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Diagnostic Tests for Sleep Disorders

  • Ali AltalagEmail author
  • Jeremy Road
  • Pearce Wilcox
  • Kewan Aboulhosn
Chapter
Part of the In Clinical Practice book series (ICP)

Abstract

We are fortunate to have a variety of investigations available when assessing for the large number of sleep breathing disorders, parasomnias, and other sleep abnormalities. In this chapter we review sleep stages and review sleep breathing pathology. We provide a discussion on components of attended and unattended polysomnography and their clinical use.

Keywords

Sleep disordered breathing Multiple sleep latency Nocturnal oximetry Sleep apnea Narcolepsy Flow-volume loop Polysomnogram Polysomnography Excessive Daytime Sleepiness Maintenance of Wakefulness Test 

References

  1. 1.
    Diagnostic Classification Steering Committee, Thorpy MJ. International Classification of sleep disorders: diagnostic and coding manual. Rochester: American Sleep Disorders Association; 1990.Google Scholar
  2. 2.
    Pack AI. Obstructive sleep apnea. Adv Intern Med. 1994;39:517–67.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc. 2004;79:1036–46.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension. A population-based study. Ann Intern Med. 1994;120:382–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320:479–82.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829–36.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, Skatrud J. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157:1746–52.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Grote L, Ploch T, Heitmann J, Knaack L, Penzel T, Peter JH. Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med. 1999;160:1875–82.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Leiby BE, Vela-Bueno A, Kales A. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 1984;160:2289–95.CrossRefGoogle Scholar
  12. 12.
    Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet (London, England). 2005;365:1046–53.CrossRefGoogle Scholar
  13. 13.
    Olson LG, King MT, Hensley MJ, Saunders NA. A community study of snoring and sleep-disordered breathing. Health outcomes. Am J Respir Crit Care Med. 1995;152:717–20.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Koskenvuo M, Kaprio J, Partinen M, Langinvainio H, Sarna S, Heikkilä K. Snoring as a risk factor for hypertension and angina pectoris. Lancet (London, England). 1985;1:893–6.CrossRefGoogle Scholar
  15. 15.
    Schmidt-Nowara WW, Coultas DB, Wiggins C, Skipper BE, Samet JM. Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity. Arch Intern Med. 1990;150:597–601.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnoea with myocardial infarction in men. Lancet (London, England). 1990;336:261–4.CrossRefGoogle Scholar
  17. 17.
    Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172:1447–51.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Simantirakis EN, Schiza SI, Marketou ME, Chrysostomakis SI, Chlouverakis GI, Klapsinos NC, Siafakas NS, Vardas PE. Severe bradyarrhythmias in patients with sleep apnoea: the effect of continuous positive airway pressure treatment: a long-term evaluation using an insertable loop recorder. Eur Heart J. 2005;25:1070–6.CrossRefGoogle Scholar
  19. 19.
    Tilkian AG, Guilleminault C, Schroeder JS, Lehrman KL, Simmons FB, Dement WC. Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med. 1977;63:348–58.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Carskadon MA, Dement WC. Nocturnal determinants of daytime sleepiness. Sleep. 1982;5(Suppl 2):S73–81.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Zwillich C, Devlin T, White D, Douglas N, Weil J, Martin R. Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest. 1982;69:1286–92.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Alonso-Fernandez A, Garcia-Rio F, Racionero MA. Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive sleep apnea-hypopnea syndrome and its mechanisms. Chest. 2005;127:15–22.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gami AS, Friedman PA, Chung MK, Caples SM, Somers VK. Therapy insight: interactions between atrial fibrillation and obstructive sleep apnea. Nat Clin Pract Cardiovasc Med. 2005;2:145–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–41.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med. 2005;172:1590–5.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bradley TD, Rutherford R, Grossman RF, Lue F, Zamel N, Moldofsky H, Phillipson EA. Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis. 1985;131:835–9.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Sajkov D, Cowie RJ, Thornton AT, Espinoza HA, McEvoy RD. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1994;149:416–22.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Guidry UC, Mendes LA, Evans JC, Levy D, O’Connor GT, Larson MG, Gottlieb DJ, Benjamin EJ. Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study. Am J Respir Crit Care Med. 2001;164:933–8.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Arias MA, García-Río F, Alonso-Fernández A, Martínez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J. 2006;27:1106–13.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Horne JA, Reyner LA. Sleep related vehicle accidents. BMJ. 1995;310:565–7.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Masa JF, Rubio M, Findley LJ. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Respir Crit Care Med. 2000;162:1407–12.CrossRefGoogle Scholar
  32. 32.
