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Message
from the (New) President ESRS Congress in Reykjavik, June 2002.
On behalf of the previous
board I’d like to thank Cinzia Castronovo for all her efforts done
for our society. We’re happy that she is willing to give advise in
the future as Honorary President. Her past work will inspire me and
the rest of the board to unite technologists all over Europe. Maud
Verhelst August
2002
Page
4
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Newsletter 2002
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alpha night 1 |
alpha night 2 |
Alpha night 1 + 2 |
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Significance VAF |
0.030 0.047 |
0.028 0.048 |
0.024 0.051 |
References
1.
Moldofsky H.; Lue F. The relationship
of alpha and delta EEG frequencies to pain and mood in fibrositis
patients treated with chlorpromazine and L-tryptophane. Elecectroencephalogr
Clin Neurophysiol. 1980; 50: 71-80.
2.
Kryger M.H.; Roth T.; Dement
W.C. Principles and Practice of Sleep Medicine, second edition. W.B.
Saunders Company. 1994: 530-531.
3.
Schneider-Helmert D. Alpha-sleep
variations with sleepless patients. (Abstract), Brussels: 13th congress
of the European Sleep Research Society. 1996: 4-6.
4.
Moldofsky H.; Lue F.; Mously
C.; Roth-Schechter B.; Reynolds W.J. The effect of Zolpidem in patients
with fibromyalgia: a dose ranging, double blind, placebo controlled,
modifed crossover study. J Rheumatol. 1996; 23: 529-533.
5.
Vandeputte M; Kemp B; de Weerd
A.W. Alphasleep and fatigue. Sleep-Wake Research in the Netherlands.
Volume 11 2000: 127-129.
6.
Van Sweden B., Kemp B., Kamphuisen
H. A. C., Van der Velde E. A. Alternative electrode placement in (automatic)
sleep scoring (Fpz-Cz/Pz-Oz
versus C4-A1). Sleep. 1990; 13: 279-283.
7.
Horne J.A.; Shackell B.S. Alpha-like
EEG activity in non REM sleep and the fibromyalgia (fibrositis) syndrome.
Electroencephalogr Clin Neurophysiol.
1991; 79: 271-276.
8.
Mulder-Hajonides van der Meulen
W.R.E.H.; Van der Hoofdakker R.H. The Groningen Sleep Quality Scale.
Book of Abstracts, 14th CINP Congress. 1984.
9.
Smets E.M.A.; Garssen B.; Bonke
B. The Multidimensional Fatigue Inventory (MVI-20). Academisch Medisch Centrum. Universiteit van Amsterdam.
1995.
10.
Mc. Nair D.M.; Lorr M.; Droppleman L.F.; (1981). Edits Manual for the Profile of Mood States. San Diego, CA: Educational and
Industrial Testing Service (original work published 1971).
Multiple
Sleep Latency Test, Maintenance of Wakefulness Test and the OSLER-test:
technics, value and latest findings.
MSLT and MWT are considered as helpfull diagnostic tests, for disorders of excessive somnolence like narcolepsy and sleep apnea syndrome. They are used as a clinical tool to evaluate excessive daytime sleepiness (EDS) of a subject. MSLT and/or MWT are used for evaluating professional drivers and (dangerous) machine handlers.
Page
9
Diagnostic criteria
for PLM and RLS syndrome: scoring rules and controversy
E. Sforza, Sleep laboratory, Department of Psychiatry, University
of Geneva, Switzerland.
Three
points are cardinal in the scoring of the PLM: the event detection,
the event classification and the event analysis. Considering the PLM
detection two criteria are commonly used: the duration, i.e. 0.5-
to 5 s, and the amplitude, i.e. an increase of at least 25% of the
EMG envelope recorded during calibration. For the PLM analysis the
most important criterion is the definition of a PLM sequence that
is a sequence of 4 or more leg movements separated by at least 5 s
and no more than 90 s. The PLM sequence analysis allows the scorer
to define the leg movement period, the leg movements periodicity and
the number of leg movements occurring as a part of the PLM sequence.
