POLYSOMNOGRAPHY

OPENING AND CLOSING THE SLEEP STUDY FINALS

Objectives:

 Discuss the process on how to start the sleep study  Last name of the patient
 Discuss the process on how to close the sleep study  Referring Physician – ENT doctor
 Interpreting Physician – doctors of
sleep
medicine

*To start study * if nagreklamo *checked by the

usually when the na ang partner ENT
husband snores that’s the time na
and could disrupt they will go to the
the sleeping pattern ENT. You will not
of the wife directly go to the
sleep study.

 Patient’s information
 Last name
 First name
 Middle name
*They will have *Send the results *Proceed to the  Patients ID
to let the patient to the sleep sleep study with  Birthday
Sign the document- doctor sleep facility and  Gender
tation explain the
 Contact information
procedure and
after that they
will gave to put
some electrodes
(EEG, EOG, EMG)

STARTING THE SLEEP STUDY

 Wear comfortable clothing

 The patient should be prepared especially mentally
and also psychologically
 Avoid caffeinated drinks and (bawal mag full meal for  Patient’s stats
how many hours)  Height
 Documentation (personal details)  Weight
 Put the electrodes  BMI
 Neck size – using tape measure
 Age
PHILIPSRESPIRONICS–software
  Different medication
 Ongoing medication/ maintenance medication CLOSING THE SLEEP STUDY
 All medications should be list in there
 RESULT

 Referring physician  If awake na si patient all you have

 Interpreting physician to do is to click the x (red button)

 Download the video until such

 Configuration- diagnostic or split study
time na tapos na
 Diagnostic- first 6 hours is purely diagnostic
 The facilities will save all those
 Split study - after 6 hrs. you can give therapy
data gathered
to the patient ( one of the therapy being use is
CPAP)

 Remove all the electrodes

Waveforms
 After the sleep study collect the
Channels subjective data of the patient

Straight lines meaning Video- to monitor the

either hindi naka connect sa EMG position of the
patient
POLYSOM | LEC 4
CALIBRATION AND BIOCALIBRATION
OBJECTIVES:
˃ Discuss the importance of biocalibration.
˃ Can recognize the waveforms that appear
during biocalibration.
˃ Can perform the biocalibration during a sleep
study
CALIBRATION
• Calibration is done to check that all the channels are
getting adequate information and are free from
artifacts.
- meaning that you have to do that in order for you to
check if it is functioning well and you could get
accurate data from that
- check the system itself kung ga function ba
- maraming artifacts can lead to misdiagnosing a
patient
• This should be done before every study.
• The position of calibration command varies among
software provided by different manufacturers
= just click the calibration signal in the tool, then magca-
calibrate na ito siya
= din click start acquisition
1st SEMESTER| FINALS
= so after ito na ang makita mga different waveforms.
• 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 similar waveform during
calibration.
• This should be done for at least 10 seconds
• For optimal quality signals, the 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.
- Any movement ni patient ma pipick up
- Example ask the patient to blink, so dapat pag mag
blink si patients makita pud sa monitor nga ga blink
si patient.
POLYSOM | LEC 4
1. RECORD WITH EYES OPEN AND EYES CLOSED FOR AT
LEAST 30 SECONDS DURATION EACH
2. ASK THE PATIENT TO BLINK HIS/HER EYES 5 TIMES.
Figure 8.3 Calibration of blinking: Blinking appears as
positive wave in frontal derivations as positively charged
cornea moves towards frontal derivations due to bells-eye
phenomenon during blinking
3. ASK THE PATIENT TO LOOK UP AND DOWN 3 TIMES
AND THEN RIGHT AND LEFT 3 TIMES WITHOUT
MOVING HEAD.
Figure 8.4 Calibration of eye movement: Eye movements
appear as darting signals, which are of phase, i.e., move away
from each other. In this epoch signals from left EOG are shorter
in amplitude compared to signals from right EOG. This is
because of higher impedance in left EOG. Also appreciate
spillage of eye movement signals
4. ASK THE PATIENT TO CLOSE EYES FOR 10 SECONDS
AND LOOK FOR CHANGE IN EEG (APPEARANCE OF
ALPHA RHYTHM IN OCCIPITAL LEADS)
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Figure 8.5 Calibration for Alpha: Alpha waves appear in the
occipital derivations during quiet wakefulness. However,
about 10% individuals are not alpha producers. See the
low voltage mixed frequency activity during open eyes.
Rapid eye movements suggest that patient is scanning the
environment. Alpha appears as soon as he is asked to close
his eyes.
1st SEMESTER| FINALS
5. ASK THE PATIENT TO OPEN HIS/HER EYES.
6. NOW ASK THE PATIENT TO STOP BREATHING FOR
10 SECS
Figure 8.6 Calibration of respiratory signals: Flattening
of signals in the flow and respiratory effort sensors
appear during wishful breath holding. Look after "Hold
Breath."
7. ASK THE PATIENT TO RESUME BREATHING AND
PRODUCE A SNORING SOUND
Figure 8.7 Calibration for microphone: Snoring usually
appear as crescendo-decrescendo signals in microphone
channel. See signals just before "Snore" in Snoring
Channel. Wishful snoring sound also creates signals in
Chin EMG Channel.
8. ASK THE PATIENT TO MOVE HIS/HER FEET UP AND
DOWN
Figure 8.8 Calibration of leg EMG signals: Patient is
asked to flex each of his feet up and down without
moving thighs or legs. Signals appear in Leg channel.
POLYSOM | LEC 4
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
1st SEMESTER| FINALS
o 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.