    American Thoracic Society. Sleep apnea, sleepiness, and driving risk. Am J Respir Crit Care Med. 1994;150:1463–73.Google Scholar
  33. 33.
    Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998;97:2154–9.CrossRefGoogle Scholar
  34. 34.
    Javaheri S, Parker TJ, Wexler L, Michaels SE, Stanberry E, Nishyama H, Roselle GA. Occult sleep-disordered breathing in stable congestive heart failure. Ann Intern Med. 1995;122:487–92.CrossRefGoogle Scholar
  35. 35.
    Dowdell WT, Javaheri S, McGinnis W. Cheyne-Stokes respiration presenting as sleep apnea syndrome. Clinical and polysomnographic features. Am Rev Respir Dis. 1990;141:871–9.CrossRefGoogle Scholar
  36. 36.
    Enright PL. The Six-Minute Walk Test. Arch Phys Med Rehabil. 2012;93:1359–64.CrossRefGoogle Scholar
  37. 37.
    Brazier MAB. The electrical fields at the surface of the head during sleep. Electroencephalogr Clin Neurophysiol. 1949;1:195–204.CrossRefGoogle Scholar
  38. 38.
    Sun X, Hansen JE, Oudiz R, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation. 2011;104(4):429–35.CrossRefGoogle Scholar
  39. 39.
    Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, Troester MT, Vaughn BV. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med. 2017;13:665–6.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Rechtschaffen A, Kales A, editors. A manual of standardized terminology: techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain Research Institute; 1968.Google Scholar
  41. 41.
    Blake H, Gerard RW, Kleitman N. Factors influencing brain potentials during sleep. J Neurophysiol. 1939;2:48–60.CrossRefGoogle Scholar
  42. 42.
    Jasper HH. The ten twenty electrode system of the International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl. 1958;52:3–6.Google Scholar
  43. 43.
    DiPerri R, Meduri M, DiRosa AE, Simone F. Sleep spindles in healthy people: I) Quantitative, automatic analysis in youngadult subjects. Boll Soc Ital Biol. 1977;53:983–9.Google Scholar
  44. 44.
    Berger RJ, Olley P, Oswald I. The EEG eye movements and dreams of the blind. Psychology. 1962;14:182–6.Google Scholar
  45. 45.
    Keenan S, Hirshkowitz M. Monitoring and staging human sleep. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 5th ed. St. Louis: Elsevier Saunders; 2011. p. 1602–9.CrossRefGoogle Scholar
  46. 46.
    American Sleep Disorders Association. The Atlas Task Force: EEG arousals: scoring rules and examples. Sleep. 1992;15:174–84.CrossRefGoogle Scholar
  47. 47.
    Johnson LC, Nute C, Austin MT, Lubin A. Spectral analysis of the EEG during waking and sleeping. Electroencephalogr Clin Neurophysiol. 1967;23:80.PubMedGoogle Scholar
  48. 48.
    Mathur R, Douglas NJ. Frequency of EEG arousals from nocturnal sleep in normal subjects. Sleep. 1995;18:330–3.CrossRefGoogle Scholar
  49. 49.
    Carskadon MA, Brown ED, Dement WC. Sleep fragmentation in the elderly: relationship to daytime sleep tendency. Neurobiol Aging. 1982;3:321–7.CrossRefGoogle Scholar
  50. 50.
