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Presentaties ISMC - When and how to study sleep, why do we sleep

Q: What are the key points for recording and analyzing sleep for diagnostics?

Recording sleep is crucial for diagnostics. Polysomnography is the main standard. Variations : ambulatory vs. clinical methods. Polygraphy is used with suspicion of uncomplicated OSA. Detailed reporting from events to trends. Surrogate measures : actigraphy with specific indicators. Avoid unnecessary diagnostics and false positives.

Q: What is associated with antidepressant use according to PSG?

Long REM sleep delay is commonly linked to the use of antidepressants.

Q: What are the PSG and subjective sleep metrics shown?

PSG: TST: 6 hr 53 min Sleep onset: 5 min Subjective: TST: 2 hr Sleep onset: 90 min

Q: What is shown in a polysomnography graph?

Hypnogram : Displays sleep stages over time. SpO2 : Monitors oxygen saturation levels. Apnea events : Indicates obstructive, central, and mixed. Respiratory data : Includes respiration rate and snoring. Brain waves : Alpha and delta activities. Position Summary : Shows body position changes.

Q: What does the actigraphy data reveal about sleep patterns?

Lights out : 22:15 to 23:00 Fell asleep : 22:23 to 23:06 Woke up : 6:29 to 8:19 Got up : 6:30 to 8:30 Time in bed : 7:30 to 10:00 Assumed sleep : 7:26 to 9:49 Actual sleep (%) : 88.9 to 93.9 Actual wake time : 0:28 to 0:54 Actual wake (%) : 6.1 to 11.1 Sleep efficiency (%) : 83.3 to 92.8 Sleep latency : 00:00 to 00:57 Sleep bouts : 19 to 49

Q: What symptoms and issues are presented in Case S4?

Age/Sex : 38-year-old man Symptoms : Daytime sleepiness, affects work/social life Incident : Almost had a car accident No issues : Hallucinations, sleep paralysis, cataplexy, weight gain Sleep diary : 7 hours on weekdays, 8 hours on weekends No difference : Daytime complaints on weekends/holidays

73 important questions on Presentaties ISMC - When and how to study sleep, why do we sleep

What are the key points for recording and analyzing sleep for diagnostics?

Recording sleep is crucial for diagnostics.
Polysomnography is the main standard.
Variations: ambulatory vs. clinical methods.
Polygraphy is used with suspicion of uncomplicated OSA.
Detailed reporting from events to trends.
Surrogate measures: actigraphy with specific indicators.
Avoid unnecessary diagnostics and false positives.

What is associated with antidepressant use according to PSG?

Long REM sleep delay is commonly linked to the use of antidepressants.

What are the PSG and subjective sleep metrics shown?

PSG:
- TST: 6 hr 53 min
- Sleep onset: 5 min
Subjective:
- TST: 2 hr
- Sleep onset: 90 min

What are the key aspects of MSLT guidelines?

Integral to diagnosing hypersomnolence disorders.
Challenging to perform but impacts outcomes.
Conducted in a quiet, dark, comfortable room.
Involves 5 episodes.
Updated guidelines as of 2021.

What is shown in a polysomnography graph?

Hypnogram: Displays sleep stages over time.
SpO2: Monitors oxygen saturation levels.
Apnea events: Indicates obstructive, central, and mixed.
Respiratory data: Includes respiration rate and snoring.
Brain waves: Alpha and delta activities.
Position Summary: Shows body position changes.

How did the patient perceive their sleep during the MSLT tests?

Test 1: 2
Test 2: 3-4
Test 3: 5
Test 4: 6
Overall perception varied from 2 to 6.

What does the actigraphy data reveal about sleep patterns?

Lights out: 22:15 to 23:00
Fell asleep: 22:23 to 23:06
Woke up: 6:29 to 8:19
Got up: 6:30 to 8:30
Time in bed: 7:30 to 10:00
Assumed sleep: 7:26 to 9:49
Actual sleep (%): 88.9 to 93.9
Actual wake time: 0:28 to 0:54
Actual wake (%): 6.1 to 11.1
Sleep efficiency (%): 83.3 to 92.8
Sleep latency: 00:00 to 00:57
Sleep bouts: 19 to 49

What were the average sleep latency and number of SLTs with REM sleep?

Gemiddelde slaaplatentie: 7.6 min.
Aantal SLT's met REM-slaap: 4

What are the key components of Case S4 regarding sleep extension?

Detailed explanation of sleep extension relevance.
Agreement to extend sleep for 6 weeks.
Aim for 9 hours in bed to increase sleep chances.

