Polysomnography

About: Polysomnography is a research topic. Over the lifetime, 19527 publications have been published within this topic receiving 858718 citations. The topic is also known as: PSG & polysomnogram.

Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men.

Abstract: One thousand and one men, aged 35-65 years, were identified from the age-sex register of one group general practice. Over four years 900 men were visited at home and asked questions about symptoms potentially related to sleep apnoea and snoring. Height, weight, neck circumference, resting arterial oxygen saturation (SaO2), and spirometric values were also determined. All night oximetry was then performed at home and the tracing analysed for the number of dips in SaO2 of more than 4%. Subjects with more than five dips of 4% SaO2 or more per hour were invited for sleep laboratory polysomnography. Seventeen per cent of the men admitted to snoring "often." Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.2%), cigarette consumption (r2 = 3.4%), and nasal stuffiness (r2 = 2%) as the only significant independent predictors of snoring. Together these account for at least a sixfold variation in the likelihood of being an "often" snorer. Forty six subjects (5%) had greater than 4% SaO2 dip rates of over five an hour and 31 of these had full sleep studies. Three subjects had clinically obvious and severe symptomatic obstructive sleep apnoea, giving a prevalence of three per 1001 men (0.3%; 95% confidence interval 0.07-0.9%). Eighteen men had obstructive sleep apnoea only when supine and in 10 the cause of the SaO2 dipping on the original home tracing was not elucidated. The greater than 4% SaO2 dip rates correlated with the history of snoring. Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.9%), alcohol consumption (r2 = 3.7%), age (r2 = 1%) and obesity (r2 = 1%) as the only significant independent predictors of the rate of overnight hypoxic dipping. This study shows that snoring in this randomly selected population correlates best with neck size, smoking, and nasal stuffiness. Obstructive sleep apnoea, defined by nocturnal hypoxaemia, correlates best with neck size and alcohol, and less so with age and general obesity.

Clinical practice guideline: Diagnosis and management of childhood obstructive sleep apnea syndrome

Abstract: To the Editor. — I have major reservations in respect to the recent clinical practice guideline on obstructive sleep apnea syndrome (OSAS).1 Although it is important to alert pediatricians to the existence of this condition, the ramifications of following the guideline do not appear to have been given adequate consideration. The authors signed letters stating they did not have a conflict of interest. I assume this means they do not run polysomnography (PSG) labs, as an obvious consequence of the report will be a markedly increased demand for their use. One problem concerns children with primary snoring (PS). This can be seen, according to the report, in up to 12% of preschool-aged children. Furthermore, there is apparently no way to rule out OSAS in these children, without doing PSG. The unmistakable conclusion, therefore, is that up to 12% of preschool-aged children should be undergoing PSG. Do other pediatricians find this concept as ludicrous as I do? A second issue concerns those children with mild OSAS, mild meaning that they are not demonstrating obvious problems such as daytime somnolence or pulmonary hypertension. These children are diagnosed when their sleep studies are found to be abnormal (ie, at the tail end of the distribution curve). The guideline indicates, in one sentence in the section on research recommendations, that the natural history of these children is not known. That did not stop the committee from recommending that these children undergo adenotonsillectomy, however, even though it is not known whether mild OSAS is an actual disease or merely a statistical finding. In summary, I believe the guideline to be poorly thought out, and it …

Psychophysiological insomnia: the behavioural model and a neurocognitive perspective.

Abstract: A number of paradoxes are apparent in the assessment and treatment of psychophysiological insomnia and sleep state misperception. Three of these paradoxes exist as discrepancies between polysomnographic (PSG) measures and the subjective impressions regarding sleep quality and quantity. The remaining incongruity exists largely within the objective domain. In the case of subjective-objective discrepancies, patients with insomnia: (1) frequently identify themselves as having been awake when awakened from PSG defined sleep; (2) tend to overestimate sleep latency and underestimate total sleep time as compared with PSG measures; (3) appear to derive more benefit from pharmacotherapy that can be explained by objective gains. The remaining paradox pertains to the observation that hypnotic medications, by and large, do not normalize sleep architecture or produce a more 'sleep-like' EEG. In this paper, we review possible explanations for these various paradoxes, introduce a new perspective and suggest possible research avenues. The model introduced is based on the observation that beta and/or gamma activity (which have been found to be associated with cognitive processes) is enhanced in insomnia at or around sleep onset. We propose that this kind of high frequency EEG activity may interfere with the normal establishment of sleep onset-related mesograde amnesia. As a result, the patient with insomnia maintains a level of information and/or memory processing that blurs the phenomenological distinction between sleep and wakefulness and influences retrospective judgments about sleep initiation and duration.

Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.

Abstract: Studies have consistently shown that sleep apnea patients have high accident rates, but the generalizability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-disordered breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-disordered breathing. Sleep-disordered breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a statewide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-disordered breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (vs. no sleep-disordered breathing) were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognized sleep-disordered breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-disordered breathing may account for a significant proportion of motor vehicle accidents.

Excessive Daytime Sleepiness in a General Population Sample: The Role of Sleep Apnea, Age, Obesity, Diabetes, and Depression

Abstract: Design and Setting: We examined this question in the Penn State cohort (a random sample of 16,583 men and women from central Pennsylvania, ranging in age from 20 to 100 yr) A random subset of thiscohort(n1,741)wasfurtherevaluatedforonenightinthesleep laboratory Main Outcome Measure: The main measure was a complaint of EDS Results: The final logistic regression model indicated depression was the most significant risk factor for EDS followed by body mass index, age, typical sleep duration, diabetes, smoking, and finally sleep apnea The strength of the association with EDS decreased with increasing age, whereas the association of depression with EDS was stronger in the young EDS is more prevalent in the young (30 yr), suggesting the presence of unmet sleep needs and depression, and in theveryold(75yr),suggestingincreasingmedicalillnessandhealth problems EDS was associated with a reduced report of typical sleep duration without any association with objective polysomnographic measures Conclusions: It appears that the presence of EDS is more strongly associated with depression and metabolic factors than with sleepdisordered breathing or sleep disruption per se Our findings suggest that patients with a complaint of EDS should be thoroughly assessed for depression and obesity/diabetes independent of whether sleepdisordered breathing is present (J Clin Endocrinol Metab 90: 4510–4515, 2005)