    Bliwise D, Bliwise NG, Kraemer HC, Dement W. Measurement error in visually scored electrophysiological data: respiration during sleep. J Neurosci Methods. 1984;12:49–56.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Calverley PMA, Shapiro CM, Caterall JR. Breathing and oxygenation during sleep are similar in normal men and normal women. Am Rev Respir Dis. 1985;132:86–8.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Bradley TD, Brown IG, Zamel N, Phillipson EA, Hoffstein V. Differences in pharyngeal properties between snorers with predominantly central sleep apnea and those without sleep apnea. Am Rev Respir Dis. 1987;135:387–91.PubMedPubMedCentralGoogle Scholar
  53. 53.
    John, et al. Canadian Thoracic Society guidelines: diagnosis and treatment of sleep disordered breathing in adults. Can Respir. 2007;13:387–92.Google Scholar
  54. 54.
    West P, Kryger MH. Continuous monitoring of respiratory variables during sleep by microcomputer. Methods Inf Med. 1983;22:198–203.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Block AJ, Boysen PG, Wynne JW, Hunt LA. Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med. 1979;300:513–7.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993;104:781–7.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Guilleminault C, Stoohs R, Kim YD, Chervin R, Black J, Clerk A. Upper airway sleep-disordered breathing in women. Ann Intern Med. 1995;122:493–501.CrossRefGoogle Scholar
  58. 58.
    Guilleminault C, Stoohs R, Clerk A, Simmons J, Labanowski M. Excessive daytime somnolence in women with abnormal respiratory efforts during sleep. Sleep. 1993;16:S137–8.CrossRefGoogle Scholar
  59. 59.
    The Atlas Task Force of the American Sleep Disorders Association: recording and scoring leg movements. Sleep. 1993;16:749–59.Google Scholar
  60. 60.
    Berry RB. Sleep medicine pearls. 1st ed. Philadelphia: Hanley Belfus; 1999.Google Scholar
  61. 61.
    Netzer N, Eliasson AH, Netzer C, Kristo DA. Overnight pulse 1340 oximetry for sleep-disordered breathing in adults: a review. Chest. 2001;120:625–33.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Miller WP. Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome. Prevalence and significance. Am J Med. 1982;73:317–21.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52:490–4.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Burger D, Catani P, West J. Multidimensional analysis of sleep electrophysiological signals. Biol Cybern. 1977;26:131–9.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Gath I, Bar-on E. Computerized method for scoring of polygraphic sleep recordings. Comput Programs Biomed. 1980;11:217–23.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Ray SR, Lee WD, Morgan CD, Airth-Kindree W. Computer sleep stage scoring--an expert system approach. Int J Biomed Comput. 1986;19:43–61.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Gaillard JM, Tissot R. Principles of automatic analysis of sleep records with a hybrid system. Comput Biomed Res. 1973;6:1–13.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Martens WLJ, Declerck AC, Wauquier A, Stefan H, Burr W, Kums DJ, Thm. Considerations on a computerized analysis of long-term polygraphic recordings. 1982. p. 265–74. In: Stefan H, Burr W, editors. Mobile long term: Proceedings of the MLE Symposium. New york: Fischer; 1982. p. 205–17.Google Scholar
  69. 69.
    Agnew HW, Webb WB. Measurement of sleep onset by EEG criteria. Am J EEG Tachnil. 1972;12:127–34.CrossRefGoogle Scholar
  70. 70.
    Webb WB. Recording methods and visual scoring criteria of sleep records: comments and recommendations. Percept Mot Skills. 1986;62:664–6.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Kryger MH, Thomas R, William CD. Principle and practice of sleep medicine. 2nd ed. Philadelphia: Saunders; 1994.Google Scholar
  72. 72.
