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Semin Neurol 2004; 24(3): 237-248
DOI: 10.1055/s-2004-835072
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

The Use of Sleep Studies in Neurological Practice

Charles Bae1 , Nancy Foldvary-Schaefer1
  • 1Department of Neurology, Section of Sleep Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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Publication History

Publication Date:
27 September 2004 (online)

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In recent years, sleep medicine has become a rapidly advancing field filled with exciting new discoveries. Many sleep disorders are diagnosed by clinical history alone. Sleep disorders such as sleep apnea, narcolepsy, periodic limb movement disorder, parasomnias, and nocturnal seizures usually require evaluation in the sleep laboratory. Sleep studies are used for diagnostic purposes, to assess disease severity, and to evaluate treatment efficacy. Sleep testing should be tailored to answer the specific clinical question at hand. This article reviews the techniques most commonly performed in the sleep laboratory and their indications, interpretation, and limitations. These include the polysomnogram, the multiple sleep latency test, and the maintenance of wakefulness test. The accurate interpretation of these studies requires a comprehensive sleep and medical history.

KEYWORDS

Polysomnography - multiple sleep latency test - maintenance of wakefulness test

REFERENCES

  • 1 American Sleep Disorders Association .The International Classification of Sleep Disorders, Revised. Diagnostic and Coding Manual Rochester, MN; Davies Printing Company 1997
    Google Scholar
  • 2 Aldrich M S. Approach to the patient with disordered sleep. In: Kryger MH, Roth T, Dement WC Principles and Practice of Sleep Medicine Philadelphia; WB Saunders Company 2000: 521-525
    Google Scholar
  • 3 Johns M W. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.  Sleep. 1991;  14 540-545
    Google Scholar
  • 4 Johns M W. Reliability and factor analysis of the Epworth Sleepiness Scale.  Sleep. 1992;  15 376-381
    Google Scholar
  • 5 Indications for Polysomnography Task Force American Sleep Disorders Association Standards of Practice Committee . Practice parameters for the indications for polysomnography and related procedures.  Sleep. 1997;  20 406-422
    PubMedGoogle Scholar
  • 6 American Academy of Sleep Medicine Task Force . Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.  Sleep. 1999;  22 667-689
    PubMedGoogle Scholar
  • 7 Chervin R D, Murman D L, Malow B A, Totten V. Cost-utility of three approaches to the diagnosis of sleep apnea: polysomnography, home testing and empirical therapy.  Ann Intern Med. 1999;  130 496-505
    CrossrefPubMedGoogle Scholar
  • 8 Partinen M, Hublin C. Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement WC Principles and Practice of Sleep Medicine Philadephia; WB Saunders Company 2000: 558-579
    Google Scholar
  • 9 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 1230-1235
    CrossrefPubMedGoogle Scholar
  • 10 Montplasir J, Michaud M, Lavigne G J. Periodic limb movements in sleep. In: Chokroverty S, Hening WA, Walters AS Sleep and Movement Disorders Philadephia; Butterworth Heinemann 2003: 300-311
    Google Scholar
  • 11 Standards of Practice Committee of the American Academy of Sleep Medicine . Practice parameters for using polysomnography to evaluate insomnia: an update.  Sleep. 2003;  26 754-760
    PubMedGoogle Scholar
  • 12 Allen R P, Piccheietti D, Hening W, Trenkwalder C, Walters A S, Montplaisi J. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology; a report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.  Sleep Med. 2003;  4 101-119
    CrossrefPubMedGoogle Scholar
  • 13 Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Washington, DC; U.S. Government Printing Office 1968
    Google Scholar
  • 14 Jasper H H. The 10-20 electrode system of the International Federation.  Electroencephalogr Clin Neurophysiol. 1958;  10 370-375
    PubMedGoogle Scholar
  • 15 American Electroencephalographic Society . Guideline thirteen: guidelines for standard electrode position nomenclature.  J Clin Neurophysiol. 1994;  11 111-113
    PubMedGoogle Scholar
  • 16 Radtke R A. Sleep disorders: laboratory evaluation. In: Daly DD, Pedley TA Current Practice of Clinical Electroencephalography. 2nd ed. New York; Raven Press, Ltd. 1990: 561-592
