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PubMed2006

The range and nature of sleep dysfunction in untreated Parkinson's disease (PD). A comparative controlled clinical study using the Parkinson's disease sleep scale and selective polysomnography.

In this study we have explored the nature and range of sleep dysfunction that occurs in untreated Parkinson's disease (PD) comparing data obtained from the use of the Parkinson's disease sleep scale (PDSS) in an untreated PD patient group compared to advanced PD and healthy controls. 25 untreated (drug-naive, DNPD) PD patients (mean age 66.9 years, range 53-80, 18 males) completed the validated Parkinson's disease sleep scale (PDSS), mean duration of PD was 2.1 years (1-10, up to 4 years in all except one patient with tremulous PD reporting tremor duration of 10 years) and mean Hoehn and Yahr score 1.9 (1-3). Data were compared to 34 advanced PD (mean age 70.2 years, range 51-88, 23 male), mean duration of PD 11 years (range 4-22), mean Hoehn and Yahr score 3.4 (3-5) and PDSS data obtained from 131 healthy controls (mean age 66.6 years, range 50-93, 56 males). Total PDSS scores and PDSS sub-items, except PDSS item 2, were highly significantly different (p<0.001) between DNPD, advanced PD and controls. Controls reported higher mean PDSS scores than both groups of patients, and advanced cases reported lower (mean+/-S.D.) PDSS scores (86.95+/-20.78) than drug-naive (105.72+/-21.5) (p<0.001). Logistic regression analysis showed that items PDSS8 (nocturia), PDSS11 (cramps), PDSS12 (dystonia), PDSS13 (tremor), and PDSS15 (daytime somnolence) were significantly impaired in DNPD compared to controls while PDSS7 (nighttime hallucinations) additionally separated advanced PD from DNPD. In a subgroup of 11 advanced PD cases (mean age 62 years, range=49-84 years, mean Hoehn and Yahr score 2.5, range=1-3) with high Epworth Sleepiness Scale (ESS) scores (mean 14.5), low item 15 PDSS score (mean 4.7) and complaints of severe daytime sleepiness, underwent detailed overnight polysomnography (PSG) studies, all showing abnormal sleep patterns. We conclude that nocturia, nighttime cramps, dystonia, tremor and daytime somnolence seem to be the important nocturnal disabilities in DNPD and some of these symptoms may be reminiscent of "off" period related symptoms even though patients are untreated. Furthermore, polysomnography in "sleepy" PD patients may help diagnose unrecognised conditions such as periodic limb movement of sleep (PLMS), obstructive sleep apnoea (OSA) and REM Sleep Behaviour Disorder.

Aged↗

PubMed2005

Assessment of obstructive apnea by using polysomnography and surgical treatment in patients with Beckwith-Wiedemann syndrome.

PURPOSE: Obstructive apnea is sometimes seen in patients with Beckwith-Wiedemann syndrome. The cause of apnea is not limited to macroglossia, and the surgical indication for obstructive apnea has not yet been established. The authors performed polysomnography for the assessment of apnea. METHOD: Overnight polysomnograms were obtained in 2 patients who developed obstructive apnea after 1-stage repair for omphalocele. CASE 1: Apnea index (AI), defined as apneic events per hour, indicated 17.3, and SpO2 below 95% occupied 80% of the total sleep time. Computed tomography and magnetic resonance imaging indicated obstruction of the airway between macroglossia and the hypopharynx. Central tongue resection and the division of the frenulum linguae for associated ankyloglossia were performed 97 days after birth. One month after surgery, apneic events disappeared and SpO2 below 95% occupied only 1% of the total sleep time. CASE 2: Obstructive AI indicated 28.1. Division of the frenulum linguae and anterior glossopexy were performed 55 days after birth. Postoperative polysomnogram indicated a marked reduction of AI. CONCLUSIONS: These results indicated that polysomnography was useful for evaluating obstructive apnea and that advancement of the tongue by division of the frenulum linguae may be recommended for the treatment of obstructive apnea in patients with Beckwith-Wiedemann syndrome.

Beckwith-Wiedemann Syndrome↗

PubMed2005

Basic principles of polysomnography including electrical concepts.

Polysomnographic technology has advanced by exponential degrees since the first sleep studies were conducted by Dement. The basic electrical concepts have remained the same since that time and are an essential element in the understanding of polysomnographic equipment. The application of these basic electrical concepts has allowed, however, for an improvement in the acquisition,manipulation, and storage of physiologic data during sleep. This article defines polysomnography in terms of its history and its current status. The basic electrical concepts are presented with their application to polysomnography. A discussion of other basic principles is included with practical application.