    Dement WC, Kleitman N. Cyclic variations in EEG during sleep and their relation to eye movements, body motility, and dreaming. Electroencephalogr Clin Neurophysiol. 1957;9:673–90.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Montplaisir J, Billiard M, Takahashi S, Bell IR, Guilleminault C, Dement WC. Twenty-four-hour recording in REM-narcoleptics with special reference to nocturnal sleep disruption. Biol Psychiatry. 1978;13:73–89.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Vogel G. Studies in the psychophysiology of dreams ill dreams narcolepsy. Arch Gen Psychiatry. 1960;3:421–8.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Dement WC, Carskadon MA, Richardson GS, Guilleminault C. Excessive daytime sleepiness in the sleep apnea syndrome. In: Alan R, editor. Sleep apnea syndrome. New York: Liss Inc.; 1978. p. 23–46.Google Scholar
  76. 76.
    Sackner MA, Landa J, Forrest T, Greeneltch D. Periodic sleep apnea: chronic sleep deprivation related to intermittent upper airway obstruction and central nervous system disturbance. Chest. 1975;67:164–71.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Phillipson EA, Sullivan CE, Read DJ, Murphy E, Kozar LF. Ventilatory and waking responses to hypoxia in sleeping dogs. J Appl Physiol. 1978;44:512–20.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Phillipson EA, Kozar LF, Rebuck AS, Murphy E. Ventilatory and waking responses to CO2 in sleeping dogs. Am Rev Respir Dis. 1997;115:251–9.Google Scholar
  79. 79.
    Karacan I. The developmental aspect and the effect of certain clinical conditions upon penile erection during sleep. Excerpta Med. 1966;150:2356–9.Google Scholar
  80. 80.
    Parmeggiani PL, Orem J, Barnes CD. Temperature regulation during sleep: a study in homeostasis. In: Orem J, Barnes CD, editors. Physiology in sleep. Research topics in physiology, vol 3. New York: Academic. p. 97–143.Google Scholar
  81. 81.
    Chesson AL, Berry RB, Pack A, American Academy of Sleep Medicine, American Thoracic Society, American College of Chest Physicians. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Sleep. 2003;26:907–13.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia MJ, Schwab RJ. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007;3:737–47.PubMedPubMedCentralGoogle Scholar
  83. 83.
    Blackman A, McGregor C, Dales R, et al. Canadian Sleep Society/Canadian Thoracic Society position paper on the use of portable monitoring for the diagnosis of obstructive sleep apnea/hypopnea in adults. Can Respir J. 2010;17:229–32.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ. 2014;186:25–51.CrossRefGoogle Scholar
  85. 85.
    Bennett JA, Kinnear WJ. Sleep on the cheap: the role of overnight oximetry in the diagnosis of sleep apnoea hypopnoea syndrome. Thorax. 1999;54:958–9.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991;46:85–90.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Rauscher H, Popp W, Zwick H. Computerized detection of respiratory events during sleep from rapid increases in oxyhemoglobin saturation. Lung. 1991;169:335–42.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Kripke DF, Ancoli-Israel S, Klauber MR, Wingard DL, Mason WJ, Mullaney DJ. Prevalence of sleep-disordered breathing in ages 40-64 years: a population-based survey. Sleep. 1997;20:65–76.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P. Sleep-disordered breathing in women: occurrence and association with coronary artery disease. Am J Med. 1996;101:251–6.CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Epstein LJ, Dorlac GR. Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome. Chest. 1998;113:97–103.CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Loube DI, Andrada TF. Comparison of respiratory polysomnographic parameters in matched cohorts of upper airway resistance and obstructive sleep apnea syndrome patients. Chest. 1999;115:1519–24.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Cooper BG, Veale D, Griffiths CJ, Gibson GJ. Value of nocturnal oxygen saturation as a screening test for sleep apnoea. Thorax. 1991;46:586–8.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Sano K, Nakano H, Ohnishi Y, Ishii Y, Nakamura T, Matuzawa K, Maekawa J, Narita N [Screening of sleep apnea/hypopnea syndrome by home pulse oximetry]. Nihon Kokyuki Gakkai Zasshi. 1998;36:948–52.Google Scholar
  94. 94.
