DM Seminar on Polysomnography. Sleep in itself is a myriad of wonders. In this presentation, we take a look at the neurobiology of sleep and how it is regulated in the human body. We also take a sneak peak into polysomnography as a window for monitoring sleep.
Polysomnography (PSG) is the gold standard test for diagnosing sleep disorders like obstructive sleep apnea. It involves simultaneous monitoring of multiple physiologic parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. PSG is used to diagnose sleep disorders, determine appropriate treatments like CPAP, and assess treatment effectiveness. It provides valuable information about sleep architecture and respiratory events that can help characterize a patient's condition.
basic of polysomnography presentation.pptxshaitansingh8
Polysomnography is a multi-parameter test used to diagnose sleep disorders. It involves the simultaneous recording of biophysiological changes that occur during sleep including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. Key components measured include EEG, EOG, EMG, respiratory effort, airflow, oximetry. Together these provide information about sleep stages and identify disorders like sleep apnea, narcolepsy, restless leg syndrome. Polysomnography is performed in a sleep lab with technicians monitoring the patient overnight.
This document provides information about polysomnography and unconventional EEGs. It discusses polysomnography components and set up, indications, patient instructions, sleep stage scoring, and interpretations. It also describes different types of polysomnography studies. Unconventional EEGs discussed include hyperventilation and intermittent photic stimulation, describing the procedures, typical responses, and contraindications.
The document provides an overview of polysomnography (PSG), which is a test used to diagnose sleep disorders. PSG involves the simultaneous recording of multiple physiological parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. It describes the components of a PSG, such as EEG, EOG, EMG, respiratory monitoring, oximetry, and other optional parameters. It also covers patient preparation, how the test is interpreted to evaluate sleep stages and respiratory events, and how indices like AHI are used to diagnose sleep apnea.
The document provides an overview of polysomnography (PSG), which is a test used to diagnose sleep disorders. PSG involves the simultaneous recording of multiple physiological parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. It describes the components of a PSG, such as EEG, EOG, EMG, respiratory monitoring, oximetry, and other optional parameters. It also covers patient preparation, test procedures, interpretation of the results, and indices used to diagnose sleep disorders like sleep apnea.
Sleep in itself is a myriad of wonders. In this presentation, we take a look at the neurobiology of sleep and how it is regulated in the human body. We also take a sneak peak into polysomnography as a window for monitoring sleep.
What are the different types of sleep apnea tests.pptxleelindesy
Among the several sleep problems that affect people, sleep apnea is a prevalent one. In this condition, patients fail to rest well at night because of obstruction in the airway. As a result, they always feel exhausted and tired.
Polysomnography (PSG) is the gold standard test for diagnosing sleep disorders like obstructive sleep apnea. It involves simultaneous monitoring of multiple physiologic parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. PSG is used to diagnose sleep disorders, determine appropriate treatments like CPAP, and assess treatment effectiveness. It provides valuable information about sleep architecture and respiratory events that can help characterize a patient's condition.
basic of polysomnography presentation.pptxshaitansingh8
Polysomnography is a multi-parameter test used to diagnose sleep disorders. It involves the simultaneous recording of biophysiological changes that occur during sleep including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. Key components measured include EEG, EOG, EMG, respiratory effort, airflow, oximetry. Together these provide information about sleep stages and identify disorders like sleep apnea, narcolepsy, restless leg syndrome. Polysomnography is performed in a sleep lab with technicians monitoring the patient overnight.
This document provides information about polysomnography and unconventional EEGs. It discusses polysomnography components and set up, indications, patient instructions, sleep stage scoring, and interpretations. It also describes different types of polysomnography studies. Unconventional EEGs discussed include hyperventilation and intermittent photic stimulation, describing the procedures, typical responses, and contraindications.
The document provides an overview of polysomnography (PSG), which is a test used to diagnose sleep disorders. PSG involves the simultaneous recording of multiple physiological parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. It describes the components of a PSG, such as EEG, EOG, EMG, respiratory monitoring, oximetry, and other optional parameters. It also covers patient preparation, how the test is interpreted to evaluate sleep stages and respiratory events, and how indices like AHI are used to diagnose sleep apnea.
The document provides an overview of polysomnography (PSG), which is a test used to diagnose sleep disorders. PSG involves the simultaneous recording of multiple physiological parameters related to sleep, including brain waves, eye movements, muscle activity, heart rate, respiration, and oxygen levels. It describes the components of a PSG, such as EEG, EOG, EMG, respiratory monitoring, oximetry, and other optional parameters. It also covers patient preparation, test procedures, interpretation of the results, and indices used to diagnose sleep disorders like sleep apnea.
Sleep in itself is a myriad of wonders. In this presentation, we take a look at the neurobiology of sleep and how it is regulated in the human body. We also take a sneak peak into polysomnography as a window for monitoring sleep.
What are the different types of sleep apnea tests.pptxleelindesy
Among the several sleep problems that affect people, sleep apnea is a prevalent one. In this condition, patients fail to rest well at night because of obstruction in the airway. As a result, they always feel exhausted and tired.
This document summarizes the history and milestones in the field of sleep medicine. It discusses investigations of sleep disorders including sleep history, medical history, examinations, laboratory tests, neurologic assessments, imaging studies, and sleep tests like polysomnography and multiple sleep latency tests. Key aspects of sleep physiology are reviewed such as sleep architecture, biological rhythms, and the neuroanatomy of sleep-wake regulation. Common sleep complaints and approaches to patient assessment are also outlined.
Brief explanation about all the essential parameters monitoring during polysomnography or sleep study with corresponding images for better understanding.Also explain briefly about the split night study.I hope this may be helpful for those who are related to this field.
Obstructive sleep apnea (OSA) is a common sleep disorder where the muscles in the back of the throat relax too much during sleep, blocking the airway and disrupting breathing. Left untreated, OSA can increase the risk of heart disease and diabetes. The document discusses risk factors for OSA like obesity, large neck size, and family history. It also describes evaluating patients for OSA through questionnaires, medical history, physical exam, and polysomnography sleep study. Treatment focuses on reducing airway obstruction through lifestyle changes and oral appliances.
