Sleep Disorders techniques staging disorders.pptx

Polysomnography

1. Technical aspects PART ONE

2. Electrodes and sensor placement

3. Electrodes and sensor placement

4. Scoring --> wakefulness

5. Scoring --> stage N1

6. Scoring --> Stage N2

7. Scoring --> Stage N3

8. Scoring --> Stage R

9. Description of PLMS: Periodic, repetitive limb movements, often involving big toe extension, sometimes ankle, knee, and hip flexion. Prevalence : Common in older adults (up to 34%), strongly associated with restless leg syndrome (90%), narcolepsy (65%), and REM sleep behavior disorder (70%). Scoring --> periodic limb movements

10. Scoring --> periodic limb movements -Amplitude increase of 8 mV above baseline. -Duration: 0.5 to 10 seconds. Scoring Criteria for Single Leg Movement (LM): -Minimum four consecutive LMs. -Interval between LMs: 5 to 90 seconds. PLM Series Criteria: 02 01 -Defined as abrupt EEG frequency shift lasting ≥3 seconds, occurring within 0.5 seconds of LM onset. -Exclusion Criteria: LM within 0.5 seconds of apneic/hypopneic events likely artifacts. Arousal Scoring: 03

11. Figure 12-22. These periodic leg movements occurring every 15 to 20 seconds represent a PLMS series. As the PLM could occur in either the left or the right limb, it is important to record from both legs. No arousal response was associated with the PLMs in this epoch.

12. Figure 12-23. The second PLM during N2 sleep is associated with a brief EEG arousal

13. Sleep Apneas and related conditions Obstructive Sleep Apnea Central Sleep Apnea 02 01 Others 03

14. Obstructive Sleep apnea Figure13-1. An obstructive apnea showing an SaO2 desaturation down to 80% (baseline SaO2 93%–94%) after 17 seconds of apnea. The lowest SaO2 desaturation occurred at about 20 seconds after the resumption of respiration. Note no air fl ow measured by nasal pressure sensor and minimal excursion by thermal sensor (>90% reduction), while maintaining chest and abdominal movements. Note the lowest SaO2 desaturation.

15. Figure 13-3. An example of an obstructive apnea lasting 20 seconds and a hypopnea lasting 45 seconds during 2 minutes of N2 sleep. Both events are associated with oxygen desaturation and EEG arousal.

16. Figure 13-4. A central apnea lasting 20 seconds during REM sleep with an SaO2 desaturation down to 88% from baseline of 96%. Note the absence of inspiratory effort as well as airfl ow. The event was terminated by movement and an awake EEG pattern with resumption of respiration.

17. Excessive day time sleeping is the m ost common caus e for patients to be referred for a laborartory based sleep study. Multiple slee Latency test: 5 nap opportunities at 2-hour interval during the patient’s normal waking hours Sleep-Onset REM period (SOREMP) : refering for any nap containing stage R sleep. Normal MSLT does not exclude Narcolepsy. Interpretetion : -values less than 8 minutes are considered abnormal -Aminimum of 2 SOREMPs is the standard for confirming the diagnosis of narcolepsy Narcolepsy

18. parasomnia

19. Case presentation Case No. 1: A 22-year-old college student under significant stress was amnestic of the confusional arousals and nocturnal wanderings witnessed by her roommates.4 Her PSG captured multiple confusional arousals from stage N3 sleep associated with standing and attempting to walk (Fig. 15-6). The technolo -gist reported her as confused and requiring repeated gentle redirection back to bed, after which she quickly fell back into sustained clinical and electrographic sleep. Upon interview the morning following this study, the patient was amnestic of all observed events

20. Case No. 1: An elderly man complained of a long history of violent dreams associated with injurious behavior. His wife also reported that he frequently “flops” his legs when he sleeps. Recently, he had a dream where he attempted to stop a man who was running from the police. Immediately prior to a full arousal, his spouse watched him jump head fi rst off their bed (isomorphism). After another similar dream-related episode, he sustained superfi cial injuries to his face. In addition, a mag_x0002_netic resonance imaging (MRI) scan of his brain revealed a right subdural hematoma.PSG , with split-screen EEG-video analysis, showed significant PLMS (with a movement index of 52.0 events/h), and abnormally elevated muscle tone in stage R sleep. In stage R sleep, the patient abruptly began having running-like movements, after which he awoke and reported that he had just had a dream where he was “chasing cattle.” His RBD resolved after taking clonazepam. Within 8 years, he developed PD with dementia, after which the patient subsequently died in a care facility.

21. Figure 15-7. PSG tracings from the study of an elderly male with RBD clearly shows an unusual elevation of EMG activity during a prolonged period of stage R sleep [REM without atonia (RWA)]. This period was followed by an episode of violent behavior and an arousal, after which the patient immediately reported a dream that approximated his observed actions (isomorphism). (Modifi ed from Dyken ME, Yamada T, Lin-Dyken DC. Polysomnographic assessment of spells in sleep: nocturnal seizures versus parasomnias. Seminars Neurol 2001;21:377–390; Fig. 17, with permission.)

22. PSG not indicated, done to exclude other sleep disorders as sleep-related breathing disorders “SBD” Delayed sleep onset Increases wakefulness after sleep onset “WASO” Altered sleep architecture; increased N1, reduced slow wave sleep“SWS” Insomnia

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