    Ryan PJ, Hilton MF, Boldy DA, Evans A, Bradbury S, Sapiano S, Prowse K, Cayton RM. Validation of British Thoracic Society guidelines for the diagnosis of the sleep apnoea/hypopnoea syndrome: can polysomnography be avoided? Thorax. 1995;50:972–5.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Deegan PC, McNicholas WT. Predictive value of clinical features for the obstructive sleep apnoea syndrome. Eur Respir J. 1996;9:117–24.CrossRefPubMedPubMedCentralGoogle Scholar
  96. 96.
    Levy P, Pepin JL, Deschaux-Blanc C, et al. Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest. 1996;109:395–9.CrossRefPubMedPubMedCentralGoogle Scholar
  97. 97.
    Vazquez JC, Tsai WH, Flemons WW, et al. Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnea. Thorax. 2000;55:302–7.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Williams AJ, Yu G, Santiago S, Stein M. Screening for sleep apnea using pulse oximetry and a clinical score. Chest. 1991;100:631–5.CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    Rauscher H, Popp W, Zwick H. Model for investigating snorers with suspected sleep apnoea. Thorax. 1991;48:275–9.CrossRefGoogle Scholar
  100. 100.
    Peck T. Waveforms are needed to interpret figures shown by pulse oximeters [letter]. BMJ. 1999;1353:318.Google Scholar
  101. 101.
    Redline S, Sanders M. Hypopnea, a floating metric: implications for prevalence, morbidity estimates, and case finding. Sleep. 1997;20:1209–17.CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Arn H, David A. Nikolaus Netzer, and Kristo: Overnight pulse oximetry for sleep-disordered breathing in adults. Chest. 2001;120:625–33.CrossRefGoogle Scholar
  103. 103.
    Ullmer E, Strobel WM, Solèr M. Cheyne-stokes respiration or obstructive sleep apnoea: patterns of desaturation. Respiration. 2000;67:203.CrossRefPubMedPubMedCentralGoogle Scholar
  104. 104.
    Calderon-Osuna E, Carmona BC, Arenas GM, et al. A comparative study with chronic obstructive pulmonary disease with and without obstructive sleep apnea syndrome. Arch Bronchoneumol. 1999;35:539–43.CrossRefGoogle Scholar
  105. 105.
    Kramer MR, Krivoruk V, Lebzelter J, Liani M, Fink G. Quantitative 15 steps exercise oximetry as a marker of disease severity in patients with chronic obstructive pulmonary disease. Isr Med Assoc J. 1999;1:165–8.PubMedPubMedCentralGoogle Scholar
  106. 106.
    Carskadon MA, Dement WC. Cumulative effects of sleep restriction on daytime sleepiness. Psychophysiology. 1981;18:107–13.CrossRefPubMedPubMedCentralGoogle Scholar
  107. 107.
    Carskadon MA, Dement WC. Effects of total sleep loss on sleep tendency. Percept Mot Skills. 1981;48:495–506.CrossRefGoogle Scholar
  108. 108.
    Carskadon MA, Harvey K, Dement WC. Sleep loss in young adolescents. Sleep. 1981;4:299–312.CrossRefPubMedPubMedCentralGoogle Scholar
  109. 109.
    Carskadon MA, Dement WC. Sleep loss in elderly volunteers. Sleep. 1985;8:207–21.CrossRefPubMedPubMedCentralGoogle Scholar
  110. 110.
    Dement WC, Seidel W, Carskadon M. Daytime alertness, insomnia, and benzodiazepines. Sleep. 1982;5:528–45.Google Scholar
  111. 111.
    Lumley M, Roehrs T, Asker D, Zorick F, Roth T. Ethanol and caffeine effects on daytime sleepiness/alertness. Sleep. 1987;10:306–12.PubMedPubMedCentralGoogle Scholar
  112. 112.
    Roehrs T, Tietz EI, Zorick F, Roth T. Daytime sleepiness and antihistamines. Sleep. 1984;7(2):137–41.Google Scholar
  113. 113.
