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PubMed1993

Pilot study: validating staff nurses' observations of sleep and wake states among critically ill patients, using polysomnography.

BACKGROUND: Effective management of sleep pattern disturbance begins with accurate assessment of the patient's sleep and wake states. OBJECTIVE: The purpose of this study was to validate staff nurses' observations of sleep and wake states among critically ill adult patients, using polysomnography. SAMPLE AND SETTING: The sample consisted of 21 adult patients with multisystem diagnoses in a 10-bed medical intensive care unit in a 540-bed acute care teaching hospital. METHOD: Each staff nurse caregiver observed a single patient for the entire data collection period of 4 hours, with a total of 15 nurses participating in the study. A total of 340 observations were made, with the possibility of 17 observations per patient. Nursing observations were made every 15 minutes on each patient and compared to the actual patient state as measured by polysomnography. RESULTS: Nurses' assessments were correct 81.9% of the time. CONCLUSIONS: There is some basis for using staff nurses as observers of sleep and wake states. Increased credence can be placed on nursing assessments and diagnosis of sleep pattern disturbance, resulting in more timely and effective management of the problem.

Adult↗

PubMed1993

[Comparative use of MESAM IV and polysomnography in sleep-related respiratory disorders].

The high prevalence of sleep-related respiratory disturbances among the male population requires development of reliable outpatient measurement systems enabling the selection of patients to be admitted to the sleep laboratory. MESAM IV is such a system. It can record for up to 18 hours via four sensors a patient's snoring sounds, heart rate, oxygen saturation and posture. To test the reliability of the instrument we compared parallel night measurements by MESAM IV and polysomnography (PSG) via the respective Respiratory Disturbance Indices (RDI = number of apnoeas plus hypopnoeas per hour). The group of subjects studied numbered 68 patients of the sleep laboratory suspected of having sleep-related respiratory disturbances (age 18-78 years, average 50.8 yrs.; height 164-192 cm, av. 175.2 cm; weight 40-160 kg, av. 99.3 kg; body mass index 13.8-49.5, av. 32.3). Assessment of the MESAM measurements was effected on the one hand by means of a computer programme (version 1.2) that is part of the system, and on the other hand by 3 independent evaluators, two of whom were already experienced in MESAM evaluation. Each evaluator was unaware of all personal and clinical data of the patients and of the results obtained by the other evaluators. Visual assessment was performed according to fixed criteria with the inclusion of all four measurement signals of the system, whereas two mutually independent respiratory disturbance indices (RDI) were calculated by computer evaluation. The results of the various MESAM IV evaluations were compared with those of polysomnography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1997

Polysomnography: a systematic review.

Polysomnography refers to the continuous monitoring of multiple neurophysiological and cardiorespiratory variables, usually over the course of a night, to study normal and disturbed sleep. Electroencephalographic, electrooculographic and electromyographic channels provide the basis for staging the recording into successive epochs of wakefulness and various non-Rapid-Eye-Movement (REM) and REM sleep. Detection of airflow at the nose and mouth by means of thermistors, and analysis of breathing patterns recorded from sensors placed around the ribcage and abdomen, sound recordings, the electrocardiogram and the combined application of several other measurement techniques allow the assessment of normal and abnormal physiological events in relation to sleep structure. Polysomnography has an important role in the diagnosis of disorders of sleep and wakefulness as well as in the assessment of treatment effects and in scientific investigations. Developments in digital signal processing have contributed to its widespread application in clinical practice and research.

Humans↗

PubMed1998

[Polysomnography in the prevention of crib death].

The authors stress the importance of polysomnography--a new electrophysiologic method--in the prevention of SIDS (cot death). SIDS is the most important and frequent cause of infant mortality between 1 and 12 months of age in western countries (nowadays between 1-2/1000!). In Hungary the frequency is not so high. In the last few years the incidence declined after the "back to sleep" campaigns, but to reach further success, it is very important to seek the so called "risk" babies. The unique cause of cot death is not yet understood exactly, but some instability in respiration (mostly during the sleep) is one of the accepted principal basic factors. The mentioned new method helps in choosing the SIDS risk infants from the "normal" population, allows to examine their respiratory irregularity or even disorders during the sleep and gives possibility for the prevention of lethal apneas. The authors describe the details of the prevention in case of abnormal polysomnography in their other publications.

Birth Weight↗

PubMed1992

Preliminary report: validity of symptom analysis and daytime polysomnography in diagnosis of sleep apnea.

