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Polymonograpy
It is a simultaneous and continuous monitoring of normal and abnormal physiological activity during sleep. Largely regarded as the gold standard for the diagnosis of sleep disorders.
This study can evaluate sleeping problems, such as: Breathing that stops during sleep ( apnea ) Trouble falling or staying asleep ( insomnia ) A problem with falling asleep suddenly during the day ( narcolepsy ) Nightmares and sleepwalking Problems with arm or leg movement during sleep
Sleep Apnea
Sleep apnea is defined as a reduction or cessation of breathing during sleep. Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, youll often move out of deep sleep and into light sleep.
As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.
Easily recognized
Treatable
OSA is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep.
In Central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe
Mixed Apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses in order for them to resume breathing, but consequently sleep is extremely fragmented and poor quality
Obstructive apnea
Central Apnea
Mixed apnea
Hypopnea
Hypopnea refers to a transient reduction of airflow (often while asleep) that lasts for at least 10 seconds, shallow breathing, or an abnormally low respiratory rate. Hypopnea is less severe than apnea (which is a more complete loss of airflow). It may likewise result in a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. It more commonly is due to partial obstruction of the upper airway.
Many labs require at least a 50% reduction in flow; however, more and more labs do not require a specific % reduction, but look at the SaO2 and EEG to affect the decision
PLMS (Periodic Limb Movement Syndrome) is a sleep disorder where the patient moves limbs involuntarily during sleep, and has symptoms or problems related to the movement. Repetitive (at least 4) episodes of muscle contraction (0.5-5 s duration), typically separated by 20-40 seconds, but not more than 90 seconds (120 seconds in some laboratories) Arousals sometimes associated with the movements
Central
Obstructive
Hypopnea
Airflow
Absent
Absent
Thoraco
Absent
Present
Present
Abdominal
Absent
Present
Present
Headbox
Patient Preparation
Patient Preparation
Snore Sensors & Microphones
Pulse Oximeter
Provides percentage of how much hemoglobin in the patients blood is saturated by oxygen Normal range is 94 98%
Respiratory Bands Placed on patients chest and abdomen Records respiratory effort
Airflow Sensors
Thermistor or thermocouple detects changes in temperature Detects airflow A small sensor extends down to detect oral flow A transducer is placed in the thermistor Detects changes in pressure Second method insures accuracy
EKG Leads
Two lead recording typical Some EKG arrhythmias are noted with two lead. Two lead recording typical
Electro-oculogram (EOG)
E1: Left Eye Left Outer Canthus 1 cm out & 1 cm down from the outside corner of the eye E2: Right Eye Right Outer Canthus
CO2
CO2: Carbon Monoxide Monitors
End Tidal CO2 (Cannula)
Frequently lose signal secondary to oral breathing which is common in children and condensation in the line AKA ETCO2
Transcutaneous CO2
Sensor on body (forehead)
More accurate May cause burns O2: Carbon Monoxide Monitors
The study is based on the idea that you should fall asleep in a shorter amount of time as your feeling of sleepiness increases. The MSLT charts your brain waves and heartbeat and records your eye and chin movements. The study also measures how quickly and how often you enter the rapid-eye-movement (REM) stage of sleep. Results of the nap study are routinely used to detect sleep disorders.
Patient remains wired with most of the wires from the polysomnogram performed the previous night. A series of four naps are taken at two-hour intervals. Each nap requires the patient to sit in a chair for 40 minutes and try to remain awake. The test is usually done by late afternoon, or 5:00pm, and there is little or no discomfort for the patient.