Noninvasive, Automated Measurement of Sleep, Wake and Breathing in RodentsInsideScientific
In this exclusive webinar sponsored by Signal Solutions LLC, Dr. Bruce O’Hara discusses methodology, best-practices and use studies of the PiezoSleep system. Discussion focuses on how these techniques can answer questions about animal behavior, phenotyping and relationships between sleep and disease. Dr. O’Hara also highlights the benefits of the PiezoSleep system that can assess sleep, wake and breathing variables.
Data Collection & Analysis in Human Autonomic Research: How to Guide to Succe...InsideScientific
This document discusses data collection and analysis in human autonomic research. It begins by outlining key learning objectives such as selecting appropriate equipment for research questions and creating a research setting conducive to reliable data collection. Several tests for measuring basal versus reflex autonomic control are described, including measures of sympathetic activity like plasma norepinephrine levels and neural recordings, and parasympathetic activity measured via cardiac vagal recordings and heart rate variability. Guidelines for optimizing heart rate variability analysis and potential issues to consider are also reviewed.
This presentation consist information about Brain death with special emphasis to differences between Indian and Western Guidelines. Also consist information about Organ transplantation and related act.
IRJET - Sleep Apnea Detection using Physiological SignalsIRJET Journal
This document summarizes a research study on detecting sleep apnea using physiological signals. The study proposes detecting sleep apnea automatically using short-term event extraction from electrocardiography (ECG) signals combined with neural network methods. Currently, sleep apnea is diagnosed through overnight polysomnography testing in a sleep lab, which is costly and has limited availability. The proposed method uses ECG signals as input data, applies signal processing techniques like notch filtering and wavelet transformation to extract features, and then uses a neural network to classify whether sleep apnea is present or not. This automated approach could enable faster diagnosis and analysis of more patients compared to current polysomnography testing.
The document discusses the diagnosis of brain death through neurological criteria. It begins by describing the main parts of the brain and their functions. It then discusses the concepts, laws, and types of brain death in India. The key components of determining brain death are described, including establishing the cause of coma, achieving normal temperature and blood pressure, performing neurological examinations to check for absence of brainstem reflexes and response to stimuli, and conducting an apnea test. Potential mimics of brain death and pitfalls in the clinical evaluation are outlined. Confirmatory ancillary tests like cerebral angiography and EEG are also discussed.
Clinical Guideline for the Evaluation, Management and Long-term Care of Obstr...Dr. Yahya Alogaibi
This document summarizes guidelines for the diagnosis and treatment of obstructive sleep apnea (OSA). It discusses diagnostic criteria and the use of polysomnography and portable monitors to diagnose OSA. Positive airway pressure is the first-line treatment, while other options include oral appliances, surgery, weight loss, and positional therapy. Surgical treatments aim to enlarge the airway but have risks. Pharmacological agents are not effective primary treatments. Follow-up is important after initiating any treatment to assess outcomes.
Wearable devices have the potential to provide valuable data for monitoring sleep and circadian rhythms, but many challenges remain. While actigraphy from wrist-worn devices can estimate sleep/wake patterns, polysomnography remains the gold standard. Consumer wearables often lack validation against clinical standards. Validated wearables could non-invasively measure sleep duration, quality, breathing, heart rate and more to help diagnose disorders. Barriers include lack of FDA approval and validation in real-world settings beyond small controlled studies. A proposed recommender system analyzed 24 volunteers' activity tracker data to provide tailored nudges to improve sleep habits based on hours, efficiency and satisfaction levels. Wearables show promise if challenges around reliability, validation
Polysomnography is a diagnostic test that uses multiple sensors to evaluate sleep disorders. It measures brain waves, eye movements, muscle activity, heart rate, oxygen levels, and breathing during sleep. Key components include sleep EEG to analyze brain waves and identify sleep stages, respiratory monitoring to detect events like apnea, and oximetry to measure oxygen saturation. Pediatric polysomnography uses some modified techniques and sleep stage scoring criteria tailored for children.
The Vitali Body 360 Analyzer is a noninvasive device that assesses over 100 biomarkers related to various body systems in just 7 minutes. It uses photoelectric plethysmography, heart rate variability, galvanic skin response, and blood pressure analysis to evaluate cardiovascular, respiratory, immune, hormonal and other body functions. The device applies a small current between electrodes on the body to record data from 22 body segments, displaying results on charts and 3D images. It can detect issues requiring further observation or treatment.
Sleep Apnea Identification using HRV Features of ECG Signals IJECEIAES
Sleep apnea is a common sleep disorder that interferes with the breathing of a person. During sleep, people can stop breathing for a moment that causes the body lack of oxygen that lasts for several seconds to minutes even until the range of hours. If it happens for a long period, it can result in more serious diseases, e.g. high blood pressure, heart failure, stroke, diabetes, etc. Sleep apnea can be prevented by identifying the indication of sleep apnea itself from ECG, EEG, or other signals to perform early prevention. The purpose of this study is to build a classification model to identify sleep disorders from the Heart Rate Variability (HRV) features that can be obtained with Electrocardiogram (ECG) signals. In this study, HRV features were processed using several classification methods, i.e. ANN, KNN, N-Bayes and SVM linear Methods. The classification is performed using subjectspecific scheme and subject-independent scheme. The simulation results show that the SVM method achieves higher accuracy other than three other methods in identifying sleep apnea. While, time domain features shows the most dominant performance among the HRV features.
Don't Miss a Beat: Understanding Continuous, Real Time Physiologic MonitoringInsideScientific
In vivo, preclinical research encompasses numerous study designs with various species and endpoints being monitored. Having access to all available study data allows the scientist to comprehensively understand the study paradigm and make informed research decisions. During Session 3 of our webseries "Biotelemetry For The Life Sciences", presenters discussed the importance of continuous, real-time monitoring in preclinical research. Case studies included using EEG as a biomarker for CNS activity and drug discovery and using telemetry for disease characterizations and and evaluation of vaccines in Biodefense research.
During this exclusive webinar sponsored by Data Sciences International, Steve Fox shares his experience from pharmaceutical development; discussing the importance of continuous EEG monitoring for sleep studies. Anna Honko explains the importance of having access to real-time, continuous data when studying infectious diseases in non-human primates in a Biodefense setting. In addition, Dusty Sarazan reviews how and why continuous, real-time monitoring has become a preferred and essential method for acquiring and studying physiology in today's preclinical research setting.
