International Institute Of Sleep Sciences

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International Institute Of Sleep Sciences

 STUDY INDICATION
 STUDY VALIDITY
 SLEEP ARCHITECTURE
 CARDIO-RESPIRATORY EVENTS
 ASSESSMENT
 PLAN

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International Institute Of Sleep Sciences

 Excessive daytime
sleepiness
 Daytime fatigue.
 Witnessed apneic spells
 Chocking
 Loud snoring
 Parasomnia.
 Difficulty in controlling BP
 Known case of
CAD,CHF,Arrythmia

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International Institute Of Sleep Sciences

 SLEEP EFFICIENCY
 SUBJECTIVE FEELING
 MICROAROUSAL INDEX
 FIRST NIGHT EFFECT
 REM ARCHITECTURE
 DELTA SLEEP
 POSITIONS DURING SLEEP
 PLM PRESENCE

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International Institute Of Sleep Sciences

 <80…….POOR
 80-85……AVG
 85-90……GOOD
 >90 …….EXCELLENT

TRY TO FIND REASON IF <80.

IF BETTER THAN HOME-EXPLORE!

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International Institute Of Sleep Sciences

Was there previous

night sleep deprivation?
External factors such as
sound/light
Bed?
Snoring from
partner?Children?pets?
Psycho physiological
Insomnia
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International Institute Of Sleep Sciences

 From Post study questionnaire

 Compared to Home sleep, how will you
rate sleep in lab?
> 70 % comparable : normal
50- 70% : Gray zone (see objective)
<50% : First night effect
Better than Home: Psycho-physiogical
Insomnia

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International Institute Of Sleep Sciences

 Total sleep time estimation:

Mostly +/- 1 hr of objective TST
If Estimation is >1 hr less than TST:
1. Sleep state misperception
2. Prolonged stage 1 sleep
Significance : Treatment will be different!!

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International Institute Of Sleep Sciences

Arousals vs. Awakenings.

Spontaneous vs. Secondary e.g:
Respiratory
PLMD
GERA

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International Institute Of Sleep Sciences

 < 5 …..Children,hypnotics on board

 5-10 ……Normal or Relative normal
 10-15….. First night effect,Insomnia,anxiety
 >15 ……..First night effect, Anxiety disorder
 >20 Definite Anxiety Disorder,will have
Somatic problems i.e Tension
Headaches,Irritable Bowel etc.

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International Institute Of Sleep Sciences

 Ideally 3 nights
 Incidence <10%
 Identify during history
 Offer adaptation night
 Post study questionnaire

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International Institute Of Sleep Sciences

Latency
Does the Onset time match
history?
% of Stage 1
Higher stage 1 seen in poor
sleepers and Sleep state
misperception.

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International Institute Of Sleep Sciences

 REM latency: 80-120 minutes Normal or

Relatively normal
 Prolonged Latency:

1.Earlier than usual bedtime

2.Alcohol Intake
3.Anti-Depressant medicines
4.First night effect

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International Institute Of Sleep Sciences

 Shortened Latency:
1.Relatively shortened due to delayed
bedtime than usual
2.Shift work
3. Endogenous Depression (40 -60 minutes)
4.Alcohol withdrawal
5.Abrupt stopping of SSRI
6.Narcolepsy (less than 40 minutes)

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International Institute Of Sleep Sciences

 Normal or relative normal ~ 20 -24% .

 Increased duration

1. recovery REM sleep

2.CPAP titration night
3.Depression

Decreased duration
1.First night effect
2. OSA
3.SSRI and other drugs.
4. Developmental anomaly
5. Delayed phase with early AM awakening in lab.

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International Institute Of Sleep Sciences

Fragmented REM
1.Alcohol
2.OSA
3.Anxiety disorder
4.First night effect
Normal Transition:
Alcohol:
Depression:

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International Institute Of Sleep Sciences

 Normal duration varies with age.

Children > 40 % .

Adults (25-40) ~ 25 to 30%.

Adults (40 -60)~ 15-20%

Adults (60-70)~ 10-15%

Adults (70 +) ~ less than 10%.
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International Institute Of Sleep Sciences

 First night effect

 Fragmented sleep due to any intrinsic
sleep disorder
 Stress with accelerated aging
 Hypnotic medicines such as
Benzo,zolpidem

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International Institute Of Sleep Sciences

 Recovery sleep after sleep deprivation

 Exercise ( Heavy lifting)
 Bhang/Ganja/Marijuana
 Sodium Oxybate, Gabotrigine

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International Institute Of Sleep Sciences

 Known as Alpha –Delta pattern

 Associated with pain syndromes

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International Institute Of Sleep Sciences

 Ideally all positions should be encouraged.

 Significance is in deciding treatment modality.
 Check for ‘fail’on abdominal and chest wall
motion during lateral positions.
 Mention if no time spent on back!

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International Institute Of Sleep Sciences

 Normal PLM index:

< 60 years : <5/hr
>60 years: <15/hr.
 Normal PLM arousal index:
< 5 /hr in all age groups.

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International Institute Of Sleep Sciences

 Sinus rhythm vs. irregular

rhythm

 Look for PR interval

lengthening

 Sympathetic variability:
1. See minimal HR vs. maximum
HR

2.PTT (pulse transit time

assessment)
lowering PTT suggest adrenalin
rush

3.See graphic HR on Histogram

page.

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International Institute Of Sleep Sciences

 Higher Variabilty: suggest sympethatic

actvation
 It is normal to have some variability!!!
 Negligible Variability:
1. Beta Blockers
2. Pacemaker
3. Transplant Heart

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International Institute Of Sleep Sciences

 AHI: A+H/ TST

Total AHI
Positional AHI: ratio has to be 2:1 to be significant
REM AHI: prominent in females
 RDI: A+H+ RERA/ TST
Comment if AHI <5 but more RERA’s seen

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International Institute Of Sleep Sciences

Nadir O2 saturation
Generally it should match
AHI.
AHI < 5 Expected O2 sat >
90%
AHI 5 -15 Expected O2 sat >
88%
AHI 16- 25 Expected O2 sat
> 80%
AHI > 25 Any nadir 2 sat

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International Institute Of Sleep Sciences

If Nadir O2 is lower than expected :

1.Check for Artifact
2. REM AHI
3.COPD

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International Institute Of Sleep Sciences

 % time spent below 90% should be

mentioned
 Significant if >1%
 In Children any time < 92% is significant!

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International Institute Of Sleep Sciences

 10% time above 45 mm is significant

 Single value > 52 mm is significant

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International Institute Of Sleep Sciences

 COMMENT ON SLEEP
ARCHITECTURE

 OSA PRESENCE

 PLMD

 CAN YOU EXPLAIN INDICATIONS

ON BASIS OF PSG?
E.G: CAN YOU EXPLAIN DAYTIME
FATIGUE/SLEEPINESS

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 NORMAL VS ABNORMAL AND

WHY?

 PRESENCE OR ABSENCE OF
AFFECTIVE PROBLEMS SUCH
AS ANXIETY/DEPRESSION

 INSOMNIA VARIETY IF PRESENT

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