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Pulmonary Function Tests in Clinical Practice pp 265–317Cite as

Diagnostic Tests for Sleep Disorders

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Part of the book series: In Clinical Practice ((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.

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Notes

  1. 1.

    Also referred to as cycles per seconds or cps.

  2. 2.

    A positive voltage in EEG means a downward deflection and vice versa, a concept that sometimes is referred to as “negative up” rule.

  3. 3.

    Slow waves may be thought of as a series of two or more K complexes.

  4. 4.

    Right and left ocular electrodes are placed at the right outer canthus (ROC) and left outer canthus (LOC), respectively, with the right electrode placed slightly above and the left slightly below the eye level, in order to record vertical eye movements [40]. Keeping the eyeball polarity in mind, moving the eyes to the right will bring the cornea (relatively positive) of the right eye closer to the right ocular lead and the retina (relatively negative) of the left eye closer to the left ocular lead. This will result in a downward (positive) deflection at ROC and an upward (negative) deflection at LOC, which means that the deflections are out of phase (opposite direction). The same thing will happen if the eyes move upward, as the right ocular lead is at a higher level than the left one. The opposite thing should happen if the eyes move to the left or downward.

  5. 5.

    Some laboratories reference the ocular leads to the auricular leads in the same side, i.e., ROC-A2 and LOC-A1 or to one auricular lead, i.e., ROC-A2 and LOC A2 [45].

  6. 6.

    In paper recording, a 50-μV stimulus results in a 1-cm longitudinal deflection. This makes 75-μV equivalent to 1.5-cm deflection.

  7. 7.

    Once a REM sleep is identified, scorer scrolls backward and restudy the previous segment of sleep and rescore it according to this rule.

  8. 8.

    The patient may be asked to breathe through the mouth, which should show movement of chest and abdominal tracing but not the airflow tracing.

  9. 9.

    If sweat artifact is synchronous (in-phase) with respiration, it is called respiratory artifact.

  10. 10.

    Lights-out is the point in time at which lights are turned off to allow the patient to sleep; lights-on is when the patient is awakened in the morning.

  11. 11.

    Diaphragm becomes the only active inspiratory muscle during phasic REM.

  12. 12.

    It is hard to pinpoint a minimum duration of sleep sufficient enough to make a confident diagnosis from a PSG. We suggest a minimum duration (TST) of 3 hours with at least 10% of REM sleep.

  13. 13.

    An ODI of 10 is widely used as the cutoff point, which, if used, increases the sensitivity but may not significantly change the specificity if compared to an ODI of 15.

  14. 14.

    False negative oximetries occur mostly in nonobese patients or in those with short duration apneas. In the case of thin patients, FRC (O2 reserve) is preserved and O2 consumption is reduced compared with obese patients.

  15. 15.

    Drugs that affect sleep latency include sedatives, hypnotics, antihistamines and stimulants; drugs that affect REM latency include tricyclic antidepressants, monoamine oxidase inhibitors, lithium, selective serotonin reuptake inhibitors (SSRIs), and amphetamines [110]–[112].

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Authors and Affiliations

  1. Prince Sultan Military Medical City, Riyadh, Saudi Arabia

    Ali Altalag

  2. University of British Columbia, Vancouver, BC, Canada

    Jeremy Road & Pearce Wilcox

  3. University of British Columbia, Victoria, BC, Canada

    Kewan Aboulhosn

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  1. Ali Altalag
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  2. Jeremy Road
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  3. Pearce Wilcox
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  4. Kewan Aboulhosn
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Correspondence to Ali Altalag .

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Editors and Affiliations

  1. Prince Sultan Military Medical City, Riyadh, Saudi Arabia

    Ali Altalag

  2. University of British Columbia, Vancouver, BC, Canada

    Jeremy Road

  3. University of British Columbia, Vancouver, BC, Canada

    Pearce Wilcox

  4. University of British Columbia, Victoria, BC, Canada

    Kewan Aboulhosn

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Altalag, A., Road, J., Wilcox, P., Aboulhosn, K. (2019). Diagnostic Tests for Sleep Disorders. In: Altalag, A., Road, J., Wilcox, P., Aboulhosn, K. (eds) Pulmonary Function Tests in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-93650-5_10

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