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At least 19 recordsLinked to original sources
PubMed1992

Comparison of nap and overnight polysomnography in children.

Overnight polysomnography is the "gold standard" for diagnosing sleep-disordered breathing. However, the limited number of resources for pediatric polysomnography make the availability of a screening test for sleep-disordered breathing highly desirable. Therefore, we compared 1 hour daytime nap polysomnography to overnight polysomnography in 40 children [mean age, 5.4 +/- 0.8 (SE) years] with sleep-disordered breathing; 76% of children were sedated with chloral hydrate for nap polysomnography; none was sedated for overnight polysomnography. Studies were done 26 +/- 4 days apart. Chest wall motion, ECG, end-tidal PCO2 (PETCO2), arterial oxygen saturation (SaO2), and electrooculogram were monitored. Nap studies had a sensitivity of 74%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 17% in predicting sleep-disordered breathing. Significantly more children had obstructive apnea and desaturation (SaO2 less than 90%) during overnight polysomnography. The peak PETCO2 and the SaO2 nadir were significantly worse during overnight polysomnography. However, the percentage of time during which abnormalities were manifested did not differ between nap and overnight polysomnography. Despite the use of sedation, nap polysomnography underestimated sleep-disordered breathing. We conclude that sleep-disordered breathing detected by nap polysomnography is always confirmed by overnight polysomnography and speculate that nap polysomnography may be an effective screening method for sleep-disordered breathing. However, overnight polysomnography should be performed if nap polysomnography is inconclusive. Chloral hydrate may be used effectively to facilitate sleep for nap polysomnography in children.

Adolescent↗
PubMed1991

Polysomnography at a sleep disorders unit in Melbourne.

OBJECTIVE: To outline the procedure of polysomnography as carried out in a sleep disorders unit in Melbourne and to describe the patients undergoing polysomnography in terms of their age and sex and the sleep disorder diagnosed. DESIGN: A retrospective survey of consecutive patients who required diagnostic polysomnography. SETTING: The Sleep Disorders Unit at Epworth Hospital, a large private hospital in Melbourne. PATIENTS: Two hundred consecutive patients who underwent polysomnography over a seven-month period. Their ages ranged from 19 to 77 years. INTERVENTIONS: All patients had diagnostic polysomnography for one night in the sleep laboratory. This involved 12 to 14 physiological variables being monitored continuously overnight by means of a new digital recording and sleep analysis system. MAIN OUTCOME MEASURES: Patients were categorised according to their main sleep disorder or primary diagnosis. Additional sleep disorders in some patients were categorised as secondary diagnoses. RESULTS: The commonest age group among both male and female patients was 40-49 years. Overall, men outnumbered women three to one. Almost two-thirds of all patients had as their primary diagnosis some degree of obstructive sleep apnoea syndrome or simple snoring. The next most common diagnosis was periodic limb movement disorder. The remaining diagnoses included a variety of sleep disorders, from narcolepsy to sleep terrors. CONCLUSIONS: Despite its complexity and time-consuming nature, polysomnography is an essential procedure for the diagnosis and treatment of a wide range of sleep disorders. More sleep laboratories and a greater emphasis on the multidisciplinary teaching of sleep disorders medicine will be required in Australia.

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↗
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↗
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↗
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↗
PubMed1990

The pathophysiology of the Rett syndrome from the standpoint of polysomnography.

Twelve polysomnographies were performed on eight cases of the Rett syndrome and the results were compared between cases under and over 5 years of age. There observed an increase in the ratio of stage REM (sREM) against slow wave sleep (SWS) with age. The ratio of the number of mentalis twitch movement (ment TM) during sREM against the number of rapid eye movements (REMs) (reflecting dopaminergic activities) was below normal in the younger cases but increased markedly. The ratio of ment TM in the period of REMs burst against the total ment TM during sREM (reflecting the noradrenergic hypofunction) was high in the younger group, while it decreased later. The nocturnal variation became inapparent with age in % SWS and the phasic components of sREM, while that of % sREM exaggerated at later ages. The early hypofunctions of the noradrenergic and dopaminergic neurons later modified by the serotonergic dysfunction and dopaminergic postsynaptic supersensitivity are suggested.

Child↗
PubMed1991

Diagnosis of sleep-disordered breathing by half-night polysomnography.

We hypothesized that sleep-disordered breathing (SDB), defined by the apnea index (AI), the apnea + hypopnea index (A + H/I), or the desaturation event frequency (number of desaturations greater than 5%/h slept) (DEF), could be diagnosed after less than full-night polysomnography (PSG). Forty-eight consecutive full-night PSG sessions were evaluated by separately analyzing the first half (PSG-1/2) and the total (PSG-T) sleep time: 134.42 +/- 35.7 and 277.15 +/- 56.5 min (mean +/- SD), respectively. PSG-1/2 and PSG-T were not different with respect to AI. The DEF was statistically but not clinically higher during PSG-1/2 (41.72 +/- 41 versus 37.95 +/- 35.8, p = 0.04). Sensitivities, specificities, and predictive values of each PSG-1/2 parameter were determined by comparing the values with those measured during PSG-T, using cutoff frequencies of both 5 and 10 events/h slept to define SDB. At a cutoff frequency of 10, sensitivities and positive predictive values were high for all PSG-1/2 parameters (range, 94.6 to 96.9%). The specificities of the DEF and AI during PSG-1/2 were also high (93.75 and 95%, respectively), but the negative predictive value of the DEF was substantially better (93.75 versus 83.3%). With SDB defined by 5 events/h slept, there also were high sensitivities (87.9 to 93%), positive predictive values (93.6 to 100%), and specificities (86.7 to 100%) for all parameters. Negative predictive values, however, were substantially reduced (62.5 to 76.5%). We conclude that PSG during 2 h of sleep is an appropriate method for evaluating SDB.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1990

Polysomnography early after uvulopalatopharyngoplasty as a predictor of late postoperative results.