The aim of this study was twofold: first, to see if the prevalence of the sleep apnea syndrome (SAS) in a given population could be fairly estimated by our patient questionnaire, mainly based upon the 1979 American Sleep Association definition of SAS; and second, to investigate whether the severity of SAS could be similarly accurately measured by daytime polysomnography (DPSG), as an alternative to the more demanding all-night polysomnography (NPSG). Of 42 patients consecutively examined due to rhonchopathy, 18 had the clinical diagnosis of SAS, which was based on the three symptoms--snoring, sleep disturbances and diurnal hypersomnia--if reported to occur habitually. In 11 patients the diagnosis was established by NPSG [apnea index (AI) greater than 10]. However, in only 10 of the 18 cases NPSG indicated the diagnosis giving a positive predictive value of 56%. When comparing DPSG versus NPSG in 36 patients, the AI ranged from -23 to +65, and the mean AI value was found to be twice as high in the former (mean difference 9.0 +/- 18.4; p less than 0.01). The positive predictive value of DPSG was 63% (10/16). Both the self-report and DPSG were burdened with some 25% false-positive results, and DPSG gave far too variable AI values to be reliable in staging the disease. On the other hand, the negative predictive values were high, 96% (23/24) and 100% (20/20), respectively, indicating their usefulness for screening purposes.

Adult↗

PubMed1991

Uvulopalatopharyngoplasty in snorers with sleep apneas: predictive value of presurgical polysomnography.

To determine its predictive value, polysomnography was performed on 14 snorers with sleep apnea syndrome (SAS) before and 3 months after uvulopalatopharyngoplasty (UPPP). In the 8 patients considered as cured (less than 10 apneas per hour after UPPP), total apnea index (TAI) decreased from 29.7 +/- 22.6 to 4.9 +/- 3.5. Rapid eye movement sleep (REM) increased from 10.9 +/- 3.6 to 14 +/- 5.7% of the total sleep period (TSP). In the 6 uncured patients, TAI decreased from 59.7 +/- 15.7 to 32 +/- 15.7 and REM increased from 7.7 +/- 5.6 to 15.8 +/- 7.2% of TSP. Snoring and drowsiness decreased in both cured and uncured patients. A presurgical apnea index less than 40 seems to be a reliable predictor of successful UPPP. The association of obstructive apnea with either central apnea or mixed apnea was not a factor of poor prognosis. Better sleeping could explain in part the clinical improvement in both cured and uncured patients, but postoperative polysomnography is needed to detect asymptomatic SAS.

Adult↗

PubMed1987

Comparison of polysomnography and sonography for assessing regularity of respiration during sleep in adenotonsillar hypertrophy.

Increasing awareness of the role of adenotonsillar hypertrophy in the etiology of chronic airway obstruction and disturbed respiration during sleep has created interest in the diagnostic methods available to assess the effects of obstruction. This study evaluates and compares simultaneously-obtained recordings of polysomnography and sleep sonography in children obstructed by adenotonsillar hypertrophy. Four hundred sixty-five 4-minute samples obtained from 18 patients in a clinical studies unit were analyzed and rated as to severity. Agreement between polysomnography and sleep sonography was very high in scoring the respiratory pattern (r = 0.79) and detecting apnea (r = 0.89). These findings demonstrate that sleep sonography is a reliable method for evaluating patients with upper airway obstruction due to adenotonsillar hypertrophy.

Adenoids↗

PubMed1992

Polysomnography: technical aspects in adolescents and adults.

Polysomnography is a complex procedure that should be performed by a trained technologist. The routine clinical polysomnogram includes the monitoring of EEG, electro-oculography, electromyography, effort of breathing and airflow, oxygen saturation electrocardiography, and body position. Other more specialized studies may include parameters such as endoesophageal pressure, endoesophageal pH, or penile circumference change. Special considerations to keep in mind when studying adolescents include attention to psychological, social, and technical issues. Polysomnography is an essential tool in the formulation of diagnosis for sleep disorders patients and in the enhancement of our understanding of sleep and its disorders.

Adolescent↗

PubMed1991

[Application of ambulatory cassette EEG system to the polysomnography in childhood epilepsy].

Using an ambulatory cassette EEG system (Oxford Medilog 9000), polysomnography was performed in 25 cases of children with epilepsy and 25 normal children. The results revealed decreases in REM sleep and REM density in intractable epilepsy. An increase of slow waves was observed during REM sleep in severe myoclonic epilepsy in infancy or its adjacent group, and this result was more clearly demonstrated by an EEG auto analysis with fast Fourier transform. This above ambulatory cassette EEG system will be utilized more easily for polysomnography, and contribute to the research not only of the pathophysiology of epilepsy but also of the sleep mechanism itself.

