These practice parameters are an update of the previously-published recommendations regarding the indications for polysomnography and related procedures in the diagnosis of sleep disorders. Diagnostic categories include the following: sleep related breathing disorders, other respiratory disorders, narcolepsy, parasomnias, sleep related seizure disorders, restless legs syndrome, periodic limb movement sleep disorder, depression with insomnia, and circadian rhythm sleep disorders. Polysomnography is routinely indicated for the diagnosis of sleep related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep related breathing disorders; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep related symptoms; to assist in the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure related; in a presumed parasomnia or sleep related seizure disorder that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement sleep disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with seizures who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression.

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Practice parameters for the indications for polysomnography and related procedures: an update for 2005.

Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. Unless otherwise stated, "insomnia" refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks.

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Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults

The role and validity of actigraphy in sleep medicine: An update

Background: Actigraphy is increasingly used in sleep research and the clinical care of patients with sleep and circadian rhythm abnormalities. The following practice parameters update the previous practice parameters published in 2003 for the use of actigraphy in the study of sleep and circadian rhythms. Methods: Based upon a systematic grading of evidence, members of the Standards of Practice Committee, including those with expertise in the use of actigraphy, developed these practice parameters as a guide to the appropriate use of actigraphy, both as a diagnostic tool in the evaluation of sleep disorders and as an outcome measure of treatment efficacy in clinical settings with appropriate patient populations. Recommendations: Actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and inpatients suspected of certain sleep disorders. More specifically, actigraphy is indicated to assist in the evaluation of patients with advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and shift work disorder. Additionally, there is some evidence to support the use of actigraphy in the evaluation of patients suspected of jet lag disorder and non-24hr sleep/wake syndrome (including that associated with blindness). When polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea. In patients with insomnia and hypersomnia, there is evidence to support the use of actigraphy in the characterization of circadian rhythms and sleep patterns/ disturbances. In assessing response to therapy, actigraphy has proven useful as an outcome measure in patients with circadian rhythm disorders and insomnia. In older adults (including older nursing home residents), in whom traditional sleep monitoring can be difficult, actigraphy is indicated for characterizing sleep and circadian patterns and to document treatment responses. Similarly, in normal infants and children, as well as special pediatric populations, actigraphy has proven useful for delineating sleep patterns and documenting treatment responses. Conclusions: Recent research utilizing actigraphy in the assessment and management of sleep disorders has allowed the development of evidence-based recommendations for the use of actigraphy in the clinical setting. Additional research is warranted to further refine and broaden its

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Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007.

Study objectives This study used empirically validated insomnia diagnostic criteria to compare depression and anxiety in people with insomnia and people not having insomnia. We also explored which specific sleep variables were significantly related to depression and anxiety. Finally, we compared depression and anxiety in (1) different insomnia types, (2) Caucasians and African Americans, and (3) genders. All analyses controlled for health variables, demographics, organic sleep disorders, and symptoms of organic sleep disorders. Design Cross-sectional and retrospective. Participants Community-based sample (N=772) of at least 50 men and 50 women in each 10-year age bracket from 20 to more than 89 years old. Measurements Self-report measures of health, sleep, depression, and anxiety. Results People with insomnia had greater depression and anxiety levels than people not having insomnia and were 9.82 and 17.35 times as likely to have clinically significant depression and anxiety, respectively. Increased insomnia frequency was related to increased depression and anxiety, and increased number of awakenings was also related to increased depression. These were the only 2 sleep variables significantly related to depression and anxiety. People with combined insomnia (ie, both onset and maintenance insomnia) had greater depression than did people with onset, maintenance, or mixed insomnia. There were no differences between other insomnia types. African Americans were 3.43 and 4.8 times more likely to have clinically significant depression and anxiety than Caucasians, respectively. Women had higher levels of depression than men. Conclusion These results reaffirm the close relationship of insomnia, depression, and anxiety, after rigorously controlling for other potential explanations for the relationship.

