EEG for sleep lab

1,988 views

Published on

Electroencephalography (EEG) basics for sleep physician. Part of a talk during Ain Shams Congress of Psychiatry, 2012. Cairo, Egypt

Published in: Health & Medicine, Business

EEG for sleep lab

  1. 1. Electroencephalography basicsfor sleep studyEgypt’s early career psychiatrists (EECP) workshopAhmed Eid el-AghouryBoard-certified, MScMed, MBChBTechnical training at Neurovirtual corporation, Florida, USAal-Abbassia Hospital for mental Health, Cairo
  2. 2. Stage?Cairo, Mar 2012 ajhuri@gmail.com 2
  3. 3. Objectives Sleep stages Key descriptive terms of EEG Common normal EEG pattern during sleep and wake Cairo, Mar 2012 ajhuri@gmail.com 3
  4. 4. Analysis of polysomnogram (PSG) The clinical interpretation of PSG is based primarily on the analysis of 3 main variables: 1) EEG-related variables (i.e., sleep stage, arousals) 2) Respiration-related variables (i.e., apneas or hypopneas) 3) Movement-related variables (i.e., periodic leg movements). Cairo, Mar 2012 ajhuri@gmail.com 4
  5. 5. Frequency bands Cairo, Mar 2012 ajhuri@gmail.com 5
  6. 6. Rules of polarityChannel 1 – 2 ?Channel 2 – 1? Cairo, Mar 2012 ajhuri@gmail.com 6
  7. 7. Frequent descriptive terms  Morphology: waveform & polarity  Amplitude: voltage  Symmetry: equal amplitudes  Frequency: CPS / Hz  Synchrony: simultaneous  Rhythmicity: similar waveforms  Distribution / topography: lobes, focal, etc  Manner: continuous, intermittent, etc  Duration: in ms  Maturation: age  Reactivity: eye closing, calculation, etc  Burst: paroxysm, run or train of activity Cairo, Mar 2012 ajhuri@gmail.com 7
  8. 8. AASM Scoring Manual, 2007Iber C, Ancoli-Israel S, Chesson A, Quan SF for the American Academy of Sleep Medicine:The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology andTechnical Specifications, 1st ed. Westchester, IL: American Academy of Sleep Medicine,2007. Cairo, Mar 2012 ajhuri@gmail.com 8
  9. 9. Sleep Stage NomenclatureBerry R: Fundamentals of sleep medicine. 2012, Elsevier Saunders, PA Cairo, Mar 2012 ajhuri@gmail.com 9
  10. 10. Summary of Important Wave Form CharacteristicsBerry R: Fundamentals of sleep medicine. 2012, Elsevier Saunders, PA Cairo, Mar 2012 ajhuri@gmail.com 10
  11. 11. The recommended EEG derivations:F4-M1, C4-M1, and O2-M1. (AASM, 2007) Cairo, Mar 2012 ajhuri@gmail.com 11
  12. 12. Background Activity Syn: occipital alpha rhythm / dominant posterior rhythm / DPR / ODR The starting point for visual analysis Around 10 Hz: ( 8 – 13 Hz) Frequency milestones (maturation): eg by age 2 ys (7 - 8 Hz ) Tested by passive eye closure Slow & Fast variants Cairo, Mar 2012 ajhuri@gmail.com 12
  13. 13. Stage W Cairo, Mar 2012 ajhuri@gmail.com 13
  14. 14. Drowsiness Syn: hypnagogic state A “presleep state”, or a “prodromal or twilight condition” between being fully awake and asleep : Background activity can be 1 to 2 Hz less than that for wakefulness Cairo, Mar 2012 ajhuri@gmail.com 14
  15. 15. Drowsiness Cairo, Mar 2012 ajhuri@gmail.com 15
  16. 16. Hypnagogic hypersynchrony Cairo, Mar 2012 ajhuri@gmail.com 16
  17. 17. Two years boy: eyes close &open Cairo, Mar 2012 ajhuri@gmail.com 17
  18. 18. Stage N2 Cairo, Mar 2012 ajhuri@gmail.com 18
  19. 19. V waves: stage? Cairo, Mar 2012 ajhuri@gmail.com 19
  20. 20. Stage N3 Cairo, Mar 2012 ajhuri@gmail.com 20
  21. 21. Stage R Cairo, Mar 2012 ajhuri@gmail.com 21
  22. 22. Stage R Cairo, Mar 2012 ajhuri@gmail.com 22
  23. 23. Cairo, Mar 2012 ajhuri@gmail.com 23
  24. 24. 14 & 6 positive burst: comb-like Cairo, Mar 2012 ajhuri@gmail.com 24
  25. 25. Cairo, Mar 2012 ajhuri@gmail.com 25
  26. 26. Cairo, Mar 2012 ajhuri@gmail.com 26
  27. 27. An elder man: stage? Cairo, Mar 2012 ajhuri@gmail.com 27
  28. 28. Cairo, Mar 2012 ajhuri@gmail.com 28
  29. 29. ECG artifact: stage? Cairo, Mar 2012 ajhuri@gmail.com 29
  30. 30. Cairo, Mar 2012 ajhuri@gmail.com 30
  31. 31. Stage N2 / N3 ? Cairo, Mar 2012 ajhuri@gmail.com 31
  32. 32. Is this epileptiform? Cairo, Mar 2012 ajhuri@gmail.com 32
  33. 33. Is this epileptiform? Cairo, Mar 2012 ajhuri@gmail.com 33
  34. 34. Cairo, Mar 2012 ajhuri@gmail.com 34
  35. 35. DPR: wax & wane. Stage? Cairo, Mar 2012 ajhuri@gmail.com 35
  36. 36. Asleep: stage? Age? Cairo, Mar 2012 ajhuri@gmail.com 36
  37. 37. First slide again: Stage? Cairo, Mar 2012 ajhuri@gmail.com 37
  38. 38. Thanks to neurovirtual formaterial & training Cairo, Mar 2012 ajhuri@gmail.com 38

×