Key Topics:
EEG as a biomarker for CNS activity and a platform for pre-clincal drug discovery
Sleep/wake patterns and rhythms, and how qEEG signatures allow for accurate clinical predictions of efficacy and CNS adverse event screening
Considering the FDA Animal Rule
Basic disease characterizations and evaluation of vaccines and therapeutics
Non-human primate models of viral biodefense and emerging pathogens
Translating pre-clinical study findings to human, clinical populations
Guest Speakers:
Steve Fox, BS
Associate Principal Scientist,
Merck & Co., Inc.
Anna Honko, PhD
Staff Scientist,
NIH/NIAID Integrated Research Facility
R. Dustan Sarazan, DVM, PhD
Vice President & Chief Scientific Officer, Data Sciences International
This document discusses sleep studies and sleep laboratories. It covers the stages of sleep, common sleep disorders like sleep apnea, and how polysomnography is used to study sleep in laboratories. There are different levels of sleep studies, from level 1 studies done in a sleep lab to level 3 home studies. A sleep lab requires equipment to monitor brain waves, breathing, oxygen levels and more during sleep. It also needs a test room, control room and preparation area to properly conduct overnight polysomnography tests and diagnose sleep disorders.
This document discusses sleep apnea detection from single-lead electrocardiogram (ECG) signals using machine learning and deep learning algorithms. It analyzes 70 ECG recordings from a publicly available dataset. The document outlines existing sleep apnea detection methods, the advantages of using ECG signals, and proposes a system to collect ECG data, extract features, build models using machine and deep learning, and detect sleep apnea. Key steps include pre-processing ECG signals, extracting time, frequency and nonlinear heart rate variability features, selecting important features, and comparing different machine and deep learning models for sleep apnea classification.
Case presentation obstructive sleep apnea (osa) Vkas Subedi
This document summarizes a patient visit and evaluation for obstructive sleep apnea. The 32-year-old male patient presented with snoring, throat pain, and disturbed sleep. Examination found obesity, enlarged tonsils, and other risk factors. Polysomnography was not performed but the patient's symptoms and characteristics were consistent with severe obstructive sleep apnea. The patient underwent uvulopalatopharyngoplasty surgery, which had complications requiring extended operating time. Post-operatively, the patient required oxygen and CPAP support. Risk factors, diagnosis, treatment options and postoperative care for obstructive sleep apnea were discussed.
Dr. Jitendra Patel is an ENT specialist at the ENT Sleep Well Clinic in Manama, Bahrain. The document provides an overview of obstructive sleep apnea (OSA), including its prevalence, symptoms, risk factors, diagnostic criteria, and treatment options. It discusses how OSA is diagnosed through polysomnography and can be treated through lifestyle changes, oral appliances, CPAP machines, or surgical procedures like uvulopalatoplasty. The expected benefits of treating OSA include better blood pressure control, lower risks of heart issues and stroke, and an improved quality of life.
monitoring of anaesthetic patient.
Standardized basic monitoring requirements (guidelines) from the ASA (American Society of Anesthesiologists), CAS (Canadian Anesthesiologists’ Society) and other national societies
Many integrated monitors available
Many special purpose monitors available
Many problems with existing monitors (e.g., cost, complexity, reliability, artifacts).
health is very vital ...
Brain Death and Preparation for Organ DonationRanjith Thampi
This document discusses brain death, including definitions, causes, mechanisms, diagnostic criteria and confirmatory tests. It provides details on:
- Loss of brainstem and cortical function constituting brain death
- Common causes like stroke, trauma, hypoxia
- Mechanism of increased intracranial pressure leading to circulatory arrest
- Clinical criteria including apnea testing over multiple examinations
- Confirmatory tests like EEG, evoked potentials, angiography and imaging to demonstrate lack of cerebral blood flow
Principles and Methods of Heart Rate Variability BiofeedbackSaran A K
Biofeedback is a type of therapy that teaches a person to change and control physiological processes through practice.
Heart Rate Variability is a specific type of biofeedback that noninvasively measures harmony of autonomic nervous system.
Stress, anxiety, and maladaptive thought patterns result in incoherence.
With practice and guided exercises, individuals can utilize techniques to improve self-regulation and psychosocial functioning.
Empowers patient to be their own agent for change.
Vagus nerve stimulation involves using a device to stimulate the vagus nerve with electrical impulses. There's one vagus nerve on each side of your body. The vagus nerve runs from the lower part of the brain through the neck to the chest and stomach. When the vagus nerve is stimulated, electrical impulses travel to areas of the brain. This alters brain activity to treat certain conditions.
Vagus nerve stimulation can be done in many ways with many devices. An implantable vagus nerve stimulator has been approved by the Food and Drug Administration (FDA) to treat epilepsy and depression. The device works by sending stimulation to areas of the brain that lead to seizures and affect mood.
This document summarizes the history and milestones in the field of sleep medicine. It discusses investigations of sleep disorders including sleep history, medical history, examinations, laboratory tests, neurologic assessments, imaging studies, and sleep tests like polysomnography and multiple sleep latency tests. Key aspects of sleep physiology are reviewed such as sleep architecture, biological rhythms, and the neuroanatomy of sleep-wake regulation. Common sleep complaints and approaches to patient assessment are also outlined.
Brief explanation about all the essential parameters monitoring during polysomnography or sleep study with corresponding images for better understanding.Also explain briefly about the split night study.I hope this may be helpful for those who are related to this field.
Obstructive sleep apnea (OSA) is a common sleep disorder where the muscles in the back of the throat relax too much during sleep, blocking the airway and disrupting breathing. Left untreated, OSA can increase the risk of heart disease and diabetes. The document discusses risk factors for OSA like obesity, large neck size, and family history. It also describes evaluating patients for OSA through questionnaires, medical history, physical exam, and polysomnography sleep study. Treatment focuses on reducing airway obstruction through lifestyle changes and oral appliances.
Noninvasive, Automated Measurement of Sleep, Wake and Breathing in RodentsInsideScientific
In this exclusive webinar sponsored by Signal Solutions LLC, Dr. Bruce O’Hara discusses methodology, best-practices and use studies of the PiezoSleep system. Discussion focuses on how these techniques can answer questions about animal behavior, phenotyping and relationships between sleep and disease. Dr. O’Hara also highlights the benefits of the PiezoSleep system that can assess sleep, wake and breathing variables.