Electricity↗

PubMed2006

Infant and toddler polysomnography.

The acquisition process for infant and toddler polysomnography requires pediatric-specific equipment and specially trained personnel. Pediatric laboratories must keep in mind the importance of including the parent through-out the process. The demand for infant and pediatric polysomnography continues to grow as new research increasingly demonstrates the value of studying physiologic variables collected during the study.

Child Care↗

PubMed1998

Polysomnography and maintenance of wakefulness test as predictors of CPAP effectiveness in obstructive sleep apnea.

Nasal continuous positive airway pressure (CPAP) therapy is usually effective in the treatment of obstructive sleep apnea (OSA), reversing the excessive daytime sleepiness associated with OSA. We investigated how polysomnography and maintenance of wakefulness test (MWT) predicted response to CPAP therapy in 10 patients with obstructive sleep apnea and 10 healthy controls. After a full polysomnography and MWT the patients were started on CPAP. MWT was repeated to quantify the treatment effect. Oxygen desaturation index and the percentage of slow wave sleep were the best predictors for baseline S1 latency in MWT. Baseline S1 latency in the MWT was the most important determinant of improvement in MWT S latency after CPAP, followed by the latency to 10 min of continuous nocturnal sleep, arousal index and CPAP use. We suggest that in mild sleep apnea, knowledge of sleep architecture is not necessary before deciding whether or not to initiate CPAP treatment.

Adult↗

PubMed2000

Polysomnography in neonatal seizures.

Seizures are one of the most frequent problems in the neonatal period, and are frequently associated with high mortality and morbidity rates. On the other hand, neonatal seizures may represent a first or even the only sign of central nervous system dysfunction. However, establishing the diagnosis of neonatal seizures poses several problems, and clinical observation is not sufficient in many cases. Neonatal polysomnography is a valuable tool both in the diagnostic and in the prognostic assessment of neonatal seizures. The present text reviews some technical aspects related to neonatal polysomnographies, and its usefulness in the area of suspected neonatal seizures. Moreover, some questions are raised regarding rhythmic discharges and their significance as a possible ictal and interictal epileptic pattern in the neonate.

Brain↗

PubMed2000

Polysomnography in hypnic headache syndrome.

Hyponic headache syndrome is an unusual chronic headache that usually begins after age 60 years and occurs exclusively during sleep. Despite the relationship between the headache and sleep, no formal sleep evaluation with overnight polysomnography has been reported for this syndrome. Three patients with long-standing hypnic headache underwent overnight polysomnography. The results were quite variable, ranging from normal to marked sleep insufficiency. A hypnic headache was captured in one patient arising out of rapid eye movement sleep at a time of severe oxygen desaturation. Formal sleep evaluation should be considered in patients with hypnic headache because there may be pathophysiologic and therapeutic implications.

Aged↗

PubMed2002

Diagnostic techniques for obstructive sleep apnoea: is polysomnography necessary?

Obstructive sleep apnoea (OSA) is a common condition of childhood with significant associated morbidity. The comprehensive evaluation of children who present with suggestive symptoms involves the overnight recording and assessment of both sleep and respiration by polysomnography in a sleep laboratory. These studies require resources and facilities that are not widely available and thus simpler, more available and less expensive alternatives have been sought. This review discusses the available alternatives to polysomnography for the evaluation of the child with suspected obstructive sleep apnoea.

Child↗

PubMedDate not supplied

[Polysomnography in infancy--necessary or expensive luxury? Therapeutic and interventional consequences].

An increasing amount of polysomnographic studies are performed in early infancy. Complete pediatric sleep laboratory systems are commercially available and provide fast and exhaustive results if operated by trained personnel. Experience in evaluation is necessary, because a broad range of possible diagnostic findings exists, and artifacts are common. Based on longitudinal studies in 31 healthy infants, we present reference values for several polysomnographic parameters. Aberrant results must be interpreted in the context of patient's history, clinical state, and additional laboratory findings. In presence of a clearly defmed indication for polysomnographic testing, clear therapeutic and interventional strategies can be derived. Possible consequences include the stimulation of the respiratory drive by drugs with subsequent polysomnographic control of therapeutic effect, a transfusion, the prescription of a home monitor, and the recommendation of further diagnostics or of control polysomnographies. In conclusion, infant polysomnography is an important diagnostic tool in pediatrics.

Cost-Benefit Analysis↗

PubMed1994

Issues in computerized polysomnography.

