Fundamentals of Sleep Medicine E-Book

Expert Consult - Online and Print

Richard B. Berry

• Publisher: Saunders
• Year: 2011
• eBook ISBN:
  9781455711239
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

Written by Richard Berry, MD, author of the popular Sleep Medicine Pearls, Fundamentals of Sleep Medicine is a concise, clinically focused alternative to larger sleep medicine references. A recipient of the 2010 AASM Excellence in Education award, Dr. Berry is exceptionally well qualified to distill today's most essential sleep medicine know-how in a way that is fast and easy to access and apply in your practice.- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices.- Get clear guidance on applying the AASM scoring criteria.- Reinforce your knowledge with more than 350 review questions.- Get the answers you need quickly thanks to Dr. Berry's direct and clear writing style.- Access the complete contents online at Expert Consult, including videos demonstrating parasomnias, leg kicks, and more.

Chapter 1

Sleep Stages and Basic Sleep Monitoring

Chapter Points

• In the EEG or EOG derivation G₁-G₂, an upward deflection in the tracing is noted if input G₁ becomes negative with respect to input G₂ (negative upward polarity).

• To differentiate whether alpha waves or sleep spindles are present, change to a 10-second window and count the individual deflections in one second (see Fig. 1–3).

• K complexes and slow waves have the greatest amplitude in frontal derivations. Sleep spindles and saw-tooth waves have the greatest amplitude in central derivations.

• Alpha activity is any wave form with a frequency of 8 to 13 Hz. Alpha rhythm has a frequency of 8 to 13 Hz, is most prominent in the occipital derivations, and is enhanced by eye closure and attenuated by eye opening.

• The recommended EEG derivations are F₄-M₁, C₄-M₁, and O₂-M₁.

• The recommended EOG derivations are E₁-M₂ and E₂-M₂. Both eye electrodes are referred to a common mastoid electrode M₂.

• The front of the eye (cornea) is positive with respect to the back of the eye (retina). If the eyes move toward E₁-M₂ and away from E₂-M₂, this causes a downward deflection in E₁-M₂ and an upward deflection in E₂-M₂.

• In the recommended EOG derivations, eye movements result in out-of-phase deflections. K complexes result in in-phase deflections.

• In stage R, the chin EMG amplitude is equal to or lower than the lowest level in NREM sleep. The chin EMG activity can reach the REM level during NREM sleep. Transitions from NREM to stage R are not always associated with a drop in chin activity. Chin EMG activity is useful in differentiating stage R from stage W with the eyes open (REMs present).

Sleep is divided into non–rapid eye movement (NREM) and rapid eye movement (REM) sleep. Sleep staging is based on electroencephalographic (EEG), electro-oculographic (EOG), and submental (chin) electromyographic (EMG) criteria. EOG (eye movement recording) and chin EMG recordings are used to detect REM sleep, which is characterized by REMs and reduced muscle tone. Since 1968, sleep was usually staged according to A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects, edited by Rechtschaffen and Kales (R&K).¹ In the R&K scoring manual,¹ NREM sleep was divided into sleep stages 1, 2, 3, and 4. REM sleep was referred to as stage REM. Sleep stage nomenclature has changed following the publication of the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events (hereafter referred to as the AASM scoring manual).² The new nomenclature was introduced to denote sleep stages defined by new criteria. The old and new nomenclatures are shown in Table 1–1. Stages 3 and 4 are combined into stage N3.

TABLE 1–1

Sleep Stage Nomenclature

	R&K	AASM
Wake	Stage W	Stage W
NREM	Stage 1 Stage 2 Stage 3 Stage 4	Stage N1 Stage N2 Stage N3
REM	Stage REM	Stage R

AASM = American Academy of Sleep Medicine²; NREM = non–rapid eye movement; R&K = Rechtschaffen and Kales A¹; REM = rapid eye movement; stages 3 and 4 are combined into stage N3.

Today, digital polysomnography (sleep recording) has virtually replaced recording on paper. However, previously sleep recording was performed with polygraphs using ink writing pens with ...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Preface
• Acknowledgments
• Online Video Content
• Chapter 1: Sleep Stages and Basic Sleep Monitoring
• Chapter 2: The Technology of Sleep Monitoring: Differential Amplifiers, Digital Polysomnography, and Filters
• Chapter 3: Sleep Staging in Adults
• Chapter 4: Biocalibration, Artifacts, and Common Variants of Sleep
• Chapter 5: Sleep Staging in Infants and Children
• Chapter 6: Sleep Architecture Parameters, Normal Sleep, and Sleep Loss
• Chapter 7: Neurobiology of Sleep
• Chapter 8: Monitoring Respiration—Technology and Techniques
• Chapter 9: Monitoring Respiration—Event Definitions and Examples
• Chapter 10: Sleep and Respiratory Physiology
• Chapter 11: Cardiac Monitoring during Polysomnography
• Chapter 12: Monitoring of Limb Movements and Other Movements during Sleep
• Chapter 13: Polysomnography, Portable Monitoring, and Actigraphy
• Chapter 14: Subjective and Objective Measures of Daytime Sleepiness
• Chapter 15: Obstructive Sleep Apnea Syndromes: Definitions, Epidemiology, Diagnosis, and Variants
• Chapter 16: Pathophysiology of Obstructive Sleep Apnea
• Chapter 17: Consequences of Obstructive Sleep Apnea and the Benefits of Treatment
• Chapter 18: Obstructive Sleep Apnea Treatment Overview and Medical Treatments
• Chapter 19: Positive Airway Pressure Treatment
• Chapter 20: Oral Appliance and Surgical Treatment for Obstructive Sleep Apnea
• Chapter 21: Central Sleep Apnea and Hypoventilation Syndromes
• Chapter 22: Sleep and Obstructive Lung Disease
• Chapter 23: The Restless Leg Syndrome, Periodic Limb Movements in Sleep, and the Periodic Limb Movement Disorder
• Chapter 24: Hypersomnias of Central Origin
• Chapter 25: Insomnia
• Chapter 26: Circadian Rhythm Sleep Disorders
• Chapter 27: Clinical Electroencephalography and Nocturnal Epilepsy
• Chapter 28: Parasomnias
• Chapter 29: Psychiatry and Sleep
• Chapter 30: Sleep and Nonrespiratory Physiology—Impact on Selected Medical Disorders
• Chapter 31: Sleep and Neurologic Disorders
• Glossary
• Index