Data Collection & Analysis in Human Autonomic Research: How to Guide to Succe...InsideScientific
This document discusses data collection and analysis in human autonomic research. It begins by outlining key learning objectives such as selecting appropriate equipment for research questions and creating a research setting conducive to reliable data collection. Several tests for measuring basal versus reflex autonomic control are described, including measures of sympathetic activity like plasma norepinephrine levels and neural recordings, and parasympathetic activity measured via cardiac vagal recordings and heart rate variability. Guidelines for optimizing heart rate variability analysis and potential issues to consider are also reviewed.
This presentation consist information about Brain death with special emphasis to differences between Indian and Western Guidelines. Also consist information about Organ transplantation and related act.
IRJET - Sleep Apnea Detection using Physiological SignalsIRJET Journal
This document summarizes a research study on detecting sleep apnea using physiological signals. The study proposes detecting sleep apnea automatically using short-term event extraction from electrocardiography (ECG) signals combined with neural network methods. Currently, sleep apnea is diagnosed through overnight polysomnography testing in a sleep lab, which is costly and has limited availability. The proposed method uses ECG signals as input data, applies signal processing techniques like notch filtering and wavelet transformation to extract features, and then uses a neural network to classify whether sleep apnea is present or not. This automated approach could enable faster diagnosis and analysis of more patients compared to current polysomnography testing.
The document discusses the diagnosis of brain death through neurological criteria. It begins by describing the main parts of the brain and their functions. It then discusses the concepts, laws, and types of brain death in India. The key components of determining brain death are described, including establishing the cause of coma, achieving normal temperature and blood pressure, performing neurological examinations to check for absence of brainstem reflexes and response to stimuli, and conducting an apnea test. Potential mimics of brain death and pitfalls in the clinical evaluation are outlined. Confirmatory ancillary tests like cerebral angiography and EEG are also discussed.
Clinical Guideline for the Evaluation, Management and Long-term Care of Obstr...Dr. Yahya Alogaibi
This document summarizes guidelines for the diagnosis and treatment of obstructive sleep apnea (OSA). It discusses diagnostic criteria and the use of polysomnography and portable monitors to diagnose OSA. Positive airway pressure is the first-line treatment, while other options include oral appliances, surgery, weight loss, and positional therapy. Surgical treatments aim to enlarge the airway but have risks. Pharmacological agents are not effective primary treatments. Follow-up is important after initiating any treatment to assess outcomes.
Wearable devices have the potential to provide valuable data for monitoring sleep and circadian rhythms, but many challenges remain. While actigraphy from wrist-worn devices can estimate sleep/wake patterns, polysomnography remains the gold standard. Consumer wearables often lack validation against clinical standards. Validated wearables could non-invasively measure sleep duration, quality, breathing, heart rate and more to help diagnose disorders. Barriers include lack of FDA approval and validation in real-world settings beyond small controlled studies. A proposed recommender system analyzed 24 volunteers' activity tracker data to provide tailored nudges to improve sleep habits based on hours, efficiency and satisfaction levels. Wearables show promise if challenges around reliability, validation
Polysomnography is a diagnostic test that uses multiple sensors to evaluate sleep disorders. It measures brain waves, eye movements, muscle activity, heart rate, oxygen levels, and breathing during sleep. Key components include sleep EEG to analyze brain waves and identify sleep stages, respiratory monitoring to detect events like apnea, and oximetry to measure oxygen saturation. Pediatric polysomnography uses some modified techniques and sleep stage scoring criteria tailored for children.
The Vitali Body 360 Analyzer is a noninvasive device that assesses over 100 biomarkers related to various body systems in just 7 minutes. It uses photoelectric plethysmography, heart rate variability, galvanic skin response, and blood pressure analysis to evaluate cardiovascular, respiratory, immune, hormonal and other body functions. The device applies a small current between electrodes on the body to record data from 22 body segments, displaying results on charts and 3D images. It can detect issues requiring further observation or treatment.
Sleep Apnea Identification using HRV Features of ECG Signals IJECEIAES
Sleep apnea is a common sleep disorder that interferes with the breathing of a person. During sleep, people can stop breathing for a moment that causes the body lack of oxygen that lasts for several seconds to minutes even until the range of hours. If it happens for a long period, it can result in more serious diseases, e.g. high blood pressure, heart failure, stroke, diabetes, etc. Sleep apnea can be prevented by identifying the indication of sleep apnea itself from ECG, EEG, or other signals to perform early prevention. The purpose of this study is to build a classification model to identify sleep disorders from the Heart Rate Variability (HRV) features that can be obtained with Electrocardiogram (ECG) signals. In this study, HRV features were processed using several classification methods, i.e. ANN, KNN, N-Bayes and SVM linear Methods. The classification is performed using subjectspecific scheme and subject-independent scheme. The simulation results show that the SVM method achieves higher accuracy other than three other methods in identifying sleep apnea. While, time domain features shows the most dominant performance among the HRV features.
Don't Miss a Beat: Understanding Continuous, Real Time Physiologic MonitoringInsideScientific
In vivo, preclinical research encompasses numerous study designs with various species and endpoints being monitored. Having access to all available study data allows the scientist to comprehensively understand the study paradigm and make informed research decisions. During Session 3 of our webseries "Biotelemetry For The Life Sciences", presenters discussed the importance of continuous, real-time monitoring in preclinical research. Case studies included using EEG as a biomarker for CNS activity and drug discovery and using telemetry for disease characterizations and and evaluation of vaccines in Biodefense research.
During this exclusive webinar sponsored by Data Sciences International, Steve Fox shares his experience from pharmaceutical development; discussing the importance of continuous EEG monitoring for sleep studies. Anna Honko explains the importance of having access to real-time, continuous data when studying infectious diseases in non-human primates in a Biodefense setting. In addition, Dusty Sarazan reviews how and why continuous, real-time monitoring has become a preferred and essential method for acquiring and studying physiology in today's preclinical research setting.
Key Topics:
EEG as a biomarker for CNS activity and a platform for pre-clincal drug discovery
Sleep/wake patterns and rhythms, and how qEEG signatures allow for accurate clinical predictions of efficacy and CNS adverse event screening
Considering the FDA Animal Rule
Basic disease characterizations and evaluation of vaccines and therapeutics
Non-human primate models of viral biodefense and emerging pathogens
Translating pre-clinical study findings to human, clinical populations
Guest Speakers:
Steve Fox, BS
Associate Principal Scientist,
Merck & Co., Inc.