What symptoms and issues are presented in Case S4?

Age/Sex: 38-year-old man
Symptoms: Daytime sleepiness, affects work/social life
Incident: Almost had a car accident
No issues: Hallucinations, sleep paralysis, cataplexy, weight gain
Sleep diary: 7 hours on weekdays, 8 hours on weekends
No difference: Daytime complaints on weekends/holidays

What is the added value of ambulant 24-hr PSG compared to standard PSG?

24-hr PSG provides an extended monitoring period.
Detects sleep patterns outside typical night-time.
Captures full sleep cycle, including REM and stages N1, N2, N3.
Ensures more comprehensive data than standard PSG.

What are the key issues faced by the 20-year-old man in Case L3?

Lifelong sleep issues: difficulty falling and maintaining sleep
Diagnosed with PDD-NOS
Shifted sleep-wake rhythm
Daytime energy depletion, no hypersomnolence
Nighttime computer gaming
Assessment is needed

What criteria are used for diagnosing non-REM parasomnia according to Zadra et al.?

Diagnosis relies on history, circumstances, and PSG results.
Confident diagnosis of non-REM parasomnia is possible.
Alternative modalities involve:
- PSG with stimulation during N3
- PSG after sleep deprivation (overnight, 4 hours in morning)
Direct awakenings from N3 sleep are used.
Clinical correlate is preferred.

What were the reported behaviors and movements during the PSG for parasomnia?

23:08:25, Epoch 235: Open movement, turns on stomach.
23:34:22, Epoch 287: Looks straight, later turns on back.
0:14:55, Epoch 368: Raises head, rubs eyes, says "yes, super".
0:29:39, Epoch 397: Wakes, opens eyes, says "go now".
1:34:43, Epoch 528: Raises head, looks, resettles.
2:47:11, Epoch 873: Moves, groans painfully.
6:12:09, Epoch 1082: Movement less visible, under covers.

What parameters are recorded in overnight polysomnography?

Hypnogram: sleep stages over time.
Position Summary: body positions during sleep.
SpO2: blood oxygen levels.
Apneas: general, obstructive, mixed, and central types.
Arousals/HR/EMG: sleep disturbances, heart rate, and muscle activity.

What are the key points and considerations for Case S3 related to sleepwalking and possible diagnosis?

Physician suggested possible sleepwalking during rehabilitation, resulting in a referral.
Sleepwalking occurred in childhood but ceased around age 10.
No recent sleepwalking episodes reported.
Continued prominent sleep talking is noted.
Requires approximately 9 hours of sleep.
No known family history of parasomnia.
Possible diagnosis and work-up considerations needed.

What events led to the injuries of the 18-year-old female student in Case S3?

Attended a party, consumed about 7 beers.
Slept at a friend’s house, on the 2nd floor.
Found unconscious outside around 5:30 a.m. by police.
Open window discovered.

What defines PLM (Periodic Limb Movements) during sleep?

Sequence of 4 or more limb movements (LM’s).
Intervals of 5-90 seconds between movements.
Excludes movements caused by other sleep events.
Not scored within 0.5 seconds of respiratory events.
LM's mimic hypopnea via nasal flow signal movement.

What were the injuries sustained by the patient and the subsequent concerns?

Suffered concussion and several vertebral fractures.
Bilateral humeral fracture and bladder tear identified.
Drug use was suspected but denied.
Denied depression and suicidal attempt.

What does the data indicate regarding PLMI and AHI?

PLMI (Periodic Limb Movement Index): 151
AHI (Apnea-Hypopnea Index): 6
This suggests a high frequency of limb movements but a low apnea-hypopnea frequency during sleep.

What are the key components to interpret in a polysomnography?

EEG (Electroencephalogram): Detects brain wave activity.
EOG (Electrooculogram): Measures eye movements.
EMG (Electromyogram): Monitors muscle tension.
ECG (Electrocardiogram): Tracks heart activity.
Respiratory Channels: Includes abdominal and thoracic effort.
Oxygen Saturation: Evaluates blood oxygen levels.
Pulse Rate: Indicates heart rate.

What information does a PSG record contain?

PSG stands for polysomnography.
Records brain waves, oxygen levels, and heart rate.
Monitors eye and leg movements.
Tracks breathing patterns.
Important for diagnosing sleep disorders.

What are the key details and significance of the findings in Case L2?

56-year-old man, BMI 33
Symptoms: Snoring, breathing pauses, hypersomnolence
No restless legs complaints
PSG findings: AHI 44/hr, PLMI 51/hr
High PLMI may indicate periodic limb movements during sleep.