Considering the PLM classification two points need to be considered:
the relationship with indices of sleep fragmentation and the relationship
with respiratory disorders. These points are interesting to evaluate
the impact on sleep continuity and the etiology of the PLM.
Although
these criteria allow the scorer to identify the PLM and its effect
on sleep, some controversial data are present in the literature for
detection and analysis. The most interesting points of discussion
are the definition of the movement amplitude, the pattern of muscle
activation and the detection of PLM during wakefulness. Since in clinical
practice only the tibialis anterior muscles are recorded, the amplitude
criteria may underestimate the number of leg movements occurring in
other muscles. The pattern of expression of EMG activity may induce
an underestimation of the PLM when phasic and shorter EMG activation
occurred just before the onset of a leg movement. The most controversial
point is the detection of leg movements during wakefulness for which
no standardized criteria are present. The only criteria reported in
the literature consider a duration from 0.5 to 10 s, a periodicity
from 5 to 120 s, and an analysis of the bursts of EMG activity occurring
in association with a tonic EMG activity to detect a PLM during wakefulness.
In
any case nocturnal video-polygraphic recording is the gold standard
to improve the detection of a PLM and to differentiate these movements
from other motor disorders arising from sleep.
1)
Coleman RM. Periodic leg movements in sleep (nocturnal myoclonus)
and restless legs syndrome. In: C. Guilleminault (Ed.) Sleeping and
waking disorders. Addison-Wesley, Menlo Park, CA, 1982, 265-295.
2)
ASDA Report. Atlas and Scoring rules. Recording and scoring leg movement.
Sleep 1993, 16:748-759
CAP :
the Cyclic Alternating Pattern
Liborio Parrino
and Mario Giovanni Terzano (Italy)
Periodic activities can be characterized with 3 parameters:
- The repetitive element (phase A of the
period), represented by the recurring EEG feature.
- The intervening background (phase B of
the period), identified by the interval that separates the repetitive
elements.
- The period or cycle (the sum of phase
A and phase B duration), characterizing the recurrence rate.
Definition of
cyclic alternating pattern. The cyclic alternating
pattern (CAP) is a periodic EEG activity of non-REM sleep in which
both phase A and phase B can range between 2 and 60 s. A phase A (A)
and the following phase B (B) compose a cycle (C).
CAP appears in sequences throughout sleep stages 1, 2, 3, 4.
Phase A of CAP is identified by transient events typically observed
in non-REM sleep, which clearly stand out from the background rhythm,
usually differing in frequency and/or amplitude. Compared to phase
Bs, phase As can be composed of slower, higher-voltage rhythms, faster
lower-voltage rhythms, or by mixed patterns including both. The identification
of CAP should be preceded by the definition of sleep stages according
to the conventional criteria.
- Subtype A1. EEG synchrony is the predominant
activity. If present, EEG desynchrony occupies < 20% of the entire
phase A duration. Subtype A1 specimens include delta bursts,
K-complex sequences, vertex sharp transients, polyphasic bursts
with < 20% of EEG desynchrony.
- Subtype A2. The EEG activity is a mixture of
slow and fast rhythms with 20%-50% of phase A occupied by EEG desynchrony.
Subtype A2 specimens include polyphasic bursts with more than
20% but less than 50% of EEG desynchrony.
- Subtype A3. The EEG activity is predominantly
rapid low-voltage rhythms with > 50% of
phase A occupied by EEG desynchrony. Subtype A3 specimens
include K-alpha, EEG arousals, and polyphasic bursts with
> 50% of EEG desynchrony. A movement artifact within a CAP sequence
is also classified as subtype A3.