Anna Honko, PhD
Staff Scientist,
NIH/NIAID Integrated Research Facility
R. Dustan Sarazan, DVM, PhD
Vice President & Chief Scientific Officer, Data Sciences International
This document discusses sleep studies and sleep laboratories. It covers the stages of sleep, common sleep disorders like sleep apnea, and how polysomnography is used to study sleep in laboratories. There are different levels of sleep studies, from level 1 studies done in a sleep lab to level 3 home studies. A sleep lab requires equipment to monitor brain waves, breathing, oxygen levels and more during sleep. It also needs a test room, control room and preparation area to properly conduct overnight polysomnography tests and diagnose sleep disorders.
This document discusses sleep apnea detection from single-lead electrocardiogram (ECG) signals using machine learning and deep learning algorithms. It analyzes 70 ECG recordings from a publicly available dataset. The document outlines existing sleep apnea detection methods, the advantages of using ECG signals, and proposes a system to collect ECG data, extract features, build models using machine and deep learning, and detect sleep apnea. Key steps include pre-processing ECG signals, extracting time, frequency and nonlinear heart rate variability features, selecting important features, and comparing different machine and deep learning models for sleep apnea classification.
Case presentation obstructive sleep apnea (osa) Vkas Subedi
This document summarizes a patient visit and evaluation for obstructive sleep apnea. The 32-year-old male patient presented with snoring, throat pain, and disturbed sleep. Examination found obesity, enlarged tonsils, and other risk factors. Polysomnography was not performed but the patient's symptoms and characteristics were consistent with severe obstructive sleep apnea. The patient underwent uvulopalatopharyngoplasty surgery, which had complications requiring extended operating time. Post-operatively, the patient required oxygen and CPAP support. Risk factors, diagnosis, treatment options and postoperative care for obstructive sleep apnea were discussed.
Dr. Jitendra Patel is an ENT specialist at the ENT Sleep Well Clinic in Manama, Bahrain. The document provides an overview of obstructive sleep apnea (OSA), including its prevalence, symptoms, risk factors, diagnostic criteria, and treatment options. It discusses how OSA is diagnosed through polysomnography and can be treated through lifestyle changes, oral appliances, CPAP machines, or surgical procedures like uvulopalatoplasty. The expected benefits of treating OSA include better blood pressure control, lower risks of heart issues and stroke, and an improved quality of life.
monitoring of anaesthetic patient.
Standardized basic monitoring requirements (guidelines) from the ASA (American Society of Anesthesiologists), CAS (Canadian Anesthesiologists’ Society) and other national societies
Many integrated monitors available
Many special purpose monitors available
Many problems with existing monitors (e.g., cost, complexity, reliability, artifacts).
health is very vital ...
Brain Death and Preparation for Organ DonationRanjith Thampi
This document discusses brain death, including definitions, causes, mechanisms, diagnostic criteria and confirmatory tests. It provides details on:
- Loss of brainstem and cortical function constituting brain death
- Common causes like stroke, trauma, hypoxia
- Mechanism of increased intracranial pressure leading to circulatory arrest
- Clinical criteria including apnea testing over multiple examinations
- Confirmatory tests like EEG, evoked potentials, angiography and imaging to demonstrate lack of cerebral blood flow
Principles and Methods of Heart Rate Variability BiofeedbackSaran A K
Biofeedback is a type of therapy that teaches a person to change and control physiological processes through practice.
Heart Rate Variability is a specific type of biofeedback that noninvasively measures harmony of autonomic nervous system.
Stress, anxiety, and maladaptive thought patterns result in incoherence.
With practice and guided exercises, individuals can utilize techniques to improve self-regulation and psychosocial functioning.
Empowers patient to be their own agent for change.
Vagus nerve stimulation involves using a device to stimulate the vagus nerve with electrical impulses. There's one vagus nerve on each side of your body. The vagus nerve runs from the lower part of the brain through the neck to the chest and stomach. When the vagus nerve is stimulated, electrical impulses travel to areas of the brain. This alters brain activity to treat certain conditions.
Vagus nerve stimulation can be done in many ways with many devices. An implantable vagus nerve stimulator has been approved by the Food and Drug Administration (FDA) to treat epilepsy and depression. The device works by sending stimulation to areas of the brain that lead to seizures and affect mood.
Journal Club Presentation - AKL03 Depression.pptxSaran A K
This journal club presentation summarized a randomized controlled trial evaluating the effectiveness of a digital therapeutic called AKL-T03 on cognitive impairment in adults with major depressive disorder. The study found that AKL-T03 significantly improved performance on a test of sustained attention compared to an active control. A post-hoc analysis also found a significant difference in composite cognitive scores favoring AKL-T03. Both interventions were well-tolerated with few adverse events reported. The study provides preliminary evidence that AKL-T03 may help reduce cognitive impairment associated with depression.
Brief Overview of Autonomic Function TestsSaran A K
For most of us, stress maybe be a exam, a presentation or some personal goal you are working on. Stress is a word with broad meaning and is part and parcel of our day to day life. Now lets think or a patient with say, orthostatic hypotension, the mere act of standing up from a chair is a stress that he gives to the body. So regardless of whatever the stressor is, there is a system in our body which works tirelessly day after night in the background, that carefully orchestrates the body machinery to meet the challenges we throw at it. That strives for the golden state, that we physiologists love , homeostasis or the maintenance of milieu interior. That system to which we should be thankful to is the autonomic system.
Now in this presentation, we will talk about it but mainly about a brief overview of the autonomic function tests that are used for its assessment.
This document summarizes a presentation on Hansen's disease (leprosy) given by Dr. Saran A K. It includes an overview of leprosy, defining it as a chronic infectious disease caused by Mycobacterium leprae. It discusses the clinical case presentation, microbiology, classification systems including WHO and Ridley-Jopling, pathophysiology, clinical features, diagnosis, treatment, and provides a summary. The presentation examines all aspects of leprosy from definition to management.
This document discusses arterial blood gas (ABG) analysis and interpretation. It begins by describing how ABGs are obtained and their indications for assessing ventilation, oxygenation, and acid-base balance. It then covers sampling techniques and potential errors. The main components of an ABG are defined and methods for interpreting gas exchange and acid-base status are presented. A step-wise approach to ABG analysis involving assessing the primary disorder, compensation, and mixed disorders is also outlined.