What was the treatment outcome for the patient with obstructive sleep apnea and REM sleep behavior disorder?

Nasal CPAP was initiated.
Residual AHI of 1.5 at CPAP 7.0 cm H2O.
Treatment was well tolerated.
Significant reduction in nocturnal behaviors within 2 weeks.
No current need for additional medication.

What does a polysomnography record and what are its components?

Records sleep patterns.
Measures brain waves, oxygen levels, heart rate, breathing.
Captures eye/leg movements.
Used for sleep disorders diagnosis.
Includes EEG, EOG, EMG.

What is the vPSG procedure and criteria for RBD according to Cesari et al?

Recommendation to add extra EMG.
Prefer M flexor digitorum superficialis.
Minimum 5 minutes of REM sleep required.
3-sec epochs: EMG activity indicates RSWA.
RSWA >31.9% of REM sleep is abnormal.

What is the purpose of polysomnography and what data does it record?

Polysomnography is used for studying sleep.
Records brain waves, oxygen levels, heart rate.
Monitors blood pressure, breathing.
Captures eye and leg movements during sleep.

What are the key points regarding the patient's treatment and symptoms in Case S2?

Clonazepam was started by the neurologist at a dose up to 1.5 mg.
Nighttime complaints worsened with clonazepam use.
Morning sedation was noted.
Sleepiness occurred during the day.

What are the details of the Case S2 regarding the 68-year-old male's nighttime behaviors?

Age: 68 years old
Duration: 4-year history
Frequency: Four times per week
Timing: Second half of the night
Behaviors: Talking, screaming, cursing, kicking
Incidents: Has hit his wife twice
Awakening: Easily awakened, often with congruent dream recollection

What are the key differences between polygraphy and polysomnography?

Polygraphy excludes EEG, EOG, and EMG.
No measurement of sleep stages, arousals, or leg movements.
Hypopneas not followed by arousal are missing.
AHI calculated over assumed sleep, not actual sleep.

What are the key findings from the PG and PSG results?

PG Findings:
- 7 hr 48 min TIB
- 164 respiratory events
- AHI 21/hr
PSG Findings:
- 5 hr 54 min TST
- 169 respiratory events
- AHI 29/hr
- Information on evening and night sleep

What components are shown in the PSG overview graph?

Sleep Stages: REM, N1, N2, N3
Non-Sleep Periods: Possible in graph
Time Intervals: Marked from 16:00 to 04:00
Movement/Activity: Periods of activity displayed
Amplitude: Fluctuations visible in amplitude over time

What are the symptoms and key details for Case L1a?

Age: 60 years old
BMI: 28
Symptoms:
- Hypertension, difficult to treat
- Concentration problems
- Loud snoring
- Problems falling asleep, frequent and long awakenings

What characterizes hypopnea events in PG and PSG recordings?

PG and PSG: Includes hypopnea with desaturation and arousal.
Only PSG: Records hypopnea with arousal but without desaturation.

What is the indication for measuring sleep in Case L1a and which method to use?

Indication: Yes, sleep measurement is indicated.
Method:
- Consider PSG (Polysomnography) for detailed analysis.

What are the key details from the subsequent PSG regarding sleep time and interruptions?

Total in Bed (TIB): 8 hours
Total Sleep Time (TST): 7 hours
Wake After Sleep Onset (WASO): 62 minutes

What does the Apnea Hypopnea Index (AHI) indicate in this PSG?

AHI is 25 per hour
Obstructive events are 12 per hour

What can be considered a first-line test for uncomplicated OSA when there is a high clinical suspicion?

Ambulatory polygraphy is a first-line test for suspected uncomplicated OSA.
Results include:
- AHI: 6/hr
- ODI 3%: 7/hr
- Recording time: 5 hr 47 minutes

What are the symptoms and profile of the patient in Case L1?

Age/Gender: 53-year-old man
BMI: 23
Symptoms: Daytime sleepiness, concentration issues
Observations: Snoring, breathing pauses (by wife)
Other complaints: Insomnia, restless legs
ESS: 11

How are hypopneas and arousals characterized in this PSG?

Hypopnea with desaturations: 5 per hour
Hypopnea with arousal: 8 per hour

What methods are included in the palette of sleep diagnostics for assessing sleep?