Slow rhythms represent the main features of subtypes A1. Within
subtypes A2 and A3, slow rhythms mostly prevail in the initial part
of phase A. Different phase A subtypes can occur within the same CAP
sequence. Subtype A1 is most common as sleep EEG synchrony increases
(from light to deep non-REM sleep) and when synchrony predominates (stages
3 and 4) . Subtypes A2 and A3 are mostly concentrated as sleep-related
brain activity progresses from synchrony to greater desynchrony (for
example, in stage 2 preceding the onset of REM sleep).
Spectral Analysis
of the REM sleep: technical approach.
Francesco Lullo , G.Russo1, G.Paone1, C.Luongo2,
S.Vescia2 (Italy)
The off-line analysis is divided in four steps:
- PSD (0.5-64
Hz) of R.E.M. performed on a six seconds epochs length.
- Each epoch
was divided in phasic and tonic.
- For same
epoch ware calculated the
hearth rate and the breath frequency.
- Statistical
analysis.
The method of analysis used in our laboratory, is presented.
Further data are still in phase of acquisition.
Polysomnograpyh in children
M J Challamel (France)
Introduction
Polysomnography is the term used to describe a procedure of
objective, simultaneous recording of many different physiological
parameters during sleep. Polygraphic recordings give information on
each parameter recorded and on the interaction between different parameters.
Only complete nocturnal (or 24-H) sleep polygraphic recordings provide
accurate information regarding : sleep architecture, characterization
of cardiorespiratory function (including airflow, respiratory efforts,
blood gases, cardiac rate
and rhythm) ; characterization of arousals and body movements.
The most important aspect in obtaining a high quality polygraphic
recording in children is methodological and careful preparation. Transducers
should be adapted to children. (Table 1).
Parents and children
must be prepared in advance: doctors should discuss with the child
and his parents the reason for the recording and the procedures that
will be used. Parents of young children should be required to stay
overnight in the laboratory with their children. In our laboratory
we ask parents to arrive at least 3 hours prior to the preparation
of the children for the recording.
Polygraphic parameters :
In any cases,
recording for sleep studies should include information on at least
5 polygraphic parameters: electroencephalogram (EEG), electrooculogram
(EOG), chin electromyogram (chin EMG), heart rate (HR) or electrocardiogram
(EKG) and respiration in addition to behavioral observation (visual
or video).
Montages :
Montage selection should be determined by the need of the diagnostic study.
EEG : either bipolar
or unipolar. As in adults Ag/Agcl electrode positions are defined
according to the international 10-20 system. The positions more frequently
used are Fp1, Fp2, C3, C4, T3, T4, 01, O2. A minimum of 3 EEG leads
with frontal, parietal and occipital positions are necessary to stage
and quantify sleep. More channels of EEG may be necessary when the
EEG is the major focus of investigation ( for example in children
with parasomnias or with nocturnal epilepsy). In the younger children
usual gain is 10 mm for 50 µV.
EOG : Standard EOG
activity is monitored using two electrodes placed lateral to the outer
canthus of each eye. Two channels referenced to one mastoid are generally
recommended. In preterm infants, because of the immaturity of the
retino-corneal dipole, the
use of piezo-electric crystal transducers is the most reliable.
EMG activity : Standard
chin muscle should be used as one criterion for sleep-state identification.
When exploring respiration during sleep proper placement of
the electrodes can also provide information regarding activity of
glosso-pharyngeus muscles.
Limb movements,
respiratory efforts can also be monitored by EMG activities recorded
at limb, abdominal and intercostal levels
EKG, HR: Bipolar chest
lead. When SaO2 is measured by pulse oximetry the measurement of the
pulse wave form amplitude is a mean to control the validity of a desaturation
event.
RESPIRATION: Both thoracic
and abdominal movements, nasal and oral airflow must be recorded, to allow the classification of apnea in their
different types: central, obstructive or mixed.
Recording of respiratory
effort: Chest efforts and abdominal efforts
should be recorded on separate recording channels with either strain
gauges, piezo electric crystal or respiratory inductive plethysmography
(RIP). They should be calibrated in phase when the
child is awake since the presence of out of phase movements during
sleep, referred as paradoxical respiration, is an important criteria
for suspecting partial or complete airway obstruction during sleep.
