Download RPSGT Exam Study Guide: Introduction to Polysomnography and more Exams Advanced Education in PDF only on Docsity!
RPSGT Study guide Info Introductory Topic Why is sleep necessary? - Lack of sleep is associated with illness and impaired function. Sleep is: - basic human need, essential for healthy metabolic, immune, and cognitive function. True - More has been learned about sleep in the past 60 years than in the preceding 6,000. Research on sleep in the early and mid 20th century: - Led to classification of sleep stages, clinical practice of sleep medicine developed from research and grew in the 1970s, allowed for better description and classification of sleep disorders. Obstacles to the development of sleep programs: - All-night diagnostic study was unheard of in the 1970s, Cost of an all-night study was too high, too labor intensive, sleep disorders were not understood. Poly - refers to recording of many different parameters Somno - relating to sleep Graphy - charting of recording parameters The term polysomnography was first used to denote all-night diagnostic sleep studies in what year? - 1974 Polysomnography - test of sleep cycles and stages using continuous recordings of brain waves (EEGs), electrical activity of muscles, eye movement (electro-oculogram), respiratory rate, blood pressure, blood
oxygen saturation, heart rhythm and, sometimes, direct observation of the person during sleep using a video camera. EEG electroencephalogram - brain wave activity EOG electro-oculogram - Eye movements EMG electromyogram - muscle activity; including chin muscle (submentalis), leg muscle (tibialis anterior), and arm muscle activity Airflow - Respiratory activity of chest and abdomen EKG or ECG electrocardiogram - heart rate and rhythm SaO2 pulse oximetry - Oxygen saturation End-Tidal or Transcutaneous CO2 - carbon dioxide 1880 - EEG first recorded in animals 1929 - EEG first recorded in humans 1929 about 1951 - Eye movement sensors added 1966 - Leg leads added 1972 - Respiratory and cardiac sensors added to PSG in the USA 2007 - AASM Scoring Manual released
1975 - Blue Shield of California began to reimburse patients for sleep services. 1977 - Montefiore Hospital, New York City is first sleep center to be accredited. 1978 - The establishment of a board exam in sleep medicine for physicians. Today a board certified physician in sleep medicine is called a Diplomate, American Board of Sleep Medicine (D, ABSM) 1989 - First fellowship training in sleep medicine for physicians. American Academy of Sleep Medicine AASM - Originated from other societies established in the 1970s which were dedicated to establish standards for research as well as evaluation and treatment of people with sleep disorders. American Academy of Sleep Medicine AASM - A professional society which serves the needs of individual members and sleep disorder centers. American Academy of Sleep Medicine AASM - Rose out of the growth of scientific and clinical information about sleep medicine. American Academy of Sleep Medicine AASM - Establishes practice parameters for the practice of sleep medicine (www.aasmnet.org/documentdevelopment.aspx) American Academy of Sleep Medicine AASM - Publishes 2 journals: SLEEP (since 1978) and Journal of Clinical Sleep Medicine (since 2005) American Academy of Sleep Medicine AASM - In 2007, published The AASM Manual for the Scoring of Sleep and Associated Events
NREM Sleep 1937 - Loomis developed a classification system for brain activity including vertex waves, sleep spindles, K complexes, and delta slowing. What we now call non-rapid eye movement sleep was divided into 5 stages: A, B, C, D, and E. REM Sleep 1953 - Rapid eye movements observed in an infant. Eugene Aserinsky and Nathaniel Kleitman published the first paper describing rapid eye movement sleep. (Regularly occurring periods of eye motility, and concomitant phenomena during sleep. Science 1953; 118: 273-274.) NREM & REM Cycles - 1957. William Dement and Nathaniel Kleitman described the human sleep cycles of NREM sleep stages of increasing depth followed by periods of REM sleep with cycles repeating throughout the night. They proposed a new classification of sleep stages, using 4 stages of NREM sleep plus REM sleep. Rechtschaffen and Kales - 1968. Manual of Standardized Terminology, Techniques and scoring System for Sleep Stages of Human Subjects. Also known as "R and K". The first scoring manual for sleep, originally developed as a research tool for use in healthy young volunteers. This scoring system was replaced in July 2008 by The AASM Manual for Scoring of Sleep and Associated Events Normal Sleep in Young Adults - 7.5 to 8.5 hours per 24 hours. Normal sleep latency: 10 minutes. Normal Sleep Structure: NREM Sleep: 2% - 5% N1, 45% - 55% N2, 15% - 25% N3 REM Sleep: 20%- 25% Stage R, Sleep is entered through NREM sleep. Episodes of NREM and REM sleep alternate about every 90 minutes. Over the course of the night there is typically an orderly progression between sleep stages. Wakefulness in sleep occurs less than 5% of the night. Stages N3 sleep occur in the first third of the night. REM sleep is more prominent in second half of night. NREM Sleep - Consists of stages N1, N2, and N3. Makes up 75% - 80% of total sleep time in older children and adults. ____________ are also known as slow wave sleep (SWS) or Deep NREM sleep. - Stage N
Stage W (awake) - EEG - well formed alpha (8-13Hz) when pt is relaxed and eyes are closed (relaxed wakefulness) when >50% of the epoch has alpha over the occipital region.
