The word polysomnography, derived from the Greek roots "poly," meaning many, "somno," meaning sleep, and "graphy" meaning to write, refers to multiple tests performed on patients while they sleep. Polysomnography is an overnight test to evaluate sleep disorders. Polysomnography generally includes monitoring of the patient's airflow through the nose and mouth, blood pressure, electrocardiographic activity, blood oxygen level, brain wave pattern, eye movement, and the movement of respiratory muscle and limbs.
Polysomnography is used to help diagnose and evaluate a number of sleep disorders. For instance, it can help diagnose sleep apnea, a common disorder in middle-aged and elderly obese men, in which the muscles of the soft palate in the back of the throat relax and close off the airway during sleep. This may cause the person to snore loudly and gasp for air at night, and to be excessively sleepy and doze off during the day. Another syndrome often evaluated by polysomnography is narcolepsy. In narcolepsy, people have sudden attacks of sleep and/or cataplexy (temporary loss of muscle tone caused by moments of emotion, such as fear, anger, or surprise, which causes people to slump or fall over), sleep paralysis or hallucinations at the onset of sleep. Polysomnography is often used to evaluate parasomnias (abnormal behaviors or movements during sleep), such as sleep walking, talking in one's sleep, nightmares, and bedwetting. It can also be used to detect or evaluate seizures that occur in the middle of the night, when the patient and his or her family are unlikely to be aware of them.
Polysomnography is extremely safe and no special precautions need to be taken.
Polysomnography requires an overnight stay in a sleep laboratory. During this stay, while the patient sleeps, he or she is monitored in a number of ways that can provide very useful information.
One form of monitoring is electroencephalography (EEG), in which electrodes are attached to the patient's scalp in order to record his or her brain wave activity. The electroencephalograph records brain wave activity from different parts of the brain and charts them on a graph. The EEG not only helps doctors establish what stage of sleep the patient is in, but may also detect seizures.
Another form of monitoring is continuous electro-oculography (EOG), which records eye movement and is used to determine when the patient is going through a stage of sleep called rapid-eye-movement (REM) sleep. Both EEG and EOG can be helpful in determining sleep latency (the time that transpires between lights out and the onset of sleep), total sleep time, the time spent in each sleep stage, and the number of arousals from sleep.
The air flow through the patient's nose and mouth are measured by heat-sensitive devices called thermistors. This can help detect episodes of apnea (stopped breathing), or hypnopea (inadequate breathing). Another test called pulse oximetry measures the amount of oxygen in the blood, and can be used to assess the degree of oxygen starvation during episodes of hypnopea or apnea.
The electrical activity of the patient's heart is also measured on an electrocardiogram, or ECG. Electrodes are affixed to the patient's chest and they pick up electrical activity from various areas of the heart. They help detect cardiac arrythmias (abnormal heart rhythms), which may occur during periods of sleep apnea. Blood pressure is also measured: sometimes episodes of sleep apnea can dangerously elevate blood pressure.
In some cases, sleep laboratories monitor the movement of limbs during sleep. This can be helpful in detecting such sleep disorders as periodic limb movements.
The patient may be asked to discontinue taking any medications used to help him/her sleep. Before the patient goes to sleep, the technician hooks him or her up to all of the monitors being used.
Once the test is over, the monitors are detached from the patient. No special measures need to be taken after polysomnography.
Polysomnography may yield a number of abnormal results, indicating a number of potential disorders. For instance, abnormal transitions in and out of various stages of sleep, as documented by the EEG and the EOG, may be a sign of narcolepsy. Reduced air flow through the nose and mouth, along with a fall in oxygenation of the blood, may indicate apnea or hypopnea. If apnea is accompanied by abnormalities in ECG or elevations in blood pressure, this can indicate that sleep apnea may be particularly harmful. Frequent movement of limbs may indicate a sleep disorder called periodic limb movement.
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National Heart, Lung, and Blood Institute Working Group on Sleep Apnea, National Institutes of Health. "Sleep Apnea: Is Your Patient At Risk?" American Family Physician 53 (Jan. 1996): 247-53.
"Sleep Apnea: No Sleep for the Weary Without Proper Diagnosis." Harvard Health Letter (Nov. 1997): 4-5.
Ten Brock, Eric, and David W. Shucard. "Sleep Apnea." American Family Physician 49 (1 Feb. 1994): 385-94.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. <http://www.nhlbi.nih.gov>.
Robert Scott Dinsmoor
Cataplexy—A condition characterized by sudden loss of muscle tone brought on by emotions, often associated with narcolepsy.
Electrocardiography (ECG)—Recording of the electrical activity from various regions of the heart muscle.
Electroencephalography (EEG)—Recording of the electrical activity from various regions of the brain.
Electro-oculography (EOG)—Recording of the electrical activity of the muscles that control eye movement.
Narcolepsy—A sleep disorder characterized by attacks of sleep, cataplexy, sleep paralysis, or hallucinations with the onset of sleep.
Parasomnias—Abnormal behaviors during sleep, such as sleep walking, talking in one's sleep, nightmares, sleep paralysis, or bedwetting.
Sleep apnea—A sleep disorder characterized by lapses in breathing during sleep.
Sleep latency—The time it takes to fall asleep once the lights are out.