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Epidemiology of insomnia, depression, and anxiety

Actigraphy is a method used to study sleep-wake patterns and circadian rhythms by assessing movement, most commonly of the wrist. These evidence-based practice parameters are an update to the Practice Parameters for the Use of Actigraphy in the Clinical Assessment of Sleep Disorders, published in 1995. These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Recommendations are based on the accompanying comprehensive review of the medical literature regarding the role of actigraphy, which was developed by a task force commissioned by the American Academy of Sleep Medicine. The following recommendations serve as a guide to the appropriate use of actigraphy. Actigraphy is reliable and valid for detecting sleep in normal, healthy populations, but less reliable for detecting disturbed sleep. Although actigraphy is not indicated for the routine diagnosis, assessment, or management of any of the sleep disorders, it may serve as a useful adjunct to routine clinical evaluation of insomnia, circadian-rhythm disorders, and excessive sleepiness, and may be helpful in the assessment of specific aspects of some disorders, such as insomnia and restless legs syndrome/periodic limb movement disorder. The assessment of daytime sleepiness, the demonstration of multiday human-rest activity patterns, and the estimation of sleep-wake patterns are potential uses of actigraphy in clinical situations where other techniques cannot provide similar information (e.g., psychiatric ward patients). Superiority of actigraphy placement on different parts of the body is not currently established. Actigraphy may be useful in characterizing and monitoring circadian rhythm patterns or disturbances in certain special populations (e.g., children, demented individuals), and appears useful as an outcome measure in certain applications and populations. Although actigraphy may be a useful adjunct to portable sleep apnea testing, the use of actigraphy alone in the detection of sleep apnea is not currently established. Specific technical recommendations are discussed, such as using concomitant completion of a sleep log for artifact rejection and timing of lights out and on; conducting actigraphy studies for a minimum of three consecutive 24-hour periods; requiring raw data inspection; permitting some preprocessing of movement counts; stating that epoch lengths up to 1 minute are usually sufficient, except for circadian rhythm assessment; requiring interpretation to be performed manually by visual inspection; and allowing automatic scoring in addition to manual scoring methods.

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Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002.

Insomnia is a common and clinically important problem. It may arise directly from a sleep-wake regulatory dysfunction and/or indirectly result from comorbid psychiatric, behavioral, medical, or neurological conditions. As an important public-health problem, insomnia requires accurate diagnosis and effective treatment. Insomnia is primarily diagnosed clinically with a detailed medical, psychiatric, and sleep history. Polysomnography is indicated when a sleep-related breathing disorder or periodic limb movement disorder is suspected, initial diagnosis is uncertain, treatment fails, or precipitous arousals occur with violent or injurious behavior. However, polysomnography is not indicated for the routine evaluation of transient insomnia, chronic insomnia, or insomnia associated with psychiatric disorders.

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Practice Parameters for Using Polysomnography to Evaluate Insomnia: An Update

Fundamentals of Sleep Medicine

THE AMERICAN SLEEP MEDICINE FOUNDATION (ASMF) WAS CREATED BY THE AMERICAN ACADEMY OF SLEEP MEDICINE (AASM) IN 1998, GROWING OUT of the AASM's commitment to advancing the fields of sleep research and sleep medicine. The seeds for the foundation were planted, however, when the AASM was formed more than 30 years ago. When the AASM was established in 1975, its founders agreed that the organization should combine a sleep-center focus with an emphasis on clinical practice and research.1 This fundamental commitment to sleep science led the AASM to partner with the Sleep Research Society in forming the Associated Professional Sleep Societies LLC (APSS), which publishes the journal SLEEP and organizes the SLEEP Annual Meeting of the APSS.