We performed nocturnal diagnostic polysomnography (PSG 1), PSG early after UPPP on the second to the fifth postoperative night (PSG 2) and PSG late after UPPP (PSG 3) six or more weeks after surgery, on 15 male patients with obstructive sleep-disordered breathing. On PSG 1, the A + H/I for the group was 66.6 +/- 8.8 (mean +/- SE). During non-REM sleep the A + H/I on PSG 3 (29 +/- 10) was lower than it was on PSG 2 (54.3 +/- 11.3) (p = 0.004) and lower than that on PSG 1 (70.8 +/- 10.3) (p = 0.003). Similarly, during non-REM sleep, the AI on PSG 3 (16.1 +/- 7.4) was less than that on PSG 2 (39.1 +/- 10.4) (p = 0.003) and less than that on PSG 1 (41.7 +/- 9.6) (p = 0.015). In the eight patients in whom REM sleep was recorded on all three PSGs, there was no difference with respect to A + H/I or AI. The nadir of SaO2 during non-REM sleep was higher during PSG 3 than during PSG 1 (p = 0.002), but not different from that on PSG 2. There were no differences among the three studies with respect to REM-related nadirs of SaO2; however, there was a good deal of interindividual variability across the three PSGs. In general, individuals with satisfactory amelioration of sleep-disordered breathing on PSG 2 demonstrated similar improvement on PSG 3. Patients who did not have a substantial improvement in the early postoperative period often had improvement on PSG 3, but there was a good deal of interindividual variability in this regard. We conclude that PSG within a few days following UPPP is warranted in patients with obstructive sleep-disordered breathing to determine if there has been worsening of upper airway function or oxygenation (or both) during sleep in the early postoperative period. A satisfactory result early after UPPP suggests that a late postoperative PSG is unnecessary, with savings in cost and the convenience.

Adult↗
PubMed1991

Polysomnography in idiopathic muscle pain syndrome (fibrositis).

Muscle pain occurs in various neuromuscular disorders with characteristic physiological or biochemical abnormalities. There is, however, a group of patients in whom there is no clear physiological or structural basis for their pains. This syndrome has been called fibrositis or fibromyalgia. Sleep abnormalities have been reported in some of these patients, but have not been confirmed by others. We studied 8 patients with this disorder and found sleep abnormalities that were characterized by nocturnal myoclonus, alpha-delta sleep, and abnormalities compatible with depression. Polysomnography was, therefore, instrumental in helping direct the treatment of these patients. Therapeutic approaches aimed to correct the specific disorders were effective in improving the pain symptoms.

Alprazolam↗
PubMed1992

Polysomnography in the Rett syndrome.

The features of sleep parameters in the Rett syndrome were compared with those in early infantile autism (EIA) and hereditary progressive dystonia with marked diurnal fluctuation (HPD). The sleep-wakefulness cycle and the tonic and phasic components of sleep were evaluated in each disorder, the former was estimated by the day-by-day plot method and the latter two by polysomnography (PSG) following our method. Abnormalities of the sleep-wakefulness cycle were observed in the Rett syndrome and EIA, but in the latter these abnormalities became inapparent with age and improved markedly by correcting the environmental condition and completely by 5-hydroxytriptophan. The latter, if treated early, was followed by improvement of behavior. In the Rett syndrome, however, the abnormalities continued into late childhood to adolescence. In HPD, PSG abnormalities were restricted to the phasic component, which improved completely after levodopa in accordance with the clinical improvement. On the other hand, in the Rett syndrome as well as in EIA both the phasic and tonic components were involved and also the leakage of the components of REM stage into NREM stage was observed. In the Rett syndrome, these abnormalities aggravated with age, with disturbances in % sleep stage, nocturnal variation of tonic and phasic components of sleep and REM-NREM cycles, while in EIA the results of PSGs revealed no such progressions but showed an increase in twitch movement and a lack of normal increase in the number of REMs occurring in short intervals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[The differential diagnostic value of polysomnography].

Polysomnography (PSG) is a standard procedure for investigating sleep functions including behavior. This technique is described. The diagnostic value of PSG is shown by statistical data from the literature and our own patient sample which includes 442 insomniacs. In one out of five patients, insomnia is related to a known somatic factor, i.e. periodic movements in sleep or sleep apnea, which can only be reliably identified by PSG. A more differentiated analysis shows that PSG yields important diagnostic information in 50 to 75% of insomniacs. Three cases are reported, showing that even patients without clinical indications for sleep disturbance can have deficient sleep functions. If they can be specifically addressed, this may be the turning point of the treatment. Therefore, a wide application of PSG is favored.

Adult↗
PubMed1990

How much polysomnography is enough?

Sleep studies combined with the analysis of autonomic functions are, in several cases, necessary in order to make an accurate diagnosis. Polysomnograms require minimal technical equipment, the absence of which may cause the data obtained to be unreliable.

Humans↗
PubMed1991

Polysomnography in locked-in syndrome.

Sleep patterns were evaluated in a case of 'locked-in' syndrome. This patient had an ischemic infarction involving the ventral portion of the upper half of the pons bilaterally, with a posteromedial extension into the tegmentum. Reticular structures, notably the median raphe nuclei, supposed to play a major regulatory role in sleep, were most probably involved. Unexpectedly, repeated polysomnographic studies revealed sleep patterns with only minor abnormalities.

Electroencephalography↗