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Part I. Polysomnography

Part I. Polysomnography. What is Polysomnography?. Stimultaneous recording of numerous physiological variables during sleep: EEG, EOG, EMG, EKG, airflow, respiratory efforts, O 2 saturation, etc. Serves as a diagnostic tool for evaluation of normal and disturbed sleep

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Part I. Polysomnography

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  1. Part I. Polysomnography

  2. What is Polysomnography? • Stimultaneous recording of numerous physiological variables during sleep: EEG, EOG, EMG, EKG, airflow, respiratory efforts, O2 saturation, etc. • Serves as a diagnostic tool for evaluation of normal and disturbed sleep • Monitoring by a trained technologist

  3. Laboratory Equipment • Eliminate the influence of environmental stimuli (noise, light, temperature) • Comfortable bed • Infrared light source and a low light video camera system

  4. Patient preparation • Maintain a regular sleep-wake rhythm • Avoid sleeping pills or narcotics several days before the study • Avoid strenuous physical exercise on the day of the study • Not to drink coffee, tea, or alcoholic beverages • After a light meal, using toilet, and appropriate dressing, hook-up is performed

  5. Parameters of Routine PSG • EEG (C3/A2, C4/A1, O1/A2, O2/A2) • EOG (ROC/A1, LOC/A2) • EMG (chin & anterior tibialis) • EKG • Nasal and oral airflow • Thoracic and abdominal respiratory efforts • O2 saturation

  6. EMG (chin & anterior tibialis) - periodic leg moments; PLMs

  7. Summary • PSG is the most important tool for evaluation of sleep disorders • PSG is essential to Dx of OSA & PLMD • Findings of PSG should be interpreted within clinical context

  8. Summary • Major break-through in sleep research • PSG plays important role in scientific investigation of normal physiology of sleep & study of mechanisms of disease and their treatment

  9. 수면 무호흡증 • 코골이가 심할 경우, 수면중 약 10초이상 호흡이 정지되는 경우를 말하며 동맥혈내 산소포화도의 감소 , 부정맥등이 동반되어 나타나며 수면효율의 저하로 주간의 과도한 졸리움, 기억력 저하 및 집중력 저하등의 증상이 나타난다 • Apnea index = 무호흡수/전체수면시간ⅹ60 • 무호흡지수가 5 이하인 경우 정상

  10. 1)중추성 무호흡증(Central sleep apnea syndrome) : 모든 호흡진행이 뇌와 중추장애로 중지된다. 2)폐쇄성 무호흡증(Obstructive sleep apnea syndrome) : 상기도의 후두부의 폐쇄가 원인이며, 공기의 흐름이 막혀도 복벽 과흉부의 움직임으로 호흡을 계속해서 시도한다. 3)혼합성 무호흡증(Mixed sleep apnea syndrome) : 위의 두 가지가 혼합되어 나타나는 무호흡이다.

  11. Part II. The Clinical Use of the Multiple Sleep Latency Test

  12. Indications for the MSLT • Narcolepsy • Obstructive sleep apnea syndrome • Other causes of excessive sleepiness (idiopathic hypersomnia, PLMD, etc.) • Insomnia • Circadian rhythm sleep disorders • Assessment of treatment effects

  13. General Considerations for MSLT • 1~2 weeks of sleep diaries preceding MSLT • Following all-night PSG on habitual schedule • Careful consideration of drug schedule • Skilled, rested PSG technologist • Dress in street clothes before MSLT • Quiet, dark, temperature-controlled room • No alcohol or caffeine

  14. General Considerations for MSLT • It measures latency to sleep onset and confirms sleep onset REM period (SOREMP) • It is administered 5 times per day at 2-h intervals with no intervening sleep or stimulants • Basic underlying assumption -increased sleep latency = decreased sleepiness -decreased sleep latency = increased sleepiness

  15. Recording Montage for MSLT • C3/A2 or C4/A1, O1/A2 or O2/A1 • ROC/A1, LOC/A2, • EMG (chin) • EKG • Airflow, CPAP, respiratory sounds

  16. Scoring MSLT • Sleep latency ; elapsed time from light-out to the first epoch scored as sleep • Presence or absence of REM sleep within 15 min after sleep-onset

  17. MSLT 결과 보고서

  18. Severity of sleepiness • Mild sleepiness ; MSLT mean sleep latency of 10~15min • Moderate sleepiness ; MSLT mean sleep latency of 5~10min • Severe sleepiness ; MSLT mean sleep latency of less than 5min ->pathological daytime sleepiness

  19. Interpretation of MSLT • Mean MSLT of less than 5min & SOREMPs of more than 2 are diagnostic of narcolepsy • Medical judgement rather than absolute test scores must weigh significantly in interpretations

  20. Summary • ES is a potentially life-threatening condition • MSLT is the only scientifically validated objective test • MSLT helps establish the Dx of ES disorders such as narcolepsy • MSLT is useful for determining sleepiness severity • However, MSLT may produce false-negative results

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