Clinician-Focused Overview and Developments in Polysomnography

Abstract

Purpose of Review Polysomnography (PSG) represents a fundamental diagnostic tool used in the evaluation of sleep disorders. It represents a simultaneous recording of sleep staging, eye movements, electromyographic tone, respiratory parameters, and electrocardiogram. It is particularly helpful in the assessment of sleep-disordered breathing and its management, propensity for excessive sleepiness, complex behaviors during sleep, including motor disturbances of sleep, sleep-related epilepsy, and parasomnias. This review is intended to summarize the indications for PSG, the limitations and challenges of this diagnostic tool, indications for home sleep apnea testing options, and new developments and trends in polysomnography. Recent Findings The polysomnogram is fundamentally important in the evaluation of sleep-disordered breathing in the setting of cardiovascular comorbidities and neurologic conditions such as neuromuscular disease, stroke, and epilepsy and in the evaluation of dream enactment behavior in the setting of REM sleep behavior disorder (RBD). Because RBD is predictive of neurodegenerative disorders, recent data highlights the importance of PSG in corroborating the diagnosis of RBD and identifying people who may be at risk. However, due to cost as well as limitations in access to care, further testing has been developed and implemented including the home sleep apnea test (HSAT). The evolution of consumer wearable devices has also been a growing trend in sleep medicine; however, few have received appropriate validation. Summary PSG has been used in both the clinical and research settings and remains the gold standard clinical diagnostic test for suspected obstructive sleep apnea (OSA) or central sleep apnea (CSA). Clinicians must be familiar with the basic indications for a PSG but also recognize when it is absolutely required. At this time, the PSG is essential in the evaluation of nocturnal hypoventilation disorders of sleep, periodic limb movements of sleep, and central nervous system hypersomnia (in the absence of CSF hypocretin) when combined with the multiple sleep latency test (MSLT) and is probably the only way to help differentiate among complex behaviors during sleep, especially in the setting of RBD. The capacity to establish an early diagnostic risk of potential dementia would be of critical importance once neuroprotective agents become available.

Low-Calorie Ketogenic Diet with Continuous Positive Airway Pressure to Alleviate Severe Obstructive Sleep Apnea Syndrome in Patients with Obesity Scheduled for Bariatric/Metabolic Surgery: a Pilot, Prospective, Randomized Multicenter Comparative Study

“…Clinical data associate OSAS with hypertension (HTN), dyslipidemia (DLP), insulin resistance (IR), and inflammation [2][3][4]. Polysomnography is the gold standard for the diagnosis of OSAS [5], and the apnea-hypopnea index (AHI) is used to quantify severity based on an international score [6].…”

Sleep Characteristics According to Gender and Age Measured by Wrist Actigraphy

“…It enables electroencephalograms, electrooculograms and electromyograms records to continuous and simultaneous recording of physiologic activity during sleep. PSG also records respiration, and saturation of oxygen to assess sleep apnea [ 7 , 8 , 9 ]. However, this method requires the lab environment with professional assistants and participants must wear numerous sensors during sleep in a laboratory condition [ 7 , 10 , 11 ].…”

“…PSG also records respiration, and saturation of oxygen to assess sleep apnea [ 7 , 8 , 9 ]. However, this method requires the lab environment with professional assistants and participants must wear numerous sensors during sleep in a laboratory condition [ 7 , 10 , 11 ]. Another objective method is actigraphy, which is a widely used alternative to PSG for the identification of sleep phases and sleep parameters that assess the duration (e.g., time in bed or assumed sleep) and quality of sleep (e.g., sleep efficiency or fragmentation index).…”

Monocyte to HDL cholesterol ratio as a marker of the presence and severity of obstructive sleep apnea in hypertensive patients

“…), hypoxemic lung disease (e.g., chronic obstructive pulmonary disease, interstitial lung disease, asthma, etc. ), hematologic disease, congestive heart failure, liver or kidney disease, malignancy, pregnancy, infection, autoimmune disease, and anti-inflammatory medication use were excluded as previous studies described 9 , 10 , 25 . In total, 246 subjects were included.…”

“…Patients with comorbid conditions (including comorbid sleep disorders, neural-muscular disease, hypoxemic lung disease, congestive heart failure, etc.) that were not recommended to receive OCST instead of full PSG were excluded in this study 25 . OCST was programmed to record automatically, starting from 30 min after the patients went to bed.…”