Viewing a Polysomnogram

LEARNING OBJECTIVES
LEARNING OBJECTIVES
1. Identify the various parameters recorded in polysomnography.
2. Understand how these parameters are collected and displayed on the
record.
3. Learn the value that each parameter adds to the interpretation of the
study.
4. Understand the significance of certain recorded events.
 Viewing a Polysomnogram
Display of Data
● The term polysomnogram is derived from Greek and Latin roots.
● “Poly” indicates many and represents the many channels of data collected.
● Somno refers to sleep.
● Gram or graphy refers to the writing or display of the data.
● The channels are viewed simultaneously to show activity from several parts of the
body at one time during wake and sleep.
● Some of the channels portray fast frequency activity (electromyogram), whereas
others collect slow-frequency activity (respiratory channels). The data are displayed at
a rate, or paper speed, of 10 mm/sec.
● For polysomnography, EEG, EOG, chin EMG, and EKG activity is optimally viewed as a
30-second “page,” most often referred to as an epoch. For slower-frequency channels
like airflow, several epochs can be combined to display windows of larger time
segments.
● Common window widths range from 120 seconds (4 epochs) to 300 seconds (10
epochs).
Viewing a Polysomnogram
Viewing a Polysomnogram
 Viewing a Polysomnogram
EEG Channels
● The first type of channel on a polysomnograph is the
electroencephalogram (EEG).
● EEG leads are placed on the head to detect impulses, or brain
waves, from specific areas of the cortex.
● EEG data are used in sleep primarily for determining wakefulness
versus sleep and to distinguish the various stages of sleep.
● The amplitude, frequency, and morphology (shape) of the waves
help the reader determine the stage of sleep.
 Viewing a Polysomnogram
● EEGs are also beneficial in detecting other events such as seizure activity and
beta spindles.
● The recommended EEG montage for polysomnography is a referential
montage.
● Referential montages use one active electrode and one reference electrode for
each channel.
● For EEG channels collected in a standard diagnostic sleep study, the electrodes
on the left side of the head— namely, F3, C3, and O1—are all referenced to the
opposite mastoid, M2.
● Therefore, any signal produced at the M2 site or detected by the M2 electrode
will manifest itself in all three of these channels.
● Conversely, the electrodes on the ride side of the head —namely, F4, C4, and
O2—are all referenced to M1.
● The signals derived at F3 and F4 should be similar because they lay over the
same area of the frontal cortex on each side.
● However, they will not be identical because they have different reference
electrodes.
 Viewing a Polysomnogram
EOG Channels
● The electroocculogram (EOG) is the display of eye movements.
● Because the cornea is positively charged with respect to the retina, when a
patient looks toward the electrode, a positive charge is sent to the
polysomnograph, resulting in a downward pen deflection.
● When a patient looks away from the EOG electrode, a negative charge
results, creating an upward pen deflection.
Viewing a Polysomnogram
Viewing a Polysomnogram
Viewing a Polysomnogram
 Viewing a Polysomnogram
EMG Channels
● The electromyogram (EMG) portrays the recording of muscle activity
and tone.
● Muscle tone, particularly of the chin and jaw area, is an important
criterium used in determining sleep stages.
● Muscle tone decreases in amplitude from wake to sleep, and it
decreases further during rapid eye movement (REM) sleep.
● It is not necessary to identify specific wave forms or shapes in EMGs,
but rather amplitude changes.
● Sharp, abrupt changes in amplitude may indicate muscle movement
such as a leg jerk or twitch.
● Gradual, subtle changes in EMG amplitude may indicate a change in
muscle tone, such as when the muscles in the chin relax at sleep onset.
Viewing a Polysomnogram
Viewing a Polysomnogram
Viewing a Polysomnogram
 Viewing a Polysomnogram
ECG Channel
● The electrocardiogram (ECG), sometimes spelled electrokardiogram
(EKG) because of its German roots, is a recording of the heart’s
electrical impulse activity.
● Rate, rhythm, and intervals between the different waves are all
important factors to consider when interpreting an ECG and can
help identify abnormalities.
● The normal adult heart rate while awake is 60–100 beats per
minute. While asleep, the average heart rate decreases by 10–20
beats per minute.
 Viewing a Polysomnogram
● The normal ECG rhythm is made up of a P wave, a QRS complex, and a T wave.
● Each waveform corresponds to a portion of the heart’s electrical and mechanical
activity.
● The P wave indicates the contraction of the atria, or upper chambers of the heart.
● The QRS complex corresponds to the contraction of the ventricles, or lower
chambers of the heart.
● Lastly, the T wave indicates the repolarization of the ventricles.
● Segments and intervals of the waveform can also provide important information.
● The PR interval refers to the distance from the beginning of the P wave to the
beginning of the Q wave while the QT interval refers to distance from the
beginning of the QRS complex to the end of the T wave.
● The PR segment refers to the distance between the end of the P wave and the
beginning of the QRS while the ST segment refers to the distance from the end of
the QRS complex to the beginning of the T wave.
Viewing a Polysomnogram
 Viewing a Polysomnogram
Respiratory Channels
● Respiratory parameters recorded in polysomnography include
airflow and respiratory effort.
● Most often this is accomplished via a thermal sensor, a pressure
transducer, and respiratory effort belts. Respiratory channels are
the slowest of the AC channels on the polysomnograph. The
waveform is sinusoidal in nature, and the frequency is determined
by the speed of the breath.
Viewing a Polysomnogram
Viewing a Polysomnogram
 Viewing a Polysomnogram
Oxygen Saturation (SpO2)
● SpO2 is a measurement of the saturation of oxygen in the blood as
read by a pulse oximeter.
● In polysomnography, pulse oximetry allows a continuous measure
of oxygen saturation throughout the night without disturbing the
patient’s sleep.
● In sleepers without respiratory disturbances, the saturation remains
fairly constant throughout the night.
● Oxygen saturation decreases with respiratory disturbances such as
apneas and hypopneas.
● An oxygen desaturation in response to a respiratory disturbance
may vary anywhere from 1% to 40% or more.
 Viewing a Polysomnogram
Body Position
● The body position channel is a DC channel that displays the position in
which the patient is laying determined by readings from the body
position sensor.
● The body position sensor is placed in the middle of the chest and typically
displays the body position as supine, left, right, prone, or upright.
● The body position is particularly important in patients with
sleep-disordered breathing.
● Many patients with obstructive sleep apnea have more severe symptoms
while in the supine position. Therefore, it is important to document
information on body position during the diagnostic sleep study to identify
positional trends.
● In addition, when titrating PAP, it is important to correct the
sleep-disordered breathing while the patient is in the supine position.