Now in its 31st volume, SLEEP is recognized as the leading scientific journal in the field with an impact factor of 5.126 that places it in the top six percent of more than 6,100 journals ranked in the Journal Citation Reports Science Edition 2006.2 The SLEEP Annual Meeting is the premier gathering of sleep scientists in the world, with more than 1,100 scientific abstracts presented this past June at SLEEP 2007 in Minneapolis, Minn. At each annual meeting the AASM also presents the William C. Dement Academic Achievement Award, which recognizes members of the sleep field who have displayed exceptional initiative and progress in the area of academic sleep research, and the Young Investigator Award, which honors the outstanding contributions of young sleep scientists.

Recognizing the insufficient level of funding that was available to sleep scientists, the AASM board of directors, led by Dr. Wolfgang Schmidt-Nowara formed the ASMF to provide tangible support for the advancement of sleep research. Originally called the Sleep Medicine Education and Research Foundation (then known as SMERF), the goal of the ASMF was to support education as well as clinical and basic research. The ASMF awarded its first grants in 2000, and among the research supported by these inaugural grants were studies at the University of Pennsylvania and Stanford University that provided preliminary data for major studies subsequently funded by the National Institutes of Health.

Since its inception the ASMF has awarded nearly $3 million to fund 37 projects ranging from computational modeling of the human pharyngeal airway to genomics of the zebrafish hypocretin/narcolepsy pathway. The results of these studies have been published in prestigious journals such as SLEEP,3 Journal of the American Medical Association,4 and the American Journal of Respiratory and Critical Care Medicine.5 Young investigators were able to work with mentors at the most respected educational institutions, including Harvard University (5 grants), the University of Pennsylvania (5 grants) and Stanford University (3 grants). In 2007 the ASMF awarded funding of “Portable Monitoring in the Diagnosis and Management of Obstructive Sleep Apnea” to a consortium of researchers led by Case Western Reserve University. This large-scale, multi-center, randomized, head-to-head study comparing unattended portable monitoring and auto-titrating positive airway pressure with attended polysomnography will produce much-needed scientific evidence that will be of critical importance to the field.

The AASM provides the funding for all of the foundation's administrative costs and has funded most of the ASMF grants. A few projects have been funded by unrestricted industry grants, including an ongoing study of sleep in heart-failure patients. Individual donations and a portion of the proceeds from the annual Discovering the Secrets of Sleep fundraising dinner also have supported the ASMF. The AASM contributed $500,000 to the ASMF in 2007 for the establishment of an endowment to support future research efforts. This is in addition to $360,000 in grant support the AASM already committed to the foundation for 2007. The ASMF also received a recent donation of $2 million from the American Board of Sleep Medicine for the creation of an endowment, separate from the AASM endowment, for future initiatives.


In August 2007 the ASMF Board of Directors met to assess the foundation's resources, adopt changes to its bylaws, and refocus its goals. The Board created an Executive Board charged with development of application materials, grant review and management, budget development and fundraising. The members appointed to the Executive Board are: 


Richard Berry, MD, President of the ASMF


David Bruce, DDS, MD, Treasurer of the ASMF


Andrew Chesson Jr., MD, Chair, Academic Affairs Committee


Nancy Collop, MD, AASM Director at Large


Flavia Consens, MD, Chair, Fellowship Training Committee


Jason Mateika, PhD, Chair, Research Committee


Michael Sateia, MD, AASM Member at Large




The Executive Board will support the day-to-day operation of the ASMF and become a resource for strategies and ideas to advance the fields of sleep medicine and sleep research, while the Board of Directors will continue to provide oversight and direction for the ASMF.

At the August meeting the Board of Directors also adopted these new mission and vision statements that will provide direction for future initiatives of the ASMF:

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Richard B. Berry

Papers

Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002.

Practice Parameters for Using Polysomnography to Evaluate Insomnia: An Update

Fundamentals of Sleep Medicine

The American Sleep Medicine Foundation: New Resources, New Structure, New Goals.

Fundamentals 9 – Polysomnography I