ِAssessment Instruments in Sleep ~ Prof. Dr. Tarek Asaad
Download as PPT, PDF0 likes460 views
Polysomnography (PSG) is the primary tool used to assess sleep. PSG involves recording the electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG), respiratory effort, airflow, and oxygen saturation. It provides information about sleep stages and architecture, respiratory events like apneas, and movements during sleep. Portable PSG allows for more natural sleep but provides less information than laboratory PSG. Various conditions can be diagnosed using PSG findings, including sleep apnea and periodic limb movement disorder.
ِAssessment Instruments in Sleep ~ Prof. Dr. Tarek Asaad
- 3. TOOLS USED IN ASSESSMENT OF SLEEP • PSG. • MSLT, MWT,… • Microstructure sleep analysis, CAP, A/D,.. • Sleep EEG • Actigraphy. • Genetic studies: Narcolepsy? • Brain imaging. • Psychometric tools. • Others.
- 4. WHAT IS POLYSOMNOGRAPHY? • HYPNOGRAM (E.E.G.,E.O.G.,chin EMG). • RESPIRATORY EVENTS: airflow,chest ………and abdominal effort, O2 saturation. • LEG MOVEMENTS. • OTHERS : E.C.G., body position,snoring ………..detector,tumescence detector, ………..capnograph…etc.
- 6. Portable PSG • Easy • More acclimatization • Allow subjects to move • Recorded on a memory card • Sleep atmosphere is similar to “natural”
- 13. P.S.G. VOCABULARY • SLEEP CONTINUITY: TST , SL, SE, ………………arousal index, awakenings… • SLEEP ARCHITECTURE :stage I,II,III and IV, SWS %. • REM PARAMETERS: ……………....REM %,REML,REMD, …………...1st .REM duration and density. • RESPIRATION: apnea index,RDI,O2 ……………….desaturation.… • PLMS Index. • OTHERS.
- 14. PSG in different conditions • Different stages of sleep • Sleep apnea : Obstructive / Central • Periodic limb movements
- 23. Diagnostic criteria of “Sleep Apnea” • P.S.G. : a)- 5 0r more events ( apnea , hypopnea, or RERAs (resp. effort related arousals)/ h. b)- evidence of effort in at least part of each event. • One of : sleepiness , breath holding or loud snoring. • Not explained by sleep or other disorder. …………………….OR……………………… • PSG : 15 events / hour. • Not due to sleep or other disorder.
- 24. Diagnostic criteria in children • One or more scorable resp. event / hour. • One of the following : -frequent arousal associated with resp.effort. -desaturation with apneic episode. -hypercapnia during sleep. -markedly negative oesophageal p.swings. • One of the above associated with snoring. • Not due to sleep or other disorders.
- 28. Periodic Limb Movement of Sleep - PLMD = repetitive limb movements during sleep , usually 20-40 sec.apart , formerly termed “nocturnal myoclonus”. - Recorded on 2 or 1 channels , should include both limbs (may be unilateral) - Guidelines for scoring : 1)-patient asleep 2)- 4 or more occur in succession 3)-duration of each from 0.5-5 sec. 4)-those preceded by spontaneous arousal or termination of respiratory event are NOT recorded. - Normally, index < 5.
- 30. Post-test (1) • The following is true about “sleep spindles” EXCEPT : 1-generally <50Mv in adults 2-can persist into stage III & IV 3-not uncommon in REM 4-usually last 0.5 – 1.5 sec. 5-characteristic to stage II sleep
- 31. Post-Test (2) • Maintenance of Wakefulness Test (MWT) (EXCEPT) : 1-measurement of the intervals from “lights out” to sleep onset. 2-subjects are instructed to remain awake in a darkened room in a semi-reclined position. 3-most useful for assessment of medication effects on vigilence ability. 4-useful for assessment of “microsleeps” 5-long latencies are indicative of higher ability to remain awake.
- 32. Post-Test (3) • K-complex (EXCEPT): 1-sharp biphasic EEG wave,followed by a high voltage slow wave. 2-duration ,at least, 0.5 sec. 3-usually followed by several seconds of alpha rhythm. 4-can be elicited by external (auditory stimuli). 5-may be followed by sleep spindles.