This document discusses the physiology of speech. It begins by introducing some key speech areas in the brain, including Broca's area, Wernicke's area, and the arcuate fasciculus. It then discusses the concept of hemispheric dominance, noting that language functions are typically lateralized to the left hemisphere. The document outlines the development of speech and the complex neurophysiological processes underlying speech production, including respiration, phonation, articulation, and resonation. It also describes different types of speech and language disorders that can result from lesions to speech areas, such as aphasia, dysarthria, and aphonia. Finally, it notes some effects that can result from lesions to the non-
This document provides an overview of learning and memory. It defines learning as the acquisition of new information that alters behavior, and memory as the storage of learned information for later recall. It describes different types of learning, including incidental learning, reflex learning, associative learning (classical and operant conditioning), and non-associative learning (habituation and sensitization). The document also discusses different types of memory, including implicit, explicit, short-term, intermediate, and long-term memory. It provides details on the neurological basis of memory formation and storage, as well as disorders of memory like amnesia and dementia.
This document discusses nerve physiology and the structure and function of neurons. It describes excitable tissues like nerves and muscles. It explains the structure of neurons including the cell body, dendrites, axon and myelination. It discusses the classification of neurons based on structure and function. The document elaborates on the transport of proteins and metabolism within neurons. It also describes the peripheral nerve, nerve injury, degeneration, regeneration, and the roles of neuroglia and neurotrophins.
This document provides information on white blood cells (WBCs) or leukocytes. It begins with an overview of WBC classification, counting methods, and morphology. It then describes WBC formation (leukopoiesis) through granulocyte development in bone marrow and regulation by cytokines. The key functions of neutrophils are phagocytosis and microbial killing through processes like chemotaxis, opsonization, and degranulation.
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1. Polysomnography
Presenter : Dr. Saran A K
Preceptors : Dr. Kamlesh Jha and Dr. Ganashree C. P
DM Seminar | 13 October 2023
DEPT. OF PHYSIOLOGY, AIIMS PATNA 2
4. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
5
5. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
6
6. Case History
Mr. X, a 55-year-old male complaints of excessive day time
sleepiness for the past 6 months. He has associated increase in
body weight of 5 kgs during this period.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 7
7. Components of a good sleep history?
1. Sleep timings – hours, day-time naps?
2. Normal sleeping habits – time in/out, arousal
3. Sleep quality – refreshed after sleep?
4. Snoring – frequency/loudness/ position
5. Apneic Event – choking?
6. Abnormal behavior during sleep – limb movements?
7. Daytime functioning
DEPT. OF PHYSIOLOGY, AIIMS PATNA 8
8. 8. Personal Habits – alcohol, tobacco, stimulants?
9. Medical History –thyroid, stroke/epilepsy, heart diseases,
hypertension, diabetes, asthma, deviated nasal septum,
depression or other psychiatric illness
10. Drug History – all medications including sedatives,
antidepressants and anxiolytics
11. Occupational History – stress/ work timing/time zone change
12. Social History
DEPT. OF PHYSIOLOGY, AIIMS PATNA 9
9. • He admits that he has been sleepier as of late
• Fallen asleep during meetings - snoring
• Goes to bed around 11pm, falls asleep quickly, but may wake up
several times throughout the night.
• Wakes up at 7 am to get ready for work - drag himself out of bed
• Early morning headaches.
• He tries to catch up during the weekends by taking afternoon naps.
• He drinks 2 cups of coffee in the morning and several caffeinated
sodas throughout the day.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 10
10. • His wife mentions that he has been more tired lately when he
comes home from work and has trouble concentrating on tasks.
• He has dozed off in front of the TV while waiting for dinner.
• He has restless sleep during the night, and she is getting tired of
having her own sleep disrupted with his loud snores.
• He does little else but sleep during the weekend.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 11
11. Assessment of Sleep
• Prospective Self Report : Sleep wake diaries or sleep logs
DEPT. OF PHYSIOLOGY, AIIMS PATNA 12
13. Assessment of Sleep
• Prospective Self Report : Sleep wake diaries or sleep logs
• Retrospective self report
• Pittsburg Sleep Quality Index (Buysse et. al. 1989)
• Epsworth Sleepiness Scale (Johns, 1991)
• Insomnia Severity Scale (Bastien et. al. 2001)
• Berlin Sleep Apnea Questionnaire (Netzer et. Al. 1999)
DEPT. OF PHYSIOLOGY, AIIMS PATNA 14
14. Components of a good sleep physical examination
1. Obesity - Body Mass Index
2. Neck Circumference
3. Enlarged Tonsils
4. Larger Tongue
5. High arched hard palate
6. Facial abnormalities (retrognathia or micrognathia)
DEPT. OF PHYSIOLOGY, AIIMS PATNA 15
16. Epworth sleepiness score (ESS) is 12 out of 24.
His physical exam is remarkable for
• Blood pressure of 150/70
• Oxygen saturation of 95% on room air
• Body mass index of 35 kg/m2
• Mallampati score III
• High arched palate
• Neck size 17.5 inches (44.5 cm)
DEPT. OF PHYSIOLOGY, AIIMS PATNA 17
18. Polysomnography
It is the continuous monitoring and
simultaneous recording of the physiological
activities during sleep.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 19
19. Simultaneous recording of
• Sleep Staging
• Eye Movements
• Electromyographic Tone
• Respiratory Parameters
• Electrocardiogram
DEPT. OF PHYSIOLOGY, AIIMS PATNA 20
20. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
21
21. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
22
22. Routine indications – PSG
1. Diagnosis of sleep related breathing disorders (SRBDs)
2. Positive airway pressure titration in patients with SRBDs
3. Assessment of treatment results
4. With Multiple Sleep Latency Test (MSLT) in evaluation of suspected
narcolepsy.
5. Evaluating SRBDs that are violent or otherwise potentially injurious to
patients and others
6. Atypical or unusual parasomnias
DEPT. OF PHYSIOLOGY, AIIMS PATNA 23
23. Patient instructions - AASM
1. Follow your regular routine as much as possible
2. Avoid napping day before the study
3. Avoid caffeine after lunch
4. Avoid using hair sprays or gels that can interfere with the sleep
recording
5. Avoid alcohol or other sedatives unless otherwise prescribed by
your doctor.