Reliable, properly tested, computerized systems for recording and scoring polysomnographic data would be welcome assistants in sleep laboratories. They potentially could save time, effort, paper, storage and cost. There exists, however, questions of competence and confidence. The nature and scope of published literature fails to convince many cautious sleep specialists that the cost-benefit ratio is favorable. Nonetheless, computerized systems for polysomnography are here to stay and are improving. Most of us represent past, present or future consumers of these products. The market will adjust to our level of knowledge and demands. We can adopt a variety of perspectives; however, the three basic modes of use should guide our thinking. For clarity, it is helpful to dissect 1) recording issues, 2) scoring issues and 3) monitoring issues from one another. Also, we should insist on greater statistical sophistication in testing trials. Manufacturers face a dilemma. Sleep disorders medicine has few true standards and many idiosyncratic practices. The expertise of consultants vary and manufacturers may be in no position to judge their collaborators. We desperately need guidelines to meet both manufacturers' and clinicians' expectations for testing and using computerized polysomnography.

Humans↗

PubMed2001

Feasibility of using unattended polysomnography in children for research--report of the Tucson Children's Assessment of Sleep Apnea study (TuCASA).

STUDY OBJECTIVES: The Tucson Children's Assessment of Sleep Apnea study (TuCASA) is designed to investigate the prevalence and correlates of objectively measured sleep-disordered breathing in pre-adolescent children. This paper documents the methods and feasibility of attaining quality unattended polysomnograms in the first 162 TuCASA children recruited. DESIGN: A prospective cohort study projected to enroll 500 children between 5 and 12 years of age who will undergo unattended polysomnography, neurocognitive evaluation, and physiological and anatomical measurements thought to be associated with sleep-disordered breathing. SETTING: Children are recruited through the Tucson Unified School District. Polysomnograms and anthropometric measurements are completed in the child's home. PARTICIPANTS: Of the 157 children enrolled in TuCASA, there were 100 children (64%) between 5-8 years old and 57 children (36%) between the ages of 9 to 12. There were 74 (47%) Hispanic children, and 68 (43%) female participants. INTERVENTIONS: N/A. MEASUREMENTS & RESULTS: Technically acceptable studies were obtained in 157 children (97%). The initial pass rate was 91%, which improved to 97% when 9 children who failed on the first night of recording completed a second study which was acceptable. In 152 studies (97%), greater than 5 hours of interpretable respiratory, electroencephalographic, and oximetry signals were obtained. The poorest signal quality was obtained from the chin electromyogram and from the combination thermister/nasal cannula. Parents reported that 54% of children slept as well as, or better than usual, while 40% reported that their child slept somewhat worse than usual. Only 6% were observed to sleep much worse than usual. Night-to-night variability in key polysomnographic parameters (n=10) showed a high degree of reproducibility on 2 different nights of study using identical protocols in the same child. In 5 children, polysomnograms done in the home were comparable to those recorded in a sleep laboratory. CONCLUSIONS: The high quality of data collected in TuCASA demonstrates that multi-channel polysomnography data can be successfully obtained in children aged 5-12 years in an unattended setting under a research protocol.

Anthropometry↗

PubMed2003

Practice parameters for using polysomnography to evaluate insomnia: an update.

Insomnia is a common and clinically important problem. It may arise directly from a sleep-wake regulatory dysfunction and/or indirectly result from comorbid psychiatric, behavioral, medical, or neurological conditions. As an important public-health problem, insomnia requires accurate diagnosis and effective treatment. Insomnia is primarily diagnosed clinically with a detailed medical, psychiatric, and sleep history. Polysomnography is indicated when a sleep-related breathing disorder or periodic limb movement disorder is suspected, initial diagnosis is uncertain, treatment fails, or precipitous arousals occur with violent or injurious behavior. However, polysomnography is not indicated for the routine evaluation of transient insomnia, chronic insomnia, or insomnia associated with psychiatric disorders.

Chronic Disease↗

PubMed2004

Polysomnography performed in the unattended home versus the attended laboratory setting--Sleep Heart Health Study methodology.