Adolescent↗

PubMed1993

[Screening of sleep apnea syndrome using daytime polysomnography--its usefulness and the characteristics of daytime sleep in the patients with sleep apnea syndrome].

Some attempts have been made to screen sleep apnea syndrome (SAS). In this study, we performed daytime polysomnography (DPSG) as a means of screening SAS. 33 patients (28 males and 5 females, a mean age of 50.7 years) who were seen with the complaints of sleep-wake disorders, snoring and breathing disturbance in their nocturnal sleep were subjects for the screening. EEG, EMG, and EOG according to standard polysomnographic technique were recorded from 3:30 (p.m.) for 60 minutes, as additional indicators, oro-nasal airflow and abdominal movement were monitored simultaneously to confirm cessation of breathing. After the screening, we performed conventional polysomnography (PSG) to make a diagnosis of SAS, and compared the diagnosis with the appearance of apnea in the screening. We studied on the characteristics of daytime sleep in SAS and NonSAS by the comparison of EEG variables obtained from DPSG. Sleep apnea was detected in 20 cases with DPSG, 18 cases of these 20 were diagnosed as SAS. However, there were 6 patients who were diagnosed as SAS without the appearance of apnea in the screening. Dominant type of apnea in the screening were corresponded to ones confirmed with PSG, 16 cases showed obstructive type and 4 cases indicated central type. Some statistical differences of EEG variables between SAS and NonSAS were recognized. Number of stage shifts and percentage of stage W to total sleep time were significantly increased in SAS, on the contrary, percentage of stage 2 to total sleep time tended to be lower in SAS.(ABSTRACT TRUNCATED AT 250 WORDS)

Electroencephalography↗

PubMed2006

Excessive daytime sleepiness in patients with Parkinson's disease: a polysomnography study.

To investigate excessive daytime sleepiness (EDS) in patients with Parkinson's disease (PD), the reasons for which have not yet been clarified, polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT) were performed in 46 patients with PD, and, in addition, PSG was performed in 30 healthy controls. Assessment included Epworth Sleepiness Score (ESS), Mini-Mental State Examination (MMSE), and Hamilton Test (HT) for depression. Fifty percent of PD patients reported EDS (ESS, 10 +/- 4.5 vs. 6.9 +/- 3.7; P = 0.01). Compared with controls, PD patients as a group had lower sleep efficiency (65 +/- 22 vs. 77 +/- 14; P = 0.03), a longer Stage 2 (73 +/- 12 vs. 67 +/- 12; P = 0.03), and a shorter rapid eye movement stage (8 +/- 8 vs. 17 +/- 8; P < 0.001). Clinical data and sleep characteristics were similar in PD with/without EDS. Of interest, patients treated with clonazepam (CLNZ) had lower EDS than those without CLNZ (ESS, 7.9 +/- 4.7 vs. 11.3 +/- 4.0; P = 0.03). These patients suffered less periodic leg movement during sleep (2.1 +/- 2.7 vs. 12.4 +/- 28; P = 0.04), which might explain the finding. No correlation was found between ESS, MSLT, and all other clinical features analyzed. In PD patients, according to the data obtained, severity of EDS does not depend on any specific clinical factor and the etiology is probably multifactorial. Paradoxically, PD patients treated with CLNZ were less sleepy than patients not treated with CLNZ.

Aged↗

PubMed2002

Results of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients.

We subjectively and objectively evaluated 136 patients with socially unacceptable snoring (SUS) or obstructive sleep apnoea syndrome (OSAS) treated with uvulopalatopharyngoplasty (UPPP) after a diagnostic workup by sleep registration (polysomnography, PSG) and sleep endoscopy. Of the 136 patients, there were 88 with OSAS and 48 with SUS. The results of the procedure were considered subjectively to be an improvement in 38 (79%) of the SUS patients and in 74 (84%) of the patients with OSAS. In 36 (40%) of the 88 patients with OSAS, repeating PSG postoperatively was considered unnecessary because of obvious improvement. Of the 52 patients with a measurement after UPPP, a decrease in the apnoea hypopnoea index (AHI) was found in 38 (73%; median decrease: 48%), and AHI dropped below 20 in 32 (62%). The apnoea index (AI) was available in 49 (56%) patients and was reduced in 31 (63%; median decrease: 73%). An overall positive result in the 88 patients with OSAS (combining available data on subjective and objective results) was therefore found in 61 (69%; positive subjective result and AHI <15) or 71 (81%; positive subjective result and decrease in AHI), respectively, depending on the definition. We conclude that after diagnostic workup by sleep registration and sleep endoscopy, the success rate of UPPP increases as compared to historical controls.