6. Comfortable clothes to sleep in, cotton clothes preferred
DEPT. OF PHYSIOLOGY, AIIMS PATNA 24
24. Types of monitors
Types
Type I In laboratory, technologist attending PSG
Usual channels : EEG, EOG, chin EMG, ECG, airflow, respiratory
effort and Spo2 (minimum of 7 channels as per AASM criteria)
Type II Unattended polysomnography (minimum of 7 channels, as above)
Type III Portable monitoring with minimum of 4 channels, including
respiratory movement, airflow, heart rate, SpO2
Type IV Portable monitoring with only one or two channels, including
pulse oximetry
DEPT. OF PHYSIOLOGY, AIIMS PATNA 25
25. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
26
26. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
27
28. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
29
29. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
30
32. 1. Electroencephalogram
• International 10-20 System.
• A minimum of 3 EEG derivations are required - frontal, central and
occipital regions.
• M1 and M2 refer to the left and right mastoid process.
• The recommended derivations are F4-M1, C4-M1 and O2-M1
• Backup electrodes should be placed at F3, C3, O1 and M2.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 33
33. The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 34
35. 2. Electrooculogram
Recording of the movement of the corneo‐retinal potential
difference, not the movement of eye muscle.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 36
36. The recommended EOG derivations are E1-M2 (E1 is placed 1cm
below the left outer canthus) and E2-M2 (E2 is placed 1 cm above
the right outer canthus)
Right out and up / Left out and down
E1
E2
DEPT. OF PHYSIOLOGY, AIIMS PATNA 37
37. The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 38
39. 3. Chin Electromyogram
A- Reduction in chin EMG
C- Rapid eye movements
The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 40
40. 4. Electrocardiogram
Single modified
lead II electrode
and torso electrode
The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 41
41. 5. Leg Electromyogram
Tibialis anterior
The AASM manual for the scoring of sleep and associated events,2018
Extensor digitorum superficialis Extensor digitorum communis
DEPT. OF PHYSIOLOGY, AIIMS PATNA 42
42. 6. Respiratory Flow
• Important signal to score apnea and
hypopnea.
• It is measured using a thermistor and a
pressure transducer
• The thermistor is important for the
diagnosis of apnea while a pressure
transducer helps in recognizing hypopnea
DEPT. OF PHYSIOLOGY, AIIMS PATNA 43
43. 7. Respiratory Effort
• Important for differentiating between
obstructive and central respiratory events
(both apneas and hypopneas).
• RIP belts are considered superior and
are recommended.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 44
44. 8. Oxygen Saturation
Pulse oximeter that provides a SpO2
average of 3 seconds values.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 45
45. Other sensors
9. Body position
10.Synchronized PSG Video
DEPT. OF PHYSIOLOGY, AIIMS PATNA 46
47. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
48
48. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
49
50. • Sleep Staging
• Score sleep stages in 30s, sequential epoch commencing at the start
of the study – EMG, EEG and EOG
• Assign a stage to each of the epoch
• If 2 or more stages coexist during a single epoch, assign the stage
comprising the greatest portion of the epoch.
• Respiratory events- 2min / 5min epoch
• EEG arousals- 30s epoch
DEPT. OF PHYSIOLOGY, AIIMS PATNA 51
53. Wakefulness – W (Eyes open)
EEG → high-frequency, low-voltage activity (chiefly beta and alpha
frequencies) without the rhythmicity of alpha rhythm ⇒ indicative of
the unique activity of individual cortical neurons
EOG → Rapid eye movements (initial deflection is less than 500ms)
and eye blinks (vertical movements 0.5–2 Hz), Reading eye
movements
EMG → Chin EMG relatively increased compared with that during
sleep - high-frequency activity
54
DEPT. OF PHYSIOLOGY, AIIMS PATNA
55. Wakefulness –W (Eyes closed)
● EEG → Rhythmic waves in the alpha range (8–13 Hz),
particularly over the occipital region
● EOG → Slow eye movements (SEMs) may be present
● EMG → Chin EMG activity is variable and relatively high
DEPT. OF PHYSIOLOGY, AIIMS PATNA 56
56. Drowsy (before sleep onset) alpha waves, seen in EEG leads (red rectangle), occupy greater than 50% of the 30-second
epoch
Otolaryngol Clin North Am. 2016 Dec;49(6):1307-1329
DEPT. OF PHYSIOLOGY, AIIMS PATNA 57
57. • Transition phase includes Alpha rhythm and Low Amplitude
Mixed Frequency waves (LAMF) with SEMs
• Time with the patient disconnected from the recording
equipment should be scored as Stage W.
• Brief episodes of sleep during this time are not considered
significant for stage scoring summary.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 58
58. N1
• Consciousness begins to fade, but the individual may still be awakened
by minimal stimulation
• EEG → slows and shows low-amplitude mixed-frequency (LAMF) activity
(4-7 Hz) activity (more than 50% of epoch) + absence of sleep
spindles (SSs) and K complexes (KCs) not associated with arousal
• EOG → Slow roving eye movements
• EMG → less activity
DEPT. OF PHYSIOLOGY, AIIMS PATNA 59
61. N2
• Sleep deepens and there is a further lack of sensitivity to
activation and arousal
• EEG- Low Amplitude Mixed Frequency (LAMF) - Slow activity in
the theta (0.5−4 Hz)
• EOG– Occasionally SEMs near sleep onset
• EMG – Tonic activity, low level
DEPT. OF PHYSIOLOGY, AIIMS PATNA 62
62. Sleep Spindle: A train of distinct waves with frequency 11-16 Hz
with a duration of ≥ 0.5 seconds usually maximal in amplitude
using central derivations
The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 63
63. K Complex: A well delineated negative sharp wave immediately
followed by a positive component standing out from the
background EEG, with total duration ≥ 5 seconds, usually
maximal in amplitude when recorded using frontal derivations
The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 64
65. N3
• Deep sleep - Activation and arousal occurs only if stimulus is
strong When awakened, does not report of dreams
• EEG
• Abundant, high-voltage very slow delta waves → slow
wave activity (delta 0.5-4 Hz) , ≥ 20% of epoch
• Chin EMG → variable, low level
• EOG – None, picks up EEG
DEPT. OF PHYSIOLOGY, AIIMS PATNA 66
67. R
• EEG
• Rapid, low voltage waves resembling alert, awake state
• Without KCs and SS
• As brain is highly active → metabolism increased by 20% -
Paradoxical
• Ponto Geniculo-occipital spikes (PGO) spikes
• EOG → rapid eye movements
• EMG → low chin EMG tone (activity)
DEPT. OF PHYSIOLOGY, AIIMS PATNA 68
71. Arousal
• An arousal is a brief awakening from sleep that lasts at least 3
seconds.