STUDY OBJECTIVE: To compare polysomnographic recordings obtained in the home and laboratory setting. DESIGN AND SETTING: Multicenter study comparing unsupervised polysomnography performed in the participant's home with polysomnography supervised at an academic sleep disorders center, using a randomized sequence of study setting. Sleep Heart Health Study (SHHS) standardized polysomnographic recording and scoring techniques were used for both settings. PARTICIPANTS: 64 of 76 non-SHHS participants recruited from 7 SHHS field sites who had both a laboratory and home polysomnogram meeting acceptable quality criteria. MEASUREMENTS AND RESULTS: Median sleep duration was greater in the home than in the laboratory (375 vs 318 minutes, respectively, P < .0001) as was sleep efficiency (86% vs 82%, respectively, P < .0024). Very small, but significant increases in percentage of rapid eye movement sleep and decreases in stage 1 sleep were noted in the laboratory. Employing multiple definitions of respiratory disturbance index (RDI), median RDI was similar in both settings (for example, RDI with 3% desaturation: home 12.4, range 0.6-67; laboratory 9.5, range 0.1-93.4, P = .41). Quartile analysis of laboratory RDI showed moderate agreement with home RDI measurements. Based on the mean of laboratory and home RDI and using a cutpoint of 20, there was a biphasic distribution, with the RDI 3% above 20 being more common in the recordings performed in the laboratory than in the home and below 20 being more common in the recordings performed in the home than in the laboratory. These differences could not be attributed to quality of recording, age, sex, or body mass index. CONCLUSIONS: Using SHHS methodology, median RDI was similar in the unattended home and attended laboratory setting with differences of small magnitude in some sleep parameters. Differences in RDI between settings resulted in a rate of disease misclassification that is similar to repeated studies in the same setting.

Adult↗

PubMed2004

Incidence of serious adverse events during nocturnal polysomnography.

OBJECTIVES: The purpose of the study was to verify whether minimal concern is warranted in regard to serious adverse effects in the sleep laboratory. DESIGN: A prospective multicenter study PARTICIPANTS: Three scoring teams for 17 sleep laboratories. METHODS: Reports of adverse events occurring during polysomnography or identified upon scoring a study were collected over an 18-month time period. Incidence of mortality and adverse events were evaluated using a binomial distribution based on the Bernoulli process. RESULTS: Of 16,084 studies, the mortality rate during or 2 weeks after an adverse event, as noted, was 0.006%, and the overall rate of adverse events was 0.35%. CONCLUSIONS: Adverse event rates are low; however, procedures for handling medical emergencies or adverse events during or after polysomnography are prudent, and those studies performed for research should include preparedness for the possibility of adverse events.

Adult↗

PubMed2005

Detection of increased upper airway resistance during overnight polysomnography.

STUDY OBJECTIVES: To examine the utility of four methods used to detect increased upper airway resistance leading to arousal from sleep. DESIGN: Ten overnight sleep studies were conducted on normal subjects who reported increased snoring and/or witnessed apneas following alcohol ingestion. Alcohol was used to increase upper airway resistance in these normal subjects before ovemight polysomnography. Four methods to detect the presence of increased upper airway resistance were used: esophageal pressure manometry; respiratory inductive plethysmography; a piezoelectrically treated stretch sensor adhered to the supraclavicular fossa; nasal flow measured with oxygen cannula and differential pressure transducer. SETTING: Private Sleep Laboratory. PARTICIPANTS: Ten normal, healthy volunteers (5 male, 5 female). INTERVENTIONS: Alcohol ingestion as red wine (14% alcohol), 180-540 mL one to two hours before overnight polysomnography. Esophageal catheterisation. MEASUREMENTS AND RESULTS: Two hundred twenty-seven electroencephalogram arousals were preceded by inspiratory flow limitation and/or increased respiratory effort. Flattening of the nasal flow profile preceded all 227 arousals. In contrast, only 40% of arousals were preceded by an increase in the size of the stretch sensor signal, 22% by more-negative deflection of the esophageal pressure signal and 21% by increase in the signal size of respiratory inductance plethysmography. CONCLUSION: These findings indicate that the most reliable method of detecting increased upper airway resistance leading to arousal from sleep is the nasal cannula/pressure transducer method and suggest that many arousals induced by increased upper airway resistance may be caused by mechanoreceptor afferents.

Adult↗

PubMed2005

Comparison of nasal pressure transducer and thermistor for detection of respiratory events during polysomnography in children.