Sleep-wake diary.
Questionnaires.
Laboratory tests for melatonin curves, hypocretin-1, secondary RLS-lab tc.
Sleep 'surrogates': actigraphy, PAT, polygraphy (PG).
Polysomnography (PSG): ambulatory, clinical.
Video-polysomnography:
- Esophageal pressure, capnography.
- EMG (RBD, bruxism, etc).
- EEG (sleep-related epilepsy).
PSG after sleep deprivation.
24-hour PSG recording.
Daytime tests:
- Multiple Sleep Latency Test.
- Maintenance of Wakefulness Test.

Is there an indication for measuring sleep, and if so, which modality is suggested?

Indication: Yes, due to symptoms and observations.
Modality: Sleep study (polysomnography) recommended to assess sleep apnea and related conditions.

What do the Oxygen Desaturation Index (ODI) and PLM indices reveal from this PSG?

ODI 3%: 14 per hour
Periodic Limb Movement (PLM) Index: 38 per hour
PLM-arousal index: 9 per hour

What are the reasons to objectively study sleep?

Confirmation of a suspected diagnosis
Exclusion of potentially mimicking other sleep disorders
Detection or exclusion of comorbid sleep disorders
Estimation of relevance or severity
Assessing treatment effectiveness
Relevance to/interaction with other medical disorders

What are the different survival strategies depicted in this collection?

Yeast: Utilizes spores for survival.
Pine cone: Contains seeds for reproduction.
Deciduous tree: Undergoes seasonal dormancy.
Rotifer: Forms cysts or resting eggs.
Cecropia moth: Enters diapause.
Snails: Undergo estivation.

What does the EEG data reveal about the beluga's brain activity?

Beluga Sleep Patterns: EEG shows different patterns for right (R) and left (L) hemispheres.
EEG: Beluga, left hemisphere active compared to right.
Comparison: Similar distinctive patterns in rats.
EEG Units: Measured in microvolts (µV), time scale is in minutes.

How do sleep patterns differ between a brushtail possum and an elephant according to J. Siegel, Nature 2005?

Brushtail Possum:
- Total sleep: 18 hours
- REM sleep: 6.6 hours
Elephant:
- Total sleep: 3.9 hours
- REM sleep: 1.8 hours

What anatomical information is provided about the beluga and other animals?

Brain Cross-Section: Image roughly 1 cm in scale.
Species Comparison: Beluga's brain contrasted with rat's brain.
Imaging: Shows structural insights into brain differences between species.

What are the sleep characteristics of the golden-mantled ground squirrel and its close phylogenetic counterpart?

Golden-mantled ground squirrel:
- Total sleep: 15.9 hours
- REM sleep: 3.0 hours
Daurian pika:
- Total sleep: 2.7 hours
- REM sleep: 0 hours

What organisms are depicted and referenced in the scientific context by Allada et al, Curr Biol 2008?

Zebrafish (Image A)
- Common model organism for vertebrate studies.
Fruit fly (Image B)
- Drosophila, crucial in genetic research.
Nematode (Image C)
- Caenorhabditis elegans, used in developmental biology.

How do sleep patterns compare between domestic cats and genets?

Domestic cat:
- Total sleep: 12.5 hours
- REM sleep: 3.2 hours
Genet:
- Total sleep: 6.3 hours
- REM sleep: 1.3 hours

What are the consequences of reduced sleep according to the provided information?

Inattention: Reduced ability to focus.
Depression: Increased risk of mood disorders.
Obesity: Potential weight gain issues.
Infections: Greater susceptibility to illness.

Describe the sleep duration of owl monkeys compared to humans.

Owl monkey:
- Total sleep: 17.0 hours
- REM sleep: 1.9 hours
Human:
- Total sleep: 8.3 hours
- REM sleep: 1.9 hours

What are some different levels of activity in animals, from low to high?

Hibernation: Ground squirrel shows minimal activity.
Torpor: Hummingbird has reduced metabolic rate.
Sleep: Dog experiences regular rest periods.
Periods of Sleeplessness: Walrus might stay awake extensively.
Reduced Sleep during Migration: White-crowned sparrow cuts rest for movement.
Post-partum Constant Activity: Killer whale and calf stay highly active post-birth.

What are the sleep patterns for guinea pigs and baboons in different phylogenetic orders?

Guinea pig:
- Total sleep: 9.4 hours
- REM sleep: 0.8 hours
Baboon:
- Total sleep: 9.4 hours
- REM sleep: 1.9 hours

What protein is associated with cerebral amyloid angiopathy and Alzheimer's disease?

Amyloid Precursor Protein (APP) is associated.
APP is cleaved to form Aβ (Amyloid Beta).
Aβ can lead to Cerebral Amyloid Angiopathy and Alzheimer’s Disease.