• Apnea and hypopnea events often cause arousals from
sleep.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 72
73. Apnea
• Drop in peak signal
excursion by ≥ 90% of
pre- event baseline
using an oronasal
thermal sensor
• Duration of ≥ 90%
drop in sensor signal
lasts ≥10 seconds
The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 74
75. Fundamentals of sleep medicine
Central sleep apnea
Obstructive sleep apnea
Mixed sleep apnea
DEPT. OF PHYSIOLOGY, AIIMS PATNA 76
76. The AASM manual for the scoring of sleep and associated events,2018
Score an apnea as an obstructive apnea if:
• it meets apnea criteria and
• is associated with continued or increased inspiratory effort
throughout the entire period of absent airflow.
Score an apnea as a central apnea if:
• it meets apnea criteria and
• is associated with absent inspiratory effort throughout the entire
period of absent airflow.
Score an apnea as a mixed apnea if :
• it meets apnea criteria and
• is associated with absent inspiratory effort in the initial part of the
event, followed by resumption of inspiratory effort in the second
part of the event.
DEPT. OF PHYSIOLOGY, AIIMS PATNA 77
78. Hypopnea
Score a respiratory event as a hypopnea if all of the following criteria
are met:
• The peak signal excursions drop by ≥ 30% of pre-event baseline
using nasal pressure
• The duration of ≥30% drop in signal excursion is 10 seconds.
• There is a ≥3% desaturation from the pre-event baseline or the
event is associated with an arousal.
The AASM manual for the scoring of sleep and associated events,2018
DEPT. OF PHYSIOLOGY, AIIMS PATNA 79
79. AHI (Apnea Hypopnea Index)
The AHI refers to the total number of apnea and hypopnea events that occur
each hour of sleep - severity of sleep apnoea
• 0-5 apnoea + hypopnoea events per hour = normal
• 6-15 apnoea + hypopnoea events per hour = mild sleep apnoea
• 16-29 apnoea + hypopnoea events per hour = moderate sleep apnoea
• 30 or greater apnoea + hypopnoea events per hour = severe sleep
apnoea
DEPT. OF PHYSIOLOGY, AIIMS PATNA 81
81. Critical limb movements
DEPT. OF PHYSIOLOGY, AIIMS PATNA 83
Placement of electrodes on anterior tibialis muscle for monitoring limb
movements
Movements + muscle artefact obscuring the EEG for more than half
of each epoch to the extent that sleep stage cannot be determined
Major Body movements
82. Hypnogram
• Compressed graphic summary of entire sleep study
• Representation of multiple variables :
• Sleep stages
• Respiratory events
• Positive airway pressure (if used)
• Motor movements
• Oximetry
• End-tidal or transcutaneous CO2,
• Heart rate variability measures
• Electroencephalographic power spectrum
• Body position
Atlas of sleep medicine
DEPT. OF PHYSIOLOGY, AIIMS PATNA 84
84. DEPT. OF PHYSIOLOGY, AIIMS PATNA 86
55 M c/o excessive day time sleepiness, disturbed sleep, early morning headaches,
snoring with increase of body weight during the last 6 months. Epsworth Sleep
Score 12/24, BMI 35 kg/m2, Malampatti score III, Neck circumference 44 cm
86. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
88
87. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
89
88. Parameter Sensors Purpose
Electroencephalography Frontal, central, occipital leads
with mastoid process reference
lead
Stage sleep, detect epileptiform activity
Electrooculography Outer canthi leads with mastoid
process reference lead
Stage sleep (specifically stage R)
Electromyography Submental surface electrodes,
Anterior tibial surface electrodes
Stage sleep (specifically stage R), detect
REM without atonia, detect periodic limb
movements and other movement
abnormalities
Airflow Nasal cannula
pressure transducer
Oronasal thermal
sensor
PAP device (titration study)
Detection of hypopneas
Detection of apneas
Otolaryngol Clin North Am. 2020 Jun;53(3):367-383
DEPT. OF PHYSIOLOGY, AIIMS PATNA 90
Summary
89. DEPT. OF PHYSIOLOGY, AIIMS PATNA 91
Respiratory effort Chest and abdomen respiratory
inductance plethysmography
belts
Classify respiratory events as
obstructive, central, or mixed
Snoring Microphone, piezoelectric sensor Detect snoring
Arterial
oxygen
saturation
Pulse oximetry Detect hypoxemia
Electrocardiogram Modified lead II Monitor cardiac rate and rhythm
Position Accelerometer, video monitors Detect position
Behaviour Audio, video monitors Detect parasomnias, abnormal behaviors,
seizures
Otolaryngol Clin North Am. 2020 Jun;53(3):367-383
90. References
1. AASM Manual V 3.0 for the scoring of sleep and associated events, 2023
2. Kryger, M. H., Roth, T., Goldstein, C. A. Kryger's Principles and Practice of Sleep
Medicine, Seventh Edition. Netherlands: Elsevier Health Sciences. 2021
3. Berry, R. B. Fundamentals of Sleep Medicine. United Kingdom: Elsevier
Health Sciences. 2011
4. Kandel, E. R., Principles of Neural Science, Sixth Edition. Greece: McGraw-
Hill Education. 2021
5. Barrett, D. K. E., Barman, S. M., Yuan, J., Brooks, H. L. Ganong's Review of Medical
Physiology, Twenty Sixth Edition. United States: McGraw Hill LLC. 2019
6. Hall, J. E. Guyton and Hall Textbook of Medical Physiology, 14th Edition. United
Kingdom: Elsevier Health Sciences. 2021
DEPT. OF PHYSIOLOGY, AIIMS PATNA 92
92. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
94
93. Overview
● Case Vignette
● Indication and Types
● Digital and Technical Specifications
● Recommended Parameters
● Scoring of Sleep Events
● Summary
95