Miya Pearson
Sleep disorders can be diagnosed through various tests, including overnight oximetry, polysomnography, and multiple sleep latency testing. Polysomnography, also known as a sleep study, is a common test that involves monitoring and recording different body functions while the patient sleeps, such as heart rate, respiration, muscle activity, blood pressure, brain activity, and eye movement. This test is often conducted in a sleep clinic or hospital overnight and can help diagnose conditions like sleep apnea, narcolepsy, and restless leg syndrome. Overnight oximetry is another test that measures oxygen levels and heart rate using a probe attached to the patient's finger or earlobe. While sleep studies are typically done in a controlled environment, there is a push for developing technologies that can allow for home assessment of sleep disorders.
| Characteristics | Values |
|---|---|
| Test Type | Sleep study, also known as polysomnography or polysomnogram |
| Test Method | Monitoring and recording various body functions while the patient sleeps |
| Sensors | Electroencephalography (EEG), Electro-oculography (EOG), Breathing sensors, Respiratory inductive plethysmography (RIP) belt, Pulse oximeter, Video and audio monitoring |
| Test Location | Hospital, sleep study clinic, or at home |
| Diagnosable Disorders | Sleep apnea, insomnia, restless leg syndrome, narcolepsy, parasomnias |
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What You'll Learn
Polysomnography
Respiratory inductive plethysmography (RIP) belts are used to monitor the expansion and contraction of the chest and abdomen during breathing. Pulse oximetry, a non-invasive method, is used to measure blood oxygen saturation levels and heart rate. In some cases, video and audio monitoring may be included to provide a comprehensive record of the patient's sleep behaviour.
The data collected during polysomnography can provide valuable insights into sleep disorders. It can help identify issues such as sleep apnea, where breathing patterns and oxygen levels are monitored to detect any abnormalities. Additionally, the test can assist in ruling out other potential causes of insomnia or sleep disturbances, guiding doctors toward an accurate diagnosis and facilitating the development of effective treatment plans.
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Electroencephalography (EEG)
Different types of brain waves occur during different stages of sleep, and these can be identified through an EEG. For example, when an individual first falls asleep, the low-voltage fast EEG pattern of wakefulness transitions into slower frequencies associated with non-rapid eye movement (NREM) sleep. As sleep progresses, NREM sleep goes from stage N1 (decrease in alpha waves) to stage N2 (spindles and K-complexes) and finally to stage N3 (increasing amplitude and regularity of delta rhythm).
An EEG can be used to help diagnose and monitor various conditions affecting the brain, such as epilepsy, and to identify the potential causes of certain symptoms, such as seizures or memory problems. In the context of sleep disorders, an EEG can be particularly useful in understanding the complexity of brain mechanisms during sleep and wake states. This information can be crucial in diagnosing and managing disorders such as attention deficit hyperactivity disorder (ADHD), depression, obesity, Parkinson's disease, and epilepsy.
There are different types of EEGs that can be performed, depending on the specific needs of the patient. A routine EEG is typically conducted while the patient is awake, but if this does not provide sufficient information, a sleep EEG may be recommended. In some cases, the patient may be asked to stay awake the night before the test to ensure they can sleep during the sleep EEG. Another variation is the ambulatory EEG, where brain activity is recorded continuously over one or more days while the patient goes about their daily activities. Video telemetry, or video EEG, is a special type of EEG where the patient is filmed simultaneously as the EEG recording is taken, providing additional context for understanding brain activity.
Overall, EEGs are an important tool in the diagnosis and management of sleep disorders, providing valuable insights into brain activity and functioning during sleep.
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Electro-oculography (EOG)
EOG signals are used to identify wake and REM stages as substantial eye movements occur during these stages. Sleep depth is correlated with eye movements—the movement slows down during deeper sleep. Accurate recording and clear display of eye movements are valuable because rolling eye movements signal the transition from wakefulness to light sleep, and rapid eye movements characterise REM sleep.