How does the sleep schedule differ between goats and eastern spotted skunks?

Goat:
- Total sleep: 3.9 hours
- REM sleep: 0.6 hours
Eastern spotted skunk:
- Total sleep: 3.9 hours
- REM sleep: 0.5 hours

What are three benefits of increased sleep depicted in the diagram?

Emotional Processing: Supports emotional health and stability.
Learning: Enhances cognitive functions and memory retention.
Neurogenesis: Stimulates the growth of new neurons in the brain.

What similarities exist in sleep patterns between eastern American moles and humans?

Eastern American mole:
- Total sleep: 8.4 hours
- REM sleep: 2.1 hours
Human:
- Total sleep: 8.0 hours
- REM sleep: 2.0 hours

What are the key takeaways about sleep and inactivity in lifeforms?

Many lifeforms exhibit inactivity periods, including those without a central nervous system.
No established link between sleep time, philogenetic order, or brain size.
Herbivores sleep less than carnivores and omnivores.
- Herbivores show an inverse relationship between sleep and body weight.
- Likely due to the time needed for sufficient food consumption.

What are the observed sleep states in octopuses according to the study?

Octopuses experience two main sleep states: Quiet sleep and Active sleep.
Transition cycle:
- Quiet sleep (45%)
- Quiet with open pupil (29%)
- Alert (22%)
- Active (73%)
Active sleep is observed 19% of the time.

What are the main findings about the birds' flight patterns and sleep from the study?

Birds can engage in 10-day ocean flights.
Sleep is categorized into Awake, SWS, REM states.
SWS (slow-wave sleep) occurs during flight and land.
EEG data shows alternating SWS between left and right hemispheres.
Sleep during flight mostly in SWS state.
SWA (slow-wave activity) reduces over time after landing.

What does the graph show about the night-time resting behavior of adult cetaceans and their offspring postpartum?

Adults display higher night-time rest.
Offspring have lower resting time postpartum.
Graph (a) shows data for orcas.
Graph (b) displays data for dolphins.
Minimal rest observed in offspring at 1-2 weeks postpartum.

What does the EEG data indicate about the bird's sleep dynamics?

EEG recordings show specific sleep stages.
Alternating SWS noted between left and right hemispheres.
Birds experience ASWS-left and ASWS-right phases.
EEG activity corresponds to SWS state during flight.

How does body weight correlate with hours of sleep per day in animals?

Negative correlation between weight and sleep.
Larger animals sleep less.
Correlation coefficient (R): -0.8
Significance level (p): < 0.001
Examples:
- Elephants sleep less than gerbils.

How does slow-wave activity change after birds land?

SWA (slow-wave activity) decreases post-landing.
Initial SWA is high but diminishes over time.
Represents recovery pattern after non-stop flight.
Measurement spans a period up to 24 hours.

What does the graph in the study by J. Siegel (2005) illustrate about animal sleep habits?

Displays relationship between animal weight and sleep duration.
X-axis: Weight (kg), Y-axis: Hours of sleep per day.
Includes various animals: bats, armadillos, cheetahs, etc.
R = -0.3, indicating a weak, non-significant negative correlation.

Describe the percentage of time birds spend in different states during flight versus on land.

Most time spent awake during flight.
SWS higher during land.
Very minimal time in REM during both.
Land allows more time for restorative sleep.

What is the significance of processes occurring during nocturnal sleep?

Processes during nocturnal sleep aren't necessarily linked to sleep.
Evolution might favor moving processes to the night.
Knowledge mainly comes from sleep deprivation studies, not direct sleep influence.

What differences are shown between Non-REM and REM sleep in dogs?

Non-REM Sleep:
- Deeper, restful stage.
- Minimal dreaming or simple thoughts.
- Example: Dog not dreaming vividly.
REM Sleep:
- Active dreaming.
- Increased brain activity.
- Example: Dog dreaming about treats.

What do the numbers associated with the moon and clock represent?

Moon: >30,000
- Might be related to a count or measurement.
Clock: >250,000
- Suggests a larger count or duration.

What are the characteristics of sleep?

Quickly reversible state
Decreased reactivity is present
Decreased motor activity occurs
Decreased metabolism is evident

Who presented on the topic "Why Do We Sleep?"

Presenter: Rolf Fronczek, PhD, MD
Institution: Leiden University Medical Centre, the Netherlands
Affiliation: Sleep-Wakecentre SEIN, Heemstede, The Netherlands

The question on the page originate from the summary of the following study material:

Sleep Medicine Textbook | 9781119789017 | Claudio Basseti, et al

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