STUDY OBJECTIVES: The results of small studies have suggested that a nasal-cannula pressure transducer has a higher sensitivity than a thermistor in detecting hypopneas and diagnosing sleep-disordered breathing in both adults and children. We compared a thermistor alone, and in conjunction with a pressure transducer, for detection of sleep-disordered breathing in children during in-home polysomnography. DESIGN: Retrospective analysis of a subsample of a prospective cohort study. SETTING: Students attending elementary school in the Tucson Unified School District. PARTICIPANTS: A subsample of the Tucson Children's Assessment of Sleep Apnea study population. MEASUREMENTS AND RESULTS: Polysomnographic recordings of 40 children (24 girls and 16 boys, mean age 9.2 +/- 1.7 years; range 6-11 years) were analyzed to compare the detection of sleep-disordered breathing events by 2 different methods of measuring airflow: thermistor alone and thermistor with nasal-cannula pressure transducer (transducer) used simultaneously. The transducer detected all the respiratory events detected by the thermistor, but the thermistor detected only 84% of the transducer-defined events. Consequently, the transducer-derived mean respiratory disturbance index was higher than that detected by the thermistor (7.0 +/- 3.8 vs 5.9 +/- 3.4, P < .001). The bias error between transducer respiratory disturbance index and thermistor respiratory disturbance index on a Bland-Altman plot was 1.08 (95% confidence interval, 0.8 - 1.4). There was good agreement between the thermistor and the transducer for making the diagnosis of sleep apnea using a cutoff of a respiratory disturbance index greater than 5 (kappa = 0.69). The quality of the tracings with the transducer was comparable to that of the thermistor, but the transducer dislodged more frequently. CONCLUSION: The use of a nasal transducer in conjunction with a thermistor was more sensitive than the thermistor alone in detecting sleep-disordered breathing in children during unattended polysomnography.

Catheterization↗

PubMed2006

Accuracy of seizure detection using abbreviated EEG during polysomnography.

The purpose of this study was to determine the validity of abbreviated EEG montages for seizure detection during polysomnography. Three electroencephalographers reviewed files containing seizures or nonepileptic events using 8- and 18-channel montages. Files were rated as to whether they contained seizures and assigned a "probability of seizure" score from 0% to 100% reflecting the confidence that it was a seizure. Readers then localized seizures as temporal, frontal, parieto-occipital, or nonlocalized and provided a probability of correct localization with 0% to 100% confidence. Data were analyzed using the Adjusted McNemar Test method of Obochuwski. The probability of seizure score was measured using the receiver operating characteristic curve. Observed agreement was 78% and 84% for 8- and 18-channel montages, respectively. Readers were better able to distinguish seizures from nonepileptic events using the 18-channel montage (P = 0.004). Seizures localized to the temporal and parieto-occipital regions were more likely to be correctly identified and localized. Readers were able to correctly localize 27% and 49% of seizures using the 8- and 18-channel montages, respectively (P < 0.001). Abbreviated EEG montages are inadequate in the differentiation of seizures and nonepileptic events arising from sleep during polysomnography. This seems to be particularly true in frontal lobe epilepsy.

Area Under Curve↗

PubMed1997

Nonorganic insomnia in generalized anxiety disorder. 1. Controlled studies on sleep, awakening and daytime vigilance utilizing polysomnography and EEG mapping.

Objective and subjective sleep and awakening quality as well as daytime vigilance of insomniac patients with generalized anxiety disorder (GAD) were investigated, as compared with normal controls. Forty-four outpatients (25 females, 19 males), aged 24-65 (mean 43) years, diagnosed with non-organic insomnia (ICD-10: F 51.0), related to mild GAD (F 41.1), with a Hamilton anxiety (HAMA) score of 22 +/- 6 and a Zung self-rating anxiety (SAS) score of 37 +/- 6 were included. After 1 adaptation night, sleep induction, maintainance and architecture were measured objectively by polysomnography, subjective sleep and awakening quality were assessed by self-rating scales and visual analog scales, objective awakening quality was measured by a psychometric test battery, and diurnal tiredness was measured by a 3-min vigilance-controlled EEG (V-EEG) and a 4-min resting EEG mapping. In polysomnography patients demonstrated-as compared with normals-significantly increased wake time during the total sleep period and more early-morning awakening, decreased total sleep and sleep efficiency. Subjective sleep quality was deteriorated as well, as were well-being, drive, mood, and wakefulness in the morning. In noopsychic performance, GAD patients did rather well in attention, concentration, attention variability, and numerical memory, while fine-motor activity and reaction time were deteriorated. In psychophysiology, critical flicker frequency was decreased in the morning, while muscle strength, blood pressure and pulse rate showed no differences. EEG mapping during the late morning hours (10.00-12.00 h) demonstrated hypervigilance in the V-EEG, while in the resting recording an increased sleep pressure was detected. The latter was correlated significantly to the SAS score, but less so to the observer-rated Hamilton anxiety score. Our findings suggest that CNS hypervigilance and hyperarousal, as actual symptoms of GAD, lead to nocturnal insomnia, which in turn may cause-as a consequence of sleep pressure not slept off-diurnal tiredness.

Adult↗