POLYSOM FINALS REVIEWER

PLACEMENT OF LEADS FOR THE SLEEP

STUDY

● It is important to place all the recording

channels in the proper position to obtain
optimal data.
● If the sources of the signals are not placed
at defined places, the recording will be of
suboptimal quality and the data captured
would not be accurate and would
● To overcome the problem , EEG
compromise the comparability of data
electrodes should be placed
obtained from two different persons.
according to the International 10
● To counteract these issues, the AAMS has
–20 system.
recommended appropriate places and
● The figures 10 and 20 denote the
methods of hooking up the patients.
distance between the electrodes
that are measured in percentages
ELECTROENCEPHALOGRAM (EEG)
(10% or 20%) of the length and
● For recording an EEG, electrodes are
breadth of the fixed anatomical
placed bilaterally in the frontal, central
points of the scalp.
and occipital positions. These are
referenced to the opposite mastoid (not
EEG: PLACING THE EEG ELECTRODES
the ear).
ACCORDING TO 10 -20 SYSTEM
○ Frontal electrodes best pick the
● The materials required are:
delta activity (exhibit N3 sleep)
○ Washable non -irritant marker;
○ Central electrodes best pick the
○ Non -elastic measuring tape;
Vertex waves, K complexes,
○ Abrasive material to clean the
spindles and sawtooth waves
area;
(determine N1, N2 and REM
○ Electrodes; and
stage)
○ Conductive gel
○ Occipital electrodes best pick
the alpha activity that can be
used to differentiate wakefulness
and sleep.
Even numbers = Right side
Odd numbers = Left side
POLYSOM FINALS REVIEWER

6.4 markings in the anteroposterior plane

according to the 10-20 system: If you are doing
sleep extended EEG montage (for seizure or
parasomnia) is not required, only Fz, Cz, and Oz
markings are important.

*TO FIND THE PERCENT = PERCENT/100 X

GIVEN
POLYSOM FINALS REVIEWER

ELECTROOCULOGRAM (EOG)
● Two EOG electrodes are placed, one cm
below the outer canthus of the left
eye (EO1 - M2) and another (EO2 -M1) 1
cm above the outer canthus of the
*IHALF SIYA SO: CM/2 right eye
EXAMPLE: ● These electrodes are referenced to the
opposite side of the mastoid.
● Before placing the electrodes, clean the
area adequately with an abrasive gel to
improve conductance.

*KUNG MAY GIVEN NA CM, IADD LANG

*SO EXAMPLE: FZ-F4 = 5CM, ILAN SIYA PAG
F7-F4? 5CM + 5CM + 5CM = 15 CM -> YAN NA
ANSWER SA F7-F4
POLYSOM FINALS REVIEWER

UPWARD DEFLECTION = NEGATIVE

DOWNWARD = POSITIVE

MOVE TO THE RIGHT

● EO2 = POSITIVE

● EO1 = NEGATIVE

MOVE TO THE LEFT

● EO2

● EO1

ELECTROCARDIOGRAM (ECG)

● For the ECG, usually two leads are

used—I and II.
● Opposed to the traditional ECG
recording, where these electrodes are
placed on the limbs, for sleep study,
electrodes are usually placed on the chest.
● Place one electrode at the junction of the
chest with the right shoulder, another at a
similar location on the left side, and the
ELECTROMYOGRAM (EMG)
third below the apex of the heart. This
● Electromyogram is placed at two sites in
point should align the right shoulder and
the body.
left hip
● First is to measure the tone of the
mentalis-submentalis muscle, which
helps in scoring of the sleep stage and
another one to measure the periodic
limb movements during sleep (PLMS).

PLACEMENT OF MEASURES OF
RESPIRATIONS
● Nasal airflow
● Respiratory effort
● Oximeter
● Snore microphone
POLYSOM FINALS REVIEWER

NASAL AIRFLOW ● These belts should not be too loose or

● Nasal airflow is measured using a
thermistor and a pressure transducer.
● Pressure transducer is usually attached to
a cannula that is kept close to the nostrils
● Thermistor
○ recommended for patients to
detect APNEA
○ Used to evaluate if airflow is
present or not (evaluated when
there are changes in the
temperature)
○ Not sensitive for partial flow
obstruction
● Pressure transducer
○ Used to evaluate if ever the
patient has HYPOPNEA
○ Can be used to measure end tidal
CO2
○ Also measures airflow resistance
too tight. In the former case, they will
fail to record the movement, while in
the latter case, they will produce
discomfort.
● A rule of thumb is to lengthen the belt
to the two-third of the circumference
of the chest and abdomen, and then
using its elastic property, tie it around the
chest and abdomen.
● The belly should not be twisted as it will
not only produce discomfort, but in case
of an RIP belt, also interfere with proper
signal generation.
● Placement of RIP belts:
○ RIP belt for the chest should be
at the level of nipples (nipples
- men) (under the breast -
women)
○ RIP belt for the abdomen should
be placed at the level of the
navel.
○ RIP = RESPIRATORY
INDUCTANCE
PLETHYSMOGRAPHY
○ For obese patients - place the
RIP belt below the rib cage