o Also, check that signals are good in ECG leads,

oximeter, capnograph, and video. Once you are
satisfied, you may start the study.

SUMMARY!

Figure 8.9 Calibration of blood pressure: Some PSG machines

provide real time BP based upon the surrogate signals. In
those machines, BP calibration is done by measuring the
blood pressure at the start of study and entering the values
in software. Software then calibrates the signals itself and
shows blood pressure over the duration of study.

10. ASK THE PATIENT TO CLENCH HIS/HER TEETH FOR

5 SECONDS

Figure 8.10 Calibration of teeth clenching: Teeth clenching

appear as muscle artifacts in EEG derivations and as
sustained muscle contraction in chin EMG.

11. ASK THE PATIENT TO SPEAK SOMETHING AND

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

Figure 8.11 Calibration of voice signals in microphone: This is

done by asking the patient to speak something. Check that
you can hear his voice in your room. This ensures that the
sound system is working properly. Signals are also seen on
the microphone lead.
POLYSOM | LEC 3 1ST SEMESTER | FINALS
DOCUMENTATION

okay so sa documentation natin we have examples of subjective and objective events that need documentation during
your polysomnography.
• Subjective - it comes from your patient. like feeling ni patient. Say for example “Gwapo kayo akong tulog
gabie”
- Lahat ng hindi mo makita pero kayang I voice out ni patiet

• Objective - we can observe the patient and we can also use our five senses to do that. “Nagsabi sleep tech hala
nakaabot gyod siyag N3 or deep sleep, maganda yung quality ng sleep niya”. Objective cues these are the
things na makita natin and ma observe natin, and ma measure natin for example vital signs of the patient
- you can observe this through your monitor, through using different equipment and also you can observe
this with your five senses.

PRE-SLEEP QUESTIONNAIRE – questionnaire given to patient before starting the sleep study
POLYSOM | LEC 3 1ST SEMESTER | FINALS
POST-DIAGNOSTIC NIGHT QUESTIONNAIRE – given after the study, this questionnaire is for patients lang na ang
kanilang sleep study is purely for diagnostic only. The entire study walay CPAP, gipatulog lang jud si px.

POST CPAP NIGHT QUESTIONNAIRE - this is intended for patients na naga split study meaning after diagnostics
Nag bigay sila ng therapy and that is your CPAP therapy
 EPWORTH SLEEPINESS SCALE

Answered by the patient or (kasama sa bahay)

Note: any answer within box outline is a positive
response

SCORING
Category 1: is positive with 2 or more responses to
questions 2-6
Category 2: is positive with 2 or more positive
responses to questions 7-9
Category 3: is positive with 1 positive response and/
or a BMI > 30

EQUATION (BMI)

BMI = Weight in kilogram

Height in meters squared

NOTE: 2 or more positive categories indicates high

likelihood of sleep disordered breathing

0- Would never dose

STOP- BANG QUESTIONNARE
1- Slight chance of dozing
2- Moderate chance of dozing
3- High chance of dozing

INTERPRETATION
0-5- Lower normal day time
6-10- Normal day time
11-12- Mild excessive daytime symptoms (with this
scoring you will have to submit your patient to
a sleep facility
Category 2
Category 1
BERLINE QUESTIONNAIRE

*answering yes to three or more of these questions

indicates a high likelihood for having sleep-
disordered breathing.
* Another interpretation- count the number of
“Yeses” and follow the scoring
Scoring
0-2 – low risk for moderate to severe OSA
5-8 – high risk to moderate to severe OSA
Category 3
3-4 – further criteria are required for classification