EOG is also used to assess the function of the pigment epithelium. During dark adaptation, the resting potential decreases slightly and reaches a minimum ("dark trough") after several minutes. When the light is switched on, a substantial increase in the resting potential occurs ("light peak"), which drops off after a few minutes when the retina adapts to the light. The ratio of the voltages (light peak divided by dark trough) is known as the Arden ratio. The patient is asked to switch eye positions repeatedly between two points (alternating between looking from the centre to the left and from centre to the right). Since these positions are constant, a change in the recorded potential originates from a change in the resting potential.
EOG, along with other methods such as electro-encephalography (EEG) and electromyography (EMG), are used to objectively identify different stages of sleep. These measurements are collectively known as polysomnography. The waking state is characterised by low-amplitude synchronisation of fast oscillations in the cortical EEG (also called activated EEG) in the range of 20–60 Hz and the presence of muscle tone in the EMG.
EOG is a useful technique in the diagnosis of sleep disorders. It is one of the methods used in sleep studies, which are common diagnostic tests that can help diagnose many conditions and sleep-related issues, including sleep apnea, narcolepsy, and restless leg syndrome.
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Pulse oximetry
The test involves placing a small adhesive sensor, called a pulse oximeter, on the tip of the index finger. Alternatively, it can be worn on the earlobe or forehead. The sensor uses a red light and measures changes in the colour of blood to detect oxygen desaturation and changes in heart rate. This information can indicate potential sleep disorders or lung conditions.
The accuracy of pulse oximetry can be influenced by certain factors, such as poor blood flow, sleep position, and sleep stages. To address these limitations, multiple channel recording devices have been developed to capture additional data, such as air flow, snoring, and head movement. These devices have shown high sensitivity and specificity in detecting sleep-disordered breathing.
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Multiple sleep latency testing
The MSLT is a full-day test that consists of four to five scheduled naps, each beginning two hours after the start of the previous nap. The night before the MSLT, the patient undergoes a sleep study to determine if another sleep disorder, such as sleep apnea, is causing their excessive daytime sleepiness. The patient is required to sleep at least six hours during this sleep study.
During each nap trial, the patient lies quietly in bed in a dark and quiet sleep environment and tries to fall asleep. Sensors are placed on the patient's head, face, and chin to show when they are asleep and awake, and to transmit data used to determine when they are in REM sleep. A low-light video camera also allows the technologist to observe the patient from a nearby room.
The patient will be awakened 15 minutes after they fall asleep, and if they do not fall asleep within 20 minutes, the nap trial will end. The test measures the mean sleep latency from all naps as the measure of sleepiness. A positive MSLT is obtained when the patient falls asleep with a mean sleep latency below 8 minutes in the naps and reaches REM sleep at least once (for idiopathic hypersomnia) or twice (for narcolepsy).
The results of the MSLT are examined by members of the sleep team, including a sleep technologist and a board-certified sleep medicine physician. The MSLT is considered valid and reliable and is part of the diagnostic criteria for narcolepsy and idiopathic hypersomnia. However, it is important to adhere to the established protocol to limit the effect of extraneous factors such as insufficient sleep, drugs, activity, and arousal level.
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Frequently asked questions
A polysomnogram, also known as a sleep study, is a common test used to diagnose sleep disorders. This test involves monitoring and recording various physiological parameters while the patient sleeps, including brain activity, heart rate, respiration, muscle activity, eye movements, and oxygen levels.
A sleep study can be conducted in a hospital, a sleep clinic, or at the patient's home. The location may depend on the complexity of the case and the availability of resources.
During a sleep study, sensors and electrodes are placed on the patient's body to collect data. This may include electroencephalography (EEG) sensors to detect brain waves, electro-oculography (EOG) sensors to record eye movements, and breathing sensors to monitor respiration. The patient's sleep is also typically recorded via video and audio to capture any unusual behaviours or movements.
There are several types of sleep studies, including overnight oximetry, polysomnography, and multiple sleep latency testing. The choice of test depends on the specific sleep disorder being investigated and the patient's individual needs.