Adult↗

PubMedDate not supplied

Three-dimensional computed tomography and polysomnography findings after extended uvulopalatal flap surgery for obstructive sleep apnea.

OBJECTIVES: Using both sleep physiological parameters and image data to evaluate the efficacy of extended uvulopalatal flap (EUPF) surgery in the treatment of obstructive sleep apnea (OSA). MATERIAL AND METHODS: Fifty patients with OSA underwent EUPF that consisted of bilateral tonsillectomy, dissection and removal of the submucosal adipose tissue of the soft palate and supratonsillar areas, and imbrications and repositioning of the denuded uvulopalatal flap. Polysomnography (PSG) and 3-dimensional computed tomography (3-D CT) data were obtained at baseline and 6 months postoperatively. Good response to surgery was defined as a reduction of the respiratory disturbance index (RDI) to less than 20 events/h and a greater than 50% reduction of the baseline RDI. RESULTS: Forty-two patients (84%) achieved good results. The RDI and minimal O2 saturation improved significantly (P<.0001) after EUPF. The postoperative 3-D CT evaluation showed a significant increase in the retropalatal space (P<.0001). The preoperative lateral diameter of retropalatal space was predictive of the change of RDI (R2=0.15, P=.05). The effect of increased retropalatal space (r=0.59, P=.0415) was significant in patients with baseline RDI ranged from 31 to 60 events/h. CONCLUSIONS: With special emphasis on the removal of palatal fat, EUPF appeared to be effective in the reduction of sleep apnea in selected patients. 3-D CT proved that this technique was effective in widening the upper airway by relieving the retropalatal obstruction.

Adult↗

PubMed2006

Effects of ibuprofen on sleep quality as measured using polysomnography and subjective measures in healthy adults.

BACKGROUND: Although some literature has suggested that NSAIDs may affect sleep physiology, this observation is not consistent with clinical use of these drugs and has not been verified using standard sleep-research methodologies. OBJECTIVE: This study was undertaken to determine whether ibuprofen 400 mg administered at 3, 7, and 11 pm (total daily dose, 1200 mg) produced any significant alterations in the character and quality of night-time sleep as measured by standard sleep laboratory polysomnography (PSG) and subjective measures. METHODS: This 4-day, multiple-dose, double-blind, randomized, placebo-controlled trial was conducted in a hospital-based, sleep laboratory in the United States (DENT Neurological Institute at Millard Fillmore Hospital, Buffalo, New York). Healthy subjects aged > or = 18 years spent 3 consecutive nights in a sleep laboratory. Day 1/night 1 was for acclimation; day 2/night 2, for baseline PSG and subjective sleep assessments; and day 3/night 3, for treatment effects on sleep character and quality. All subjects received placebo on days 1 and 2. On day 3, subjects received ibuprofen 400 mg or placebo TID. RESULTS: All 30 subjects (15 per group) completed the study (18 men, 12 women; all white). The mean age (SD) was 28.6 years and mean body weight was 71.4 kg. In both groups, mean values for sleep efficiency and quality of sleep were significantly higher on night 3 compared with baseline; the mean (SD) changes from baseline were not significantly different between the ibuprofen and control groups (sleep efficiency, 0.4 [6.3] and 0.3 [6.2]; quality of sleep, 8.6 [26.8] and 3.3 [21.3]). Mean night-3 sleep efficiency in the ibuprofen group was 88.6%--substantially higher than the minimally acceptable sleep efficiency of 75% stated in the protocol. Three mild adverse events were reported in 2 subjects. CONCLUSION: This study found that in these subjects a total daily dose of 1200 mg ibuprofen did not produce any clinically or statistically significant alterations in the character and quality of nighttime sleep as measured using standard sleep laboratory PSF and subjective measures.

Adolescent↗

PubMed2004

Polysomnography in children scheduled for adenotonsillectomy.