- 33. Post-Test (4( • Length of time from “lights out” until a certain number of consecutive epochs of sleep (6-10 epochs) is : 1-sleep latency 2-latency to persistent sleep 3-slow wave sleep latency 4-microsleep 5-sleep efficiency
- 34. Post-Test (5( • Respiratory Disturbance Index (RDI) = 1-number of apneas & hypopneas per hour sleep. 2-number of O2 desaturations per hour sleep. 3-number of snoring events per hour. 4-measurement of respiratory muscle effort. 5-none of the above.
- 35. Post-Test (6(-(15( • In the following 10 PSGs , identify : a(-sleep stage b(-any other abnormality
- 46. Post-Test (16(-(20( • Define the following : (16(-REM Density (17(-Alpha-delta sleep (18(-EOG (19(-Desynchronized sleep (20(-Arousal index
- 47. Non-epileptiform Patterns during sleep mimicking epilepsy • ECG artifacts, muscle artifacts, electrode pops…etc. • Sharp transients seen during sleep : 1-Positive Occipital Sharp Transients of Sleep (POSTS(. 2-Mu rhythms. 3-Post.Slow Waves of youth. 4-Vertex Sharp waves. 5-K-complexes. 6-Sharp appearing spindles. 7-Hypnagogic ( or Hypnapompic ( hypersynchrony resembling “spike-wave complex”. 8-Benign epileptiform transients of sleep(BETS(.
- 49. Positive Occipital Sharp Transients of Sleep ( POSTS( • Seen bilaterally in post.temporal & occipital electrodes. • Occur in NREM sleep , mainly in stage I & II. • Monophasic positive polarity in occipital electrodes. • May be recorded synchronously or asynchronously.
- 51. Vertex Sharp Waves • Negative potentials with a wide distribution around the vertex. • Seen mainly in C3,C4 & Cz , with spread of activities to F3, F4 , P3 , P4, Pz & Fz. • Prominent in Stages I & II (?) NREM sleep.
- 53. K-Complex & Sleep Spindles • High voltage negative-positive potential. • Spindles = 12-14 cycle per second frequency. • Different from “Mu Rhythm” ( brief bursts of 7-11 cps , over the central regions, which show attenuation on passive or active movements of the limbs or even intention to move, usually contralaterally!). • “Wicket rhythms” = similar rhythms in temporal region.
- 55. Hypnagogic ( or Hypnapompic ( Hypersynchrony • Brief burst of synchronous high voltage slow activity ( 4-5 cps ). • More in children & adolescents? • More in stage II NREM sleep.
- 57. Benign Epileptiform Transients of Sleep ( BETS( • Small sharp spikes (SSS) , seen bilaterally, but more prominent on the left side. • Best recorded in ipsilateral ear montage, during stage I NREM sleep. • May be seen asynchronously on either side as well.
- 59. Rhythmic Mid-temporal Theta of Drowsiness ( RMTD( • Brief burst of rhythmic theta activity ( 6-7 cps). • Recorded asynchronously over left & right temporal electrodes. • More in stage I NREM sleep. • Clinically related to drosiness.
- 60. Epileptiform-Like Patterns , Without Epileptogenic Significance • Triphasic waves. • Periodic or pseudo-periodic lateralized epileptiform discharge ( PLEDs ). • Periodic complexes. • Subclinical rhythmic epileptiform discharge of adults. • Burst suppression patterns.
- 61. Specialized Techniques • MSLT. • MWT. • Actigraphy. • CAP.
- 64. Sleep & Epilepsy • Predominently “nocturnal” Seizures : e.g. Benign Partial epilepsy of childhood, nocturnal frontal lobe epilepsy, juvenile myoclonic epilepsy, Landau-Kleffner syndrome, …..etc. • Most inter-ictal discharge triggered during phases I & II NREM sleep & occaisionally stages III & IV ( NREM sleep = “Convulsant”). • REM sleep , generally = “Anti-convulsant”!