OSAS when evaluating obese patients, and that polysomnography be considered for these patients.

Adolescent↗

PubMed1993

Polysomnography in obese children with a history of sleep-associated breathing disorders.

We hypothesized that obese children with a history of breathing difficulty during sleep would demonstrate (1) evidence of complete and partial obstructive sleep apnea (OSA) with hypercarbia and/or hypoxemia; and (2) correlation between symptoms, degree of obesity, adenoid and tonsil size, and polysomnography (PSG) results. We evaluated 32 obese children [% ideal body weight (IBW), 196 +/- 45%] with a sleep history questionnaire, airway radiographs, electrocardiograms (ECG), and PSG. By history, we found snoring (100%), difficulty breathing (59%), sweating (44%), restlessness (53%), arousals (41%), apnea (50%), worsening with upper respiratory infection (URI) (81%), hypersomnolence (59%), and mouth breathing (59%). We found adenoid and/or tonsil enlargement on 75% of airway x-ray pictures. ECGs were abnormal in 5 patients. Among all patients, mean sleep study oxyhemoglobin saturation (SaO2) was 85 +/- 16% and mean end-tidal CO2 (PetCO2) was 51 +/- 7 torr; 84% had paradoxical inward movement of the chest on inspiration, 59% had OSA, and 66% had partial OSA. In those with > or = 200% IBW and adenotonsillar enlargement, elevated PetCO2 and the presence of hypoxemia (SaO2 < 90%) for > or = 5% of the total sleep time (TST) were correlated, unlike in patients of similar weight but without adenotonsillar enlargement. Individuals symptoms did not correlate with the severity of PSG abnormalities. By discriminant analysis, using three variables (IBW, presence of adenotonsillar tissue, and presence of > or = 5 symptoms), we could predict PSG abnormalities with up to 81% reliability. Our findings indicate that in obese children, particularly those with %IBW > or = 200 and adenotonsillar hypertrophy, with sleep-disordered breathing evaluation by polysomnography should be considered.

Adolescent↗

PubMed2003

[Reliability of home monitoring with event-recording compared with polysomnography in infants].

AIM OF THE STUDY: Although reliable recognition of hypoxemia, apnea, bradycardia and tachycardia is absolutely necessary for home monitoring, many commercially available home monitors have not been sufficiently tested for their sensitivity. The purpose of this study was to determine the reliability of the home monitor VitaGuard 3000 by comparing it with the manual evaluation of full polysomnography (polysomnographic system Alice 3). PATIENT AND METHODS: 20 infants (11 males; 9 females) aged between 5 and 40 weeks (12.2 +/- 3.5 weeks, median 10.5) and with a gestational age between 29 and 41 weeks (37.7 +/- 6.1 weeks, median 39.0) were tested using both full polysomnography and, simultaneously, the home monitor VitaGuard 3000. The results were evaluated manually and compared. RESULTS: The monitor system detected 7/51 central apneas, 6/260 desaturations and 7/18 tachycardias. The sensitivity was 13.72% for apnea, 4.23% for desaturation and 38.80% for tachycardia. The reliability of the home monitor for detecting apnea, desaturation and tachycardia was therefore insufficient. CONCLUSION: A polysomnographic reliability test should be mandatory for all home monitoring systems prior to commercial introduction.

Age Factors↗

PubMed2007

Daytime polysomnography for early diagnosis and treatment of patients with suspected sleep-disordered breathing.

Excessive daytime sleepiness (EDS) is a common complaint among patients with sleep-disordered breathing (SDB). Population-based studies on traffic and industrial accidents suggest a relationship between EDS and life-threatening events, and adults with EDS have cognitive and memory problems. Nocturnal polysomnography (nPSG) is essential for diagnosing SDB but it is time and energy consuming. We examined the usefulness of daytime polysomnography (dPSG) for the early diagnosis and treatment of patients with suspected SDB. We studied 108 consecutive patients aged 51.9 +/- 13.5 years (mean+/-SD). All patients underwent dPSG and nPSG. The number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI) and the number of 3% desaturation episodes per hour (desaturation index: DSI) were calculated. All patients were classified into two groups. The REM group consisted of subjects who had an AHI < or = 25/h, AHI(REM)/AHI(NREM) > 2, and AHI(NREM) < 15/h. Those who did not satisfy these criteria were placed in the NREM group. Continuous positive airway pressure (CPAP) titration was performed for patients whose AHI was > or =20/h on dPSG. Using the international classification of sleep disorders, 96 patients were diagnosed as obstructive sleep apnea [including five upper airway resistance syndrome (UARS) patients], six patients were snoring, four had idiopathic hypersomnia due to a medical condition, and two had circadian rhythm sleep disorders. The sensitivity of dPSG for AHI was 81.0%, specificity was 100%, and accuracy was 83.5%. The sensitivity and accuracy of dPSG for AHI in the REM group were considerably lower than in the NREM group. There was no significant difference for optimal CPAP between dPSG and nPSG. In the five patients with UARS, their AHI, DSI, and arousal index on dPSG were 0.92 +/- 1.2/h, 2.9 +/- 3.4/h, and 29.3 +/- 3.5/h, respectively, and their AHI and DSI on nPSG were 3.2 +/- 2.5/h and 2.8 +/- 2.4/h, respectively. However, their respiratory effort-related arousals were 37.9 +/- 7.4/h, and their arousal index was 33.2 +/- 6.3/h. The five patients with UARS were also treated with CPAP, and their daytime sleepiness was improved. Although dPSG has limitations, these results indicate that dPSG recording is clinically useful for the diagnosis of and determination of types of treatment in patients with suspected SDB.

Adult↗