OBJECTIVE: Several studies suggest that a reliable diagnosis of childhood sleep-disordered breathing (SDB) requires polysomnography (PSG). We compared clinical and PSG-based diagnoses in children scheduled for adenotonsillectomy (AT). Parent responses on a validated Pediatric Sleep Questionnaire were used to determine which symptoms could help identify children with clinical diagnoses of SDB but normal PSG. STUDY DESIGN AND SETTING: Thirty-four children aged 5.0 to 12.9 years and scheduled for AT to treat clinically diagnosed sleep-disordered breathing underwent laboratory-based PSG. Results were scored by 3 different criteria: 1) >1 obstructive apnea (2 breaths or longer) per hour of sleep; 2) >5 apneas or hypopneas per hour of sleep; or 3) >1 apnea, hypopnea, or respiratory event-related arousal per hour of sleep. RESULTS: Depending on the criterion used, the PSG documented SDB from a minimum of 18/34 subjects (53%, for criterion I) to as many as 30/34 subjects (88%, for criterion III). Among symptoms studied, absence of daytime mouth breathing and habitual snoring were most helpful in identification of children who had no evidence of SDB on PSG, by criterion I (Chi-square, P < 0.05). The absence of other common symptoms, such as "loud snoring" or "trouble breathing" at night, were not helpful. CONCLUSION: Children with clinical diagnoses of SDB may not consistently meet PSG criteria for this disorder. Questions about daytime mouth breathing and habitual snoring might help clinicians recognize children who would not have SDB on objective testing. SIGNIFICANCE: Clinical identification of SDB confirmable on PSG could be improved. However, available outcome data do not yet clarify whether clinical or PSG criteria best identify children likely to suffer morbidity from SDB. EBM RATING: C.

Adenoidectomy↗

PubMed2005

The effect of polysomnography on pediatric adenotonsillectomy postoperative management.

OBJECTIVE: We retrospectively investigated the effect and predictability of preoperative polysomnography (PSG) on the postoperative course of younger pediatric patients undergoing adenotonsillectomy. STUDY DESIGN AND SETTING: A retrospective chart review was performed for patients 3 years of age and younger who had undergone adenotonsillectomy between July 1997 and July 2002 at the Children's Hospital of Wisconsin. RESULTS: Two hundred eighty-two patients were identified. Forty-three patients had preoperative PSG. No correlation between the severity of PSG results and postoperative course was identified. CONCLUSIONS: The role of PSG in upper airway obstruction and OSA remains controversial. This study suggests that although the complication rate may be higher in this younger population, these complications do not appear to have a large impact on their length of stay. SIGNIFICANCE: This study suggests that the 3-years-and-younger group, in the absence of other comorbidities, can safely undergo adenotonsillectomy without undergoing preoperative PSG. EBM raing: C.

Adenoidectomy↗

PubMed2005

Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients.

OBJECTIVE: We tested whether polysomnography (PSG) indexes were associated with sleepiness, quality of life, or reaction times at baseline and as outcome measures following surgical or sham treatment for patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND METHODS: Mild-moderate OSAS subjects were measured before and 8 weeks after surgical or sham treatment in this prospective longitudinal study. Measures included standard PSG indexes, sleepiness, quality of life, and reaction times. Associations were examined with Spearman correlations and multivariate linear regression. RESULTS: Correlations between baseline PSG and non-PSG measures ranged from -0.22 to 0.25 (n, 87 subjects; mean correlation, 0.00 +/- 0.11), with one positive association significant of 56 tested (arousal index and SF36 Mental Component Summary, r, 0.25; P = 0.03). Correlations between change in PSG and non-PSG measures ranged from -0.37 to 0.35 (n, 54 subjects; mean correlation, -0.05 +/- 0.19), with no significant positive association of 56 tested. Regression analyses confirmed these results. CONCLUSIONS: PSG indexes are not consistently associated with sleepiness, quality of life, or reaction time, both at baseline and as outcome measures in patients with mild-moderate OSAS. PSG indexes may not quantify some important aspects of OSAS disease burden or treatment outcome. Clinically important outcomes should be measured directly. EBM RATING: A.

Adult↗

PubMed2005

Troubleshooting and elimination of artifact in polysomnography.

A sleep technician who runs a sleep study without understanding the basis of the signals being acquired can spend a lot of time and energy trying to improve poor signal quality without success. Poor signal quality often results in an image that cannot be interpreted or is difficult to interpret, and extensive troubleshooting often results in a very disrupted sleep study. This article addresses trouble-shooting and elimination of artifact in polysomnography.

Amplifiers, Electronic↗