Oesophageal pressure recording, which is commonly measured in adults,
is rarely used in children. Pulse transit time is an indirect mean
to evaluate respiratory efforts ; it has not been validated in children.
Airflow is recorded at nasal and oral level by
nasal transducer canulae and/or end tidal CO2.Thermistors are
less sensitive although an oral thermistor is recommended when using
a nasal pressure canulae.
Blood gases: blood gases are non invasively estimated with PACO2, SAO2 (by pulse oximetry)
or transcutaneous techniques (tcp O2 or CO2 are used in infants).
Because of the importance in children of prolonged partial airway
obstruction and obstructive hypoventilation, PACO2 measurement of
end tidal or alveolar CO2 which requires placing a small sampling
catheter within the nostrils, is considered essential for assessment
of obstructive sleep apnea syndrome in children.
Four sources for
scoring polygraphic recording are available in children: in premature
infants the manual from Curzi and Mirmiran is a very useful tool ;
after one year polygraphic recordings are scored, as in adult, according
to Rechtschaffen and Kales criteria ; Anders’ manual is used
in full- term children less than 6 weeks, from 6 weeks to one year
modifications proposed by Guilleminault and Souquet are recommended.
In adults arousal
is defined using standard criteria laid out by theAmerican Disorders
Association (ASDA 1992). In children a modification of adult’s criteria has been proposed by Mograss
et al..
The problem of norms (References,
Table 2, 3)
They are very
few, the structure of sleep and normal values for respiration change
with age.
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Carskadon MA, Keenan SH, Dement WC. Nighttime sleep and daytime sleep
tendency in preadolescents. In C Guilleminault ed. Sleep and its disorders
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- Carskadon MA, Dement WC. Sleepiness
in normal adolescent. In C Guilleminault ed. Sleep and its disorders
in children. Raven press, New York, 1987 pp 53-66.
- Challamel MJ,
Debilly G, Leszczynski MC, Revol M. Sleep state development in Near-Miss
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and basic mechanisms. Eds RM Harper, JF Hoffman, PMA Publishing Corp
1984, 423-434.
-Coble PA, Kupfer
DJ, Taska LS, Kane J. EEG sleep in normal healthy children; part 1:
Findings using standard measurement methods ; scoring rules and
examples. Sleep 1992, 2: 174-183.
- Curzi-Dascalova
l, Challamel MJ. Neurophysiological basis of sleep development. In
sleep and breathing in children : a developmental approach. Loughlin
GM, Carrol JL, Marcus CL(eds) ; Marcel Dekker, New-York 2000 ; chap
1 : 3-38
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Korso RL, Heller N. EEG sleep patterns as a function of normal and
pathological aging in man;
J Psychiat Rev 1967 5: 107-144.
- Goetz et al. EEG sleep
of adolescents with major depression and normal controls Arch Gen
Psychiatry 1987, 44: 61-68.
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Ed Vigot 1989, pp 23-32.
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E, Elmquist D, Blennow G. Sleep and wakefulness in normal preadolescent
children. Sleep, 1989, 12: 299-308.
- Palm L, Elmquist
D, Blennow G; Automatic versus EEG sleep staging in preadolescent
children. Sleep 1989, 12: 150-156.
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HW, Williams RL, Webb WB. Sleep pattern in preadolescent children:
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- Scholle S,
Zwacka G. Arousals and obstructive sleep apnea syndrome in children.
Clin Neurophysiol 2001 ; 112 : 984-991.
- Serebrisky
D, Cordero R, Mandeli J, Kattan M, Lamm C. Assessment of inspiratory
flow limitation in children with sleep-disordered breathing by nasal
cannula pressure transducer system. Pediatr Pulmonol 2002 ; 33 : 380-387.