OXIMETER
● Two kinds of oximeter probes are usually
sup- plied along with the machine—ones
that have free ends that get fixed with the
help of an adhesive tape.
● This tape gets adhered to the finger, thus,
it prevents it from falling off.
● However, many companies supply a two-
pronged sensor that may fall off during a
study.
● To prevent misplacement, such probes
are usually fixed on the finger with the
help of an adhesive tape.
● Principle = spectrophotometry

SNORE MICROPHONE
● It should be placed on either side of the
midline close to Adam's apple.
● This should be firmly fixed at that place
with surgical tape so that it does not fall
RESPIRATORY EFFORT
off during sleep.
● Respiratory effort is measured by
either an elastic belt or an RIP belt
which is placed over the chest and
abdomen.
POLYSOM FINALS REVIEWER

BODY POSITION SENSOR

● Body position sensor is usually placed
over the chest and it gets fixed to the
respiratory chest belt.
● Most of the sensors have a diagram over
them that guides you regarding their
placement.
● Please ensure that you place it correctly to
obtain correct data.
● A loose sensor may give you spurious
data that may influence the interpretation
and management plan.

=============================
STARTING AND CLOSING THE
SLEEP STUDY

PREPARATIONS:
1. Wear comfortable clothing for sleep
2. Patient must be prepared mentally and
psychologically
3. Non caffeinated drinks
4. No full meals hours prior to testing
5. Documentation
POLYSOM FINALS REVIEWER

===================================
DOCUMENTATION
POLYSOM FINALS REVIEWER

● For electrical calibration, we usually

pass a current of around 50 μV in the
EEG channels and look for the waveform.
● All the channels must have a similar
waveform during calibration.
● This should be done for at least 10
seconds
● For optimal quality signals, the
impedance of the electrode should be
below 5 Kohms.

BIOCALIBRATION
● After calibration, it is time to check that
all channels are working properly,
that is, bio- calibration.
● This should be done by providing the
commands to the patient and checking
that the respective channels are working
properly.
● To do this, please give the following
commands and look for the changes in
the display on the monitor.

PROCEDURE:
===================================
CALIBRATION AND BIOCALIBRATION 1. RECORD WITH EYES OPEN AND
EYES CLOSED FOR AT LEAST 30
CALIBRATION SECONDS DURATION EACH.
● Calibration is done to check that all the 2. ASK THE PATIENT TO BLINK
channels are getting adequate HIS/HER EYES 5 TIMES.
information and are free from *Check for the left and right eye channel - EOG
artifacts.
● This should be done before every study.
● The position of calibration command
varies among software provided by
different manufacturers.
POLYSOM FINALS REVIEWER

3. ASK THE PATIENT TO LOOK UP AND

DOWN 3 TIMES AND THEN RIGHT
AND LEFT 3 TIMES WITH- OUT
MOVING HEAD
*Still check for the left and right eye channel -
EOG

4. ASK THE PATIENT TO CLOSE EYES

FOR 10 SECONDS AND LOOK FOR
CHANGE IN EEG (APPEARANCE OF
ALPHA RHYTHM IN OCCIPITAL
LEADS)
9. Some machines provide blood pressure in
real-time. In those machines, blood
pressure has to be calibrated after manual
measurement of blood pressure during
the start of the recording.
10. ASK THE PATIENT TO CLENCH
HIS/HER TEETH FOR 5 SECONDS
a. EMG electrodes

5. ASK THE PATIENT TO OPEN

HIS/HER EYES.
6. NOW ASK THE PATIENT TO STOP
BREATHING FOR 10 SECONDS. *Refer
to respiratory belts and abdominal*

11. ASK THE PATIENT TO SPEAK

SOMETHING AND MAKE SURE
THAT YOU CAN HEAR HIS/HER
VOICE THROUGH A SPEAKER

7. ASK THE PATIENT TO RESUME

BREATHING AND PRODUCE A
SNORING SOUND

8. ASK THE PATIENT TO MOVE

HIS/HER FEET UP AND DOWN
POLYSOM FINALS REVIEWER

➔ Body position signals are calibrated by

asking the patient to turn left and then
turn right in bed. He/She should remain
in each position for at least 5 seconds.
➔ Also, check that signals are good in ECG
leads, oximeter, capnograph, and video.
Once you are satisfied, you may start the
study.