    Richardson GS, Carskadon MA, Flagg W, Van den Hoed J, Dement WC, Mitler MM. Excessive daytime sleepiness in man: multiple sleep latency measurement in narcoleptic and control subjects. Electroencephalogr Clin Neurophysiol. 1978;45:621–7.CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Mitler MM, Van den Hoed J, Carskadon MA, Richardson G, Park R, Guilleminault C, Dement WC. REM sleep episodes during the Multple Sleep Latency Test in narcoleptic patients. Electroencephalogr Clin Neurophysiol. 1979;46:479–81.CrossRefPubMedPubMedCentralGoogle Scholar
  115. 115.
    Richardson GS, Carskadon MA, Orav EJ, Dement WC. Circadian variation of sleep tendency in elderly and young adult subjects. Sleep. 1982;5(Suppl 2):S82–94.CrossRefPubMedPubMedCentralGoogle Scholar
  116. 116.
    Hartse KM, Roth T, Zorick FJ. Daytime sleepiness and daytime wakefulness: the effect of instruction. Sleep. 1982;5(Suppl 2):S107–18.PubMedPubMedCentralGoogle Scholar
  117. 117.
    Carskadon MA. The second decade. In: Guilleminault C, editor. Sleeping and waking disorders: indications and techniques. Menlo Park: Addison Wesley; 1982. p. 99–125.Google Scholar
  118. 118.
    Sullivan SS, Kushida CA. Multiple sleep latency test and maintenance of wakefulness test. Chest. 2008;134(4):854–61. https://doi.org/10.1378/chest.08-0822.
  119. 119.
    Browman CP, Gujavarty KS, Yolles SF, Mitler MM. Forty-eight-hour polysomnographic evaluation of narcolepsy. Sleep. 1986;9:183–8.CrossRefPubMedPubMedCentralGoogle Scholar
  120. 120.
    Carskadon MA, Littell WP, Dement WC. Constant routine: alertness, oral body temperature, and performance. Sleep Res. 1985;14:293.Google Scholar
  121. 121.
    Van den Hoed J, Kraemer H, Guilleminault C, et al. Disorders of excessive daytime somnolence: polygraphic and clinical data for 100 patients. Sleep. 1981;4:23–37.CrossRefPubMedPubMedCentralGoogle Scholar
  122. 122.
    Guilleminault C, Dement WC. 235 Cases of excessive daytime sleepiness. Diagnosis and tentative classification. J Neurol Sci. 1977;31:13–27.CrossRefPubMedPubMedCentralGoogle Scholar
  123. 123.
    Carskadon MA. The role of sleep onset REM periods in narcolepsy. In: Guilleminault C, Dement WC, Passouant P, editors. Narcolepsy. New York: Spectrum; 1976. p. 499–517.Google Scholar
  124. 124.
    Reynolds CF, Coble PA, Kupfer DJ, Holzer BC. Application of the multiple sleep latency test in disorders of excessive sleepiness. Electroencephalogr Clin Neurophysiol. 1982;53:443–52.CrossRefPubMedPubMedCentralGoogle Scholar
  125. 125.
    Zorick F, Roehrs T, Koshorek G, Sicklesteel J, Hartse K, Wittig R, Roth T. Patterns of sleepiness in various disorders of excessive daytime somnolence. Sleep. 1982;5(Suppl 2):S165–74.CrossRefPubMedPubMedCentralGoogle Scholar
  126. 126.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.CrossRefPubMedPubMedCentralGoogle Scholar
  127. 127.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP Questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.CrossRefPubMedPubMedCentralGoogle Scholar
  128. 128.
    Chung F, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108:768–75.CrossRefPubMedPubMedCentralGoogle Scholar
  129. 129.
    Chung F, Abdullah HR, Liao P. STOP-bang questionnaire a practical approach to screen for obstructive sleep apnea. Chest. 2016;149:631–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Ali Altalag
    • 1
    Email author
  • Jeremy Road
    • 2
  • Pearce Wilcox
    • 2
  • Kewan Aboulhosn
    • 3
  1. 1.Prince Sultan Military Medical CityRiyadhSaudi Arabia
  2. 2.University of British ColumbiaVancouverCanada
  3. 3.University of British ColumbiaVictoriaCanada

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