    Google Scholar
  • 17 Farre R, Montserrat J M, Rotger M, Ballester E, Navajas D. Accuracy of thermistors and thermocouples as flow-measuring devices for detecting hypopneas.  Eur Respir J. 1998;  11 179-182
    CrossrefPubMedGoogle Scholar
  • 18 Kushida C A, Giacomini A, Lee M K, Guilleminault C, Dement W C. Technical protocol for the use of esophageal manometry in the diagnosis of sleep-related breathing disorders.  Sleep Med. 2002;  3 163-173
    PubMedGoogle Scholar
  • 19 Hirchkowitz M. Monitoring penile erections during sleep. In: Lee-Chiong TL, Sateia MJ, Carskadon MA Sleep Medicine. Philadelphia; Hanley & Belfus 2002: 673-679
    Google Scholar
  • 20 Martin R J, Block A J, Cohn M A et al.. Indications and standards for cardiopulmonary sleep studies.  Sleep. 1985;  8 371-379
    PubMedGoogle Scholar
  • 21 Clinical Practice Review Committee . Hypopnea in sleep-disordered breathing in adults.  Sleep. 2001;  24 469-470
    PubMedGoogle Scholar
  • 22 Gould G A, Whyte K F, Rhind G B et al.. The sleep hypopnea syndrome.  Am Rev Respir Dis. 1988;  137 895-898
    PubMedGoogle Scholar
  • 23 American Thoracic Society . Cardiorespiratory sleep studies in children.  Am J Respir Crit Care Med. 1999;  160 1381-1387
    PubMedGoogle Scholar
  • 24 Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness: the upper airway resistance syndrome.  Chest. 1993;  104 781-787
    CrossrefPubMedGoogle Scholar
  • 25 Bixler E O, Kales A, Vela-Bueno A, Jacoby J A, Scarone S, Soldatos C R. Nocturnal myoclonus and nocturnal myoclonic activity in a normal population.  Res Commun Chem Pathol Pharmacol. 1982;  36 129-140
    PubMedGoogle Scholar
  • 26 Ancoli-Israel S, Kripke D F, Klauber M R, Mason W J, Fell R, Kaplan O. Periodic limb movements in sleep in community-dwelling elderly.  Sleep. 1991;  14 496-500
    PubMedGoogle Scholar
  • 27 Agnew H W, Webb W B, Williams R L. The first-night effect: an EEG study of sleep.  Psychophysiology. 1966;  2 263-266
    CrossrefPubMedGoogle Scholar
  • 28 Meyer T J, Eveloff S E, Kline L R, Millman R P. One negative polysomnogram does not exclude obstructive sleep apnea.  Chest. 1993;  103 756-760
    CrossrefPubMedGoogle Scholar
  • 29 Le Bon O, Hoffmann G, Tecco J et al.. Mild to moderate sleep respiratory events: one negative night may not be enough.  Chest. 2000;  118 353-359
    CrossrefPubMedGoogle Scholar
  • 30 Standards of Practice Committee of the American Academy of Sleep Medicine . The clinical use of the multiple sleep latency test.  Sleep. 1992;  15 268-276
    PubMedGoogle Scholar
  • 31 Mitler M M, Gujavarty K S, Browman C P. Maintenance of wakefulness test: a polysomnographic technique for evaluating treatment efficacy in patients with excessive somnolence.  Electroencephalogr Clin Neurophysiol. 1982;  53 658-661
    PubMedGoogle Scholar
  • 32 Mitler M M, Carskadon M A, Hirshkowitz M. Evaluating sleepiness. In: Kryger MA, Roth T, Dement WC Principles and Practice of Sleep Medicine. 3rd ed. Philadelphia; WB Saunders 2000: 1251-1257
    Google Scholar
  • 33 Carskadon M A, Dement W C, Mitler M M, Roth T, Westbrook P R, Keenan S. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness.  Sleep. 1986;  9 519-524
    PubMedGoogle Scholar
  • 34 Carskadon M A, Dement W. Cumulative effects of sleep restriction on daytime sleepiness.  Psychophysiology. 1981;  18 107-113
    CrossrefPubMedGoogle Scholar
  • 35 Richardson G S, Carskadon M A, Flagg W, Van den Hoed J, Dement W C, Mitler M M. Excessive daytime sleepiness in man: multiple sleep latency measurements in narcoleptic and control subjects.  Electroencephalogr Clin Neurophysiol. 1978;  45 621-627
    PubMedGoogle Scholar
  • 36 Mitler M M, Van den Hoed J, Carskadon M A et al.. REM sleep periods during the multiple sleep latency test in narcoleptic patients.  Electroencephalogr Clin Neurophysiol. 1979;  46 479-481
    PubMedGoogle Scholar
  • 37 Aldrich M S, Chervin R D, Malow B A. Value of the multiple sleep latency test (MSLT) for the diagnosis of narcolepsy.  Sleep. 1997;  20 620-629
    PubMedGoogle Scholar
  • 38 Chervin R D, Aldrich M S. Sleep onset REM periods during multiple sleep latency tests in patients evaluated for sleep apnea.  Am J Respir Crit Care Med. 2000;  161 426-431
    PubMedGoogle Scholar
  • 39 Dauvilliers Y, Gosselin A, Paquet J, Touchon J, Billiard M, Montplasir J. Effect of age on MSLT results in patients with narcolepsy-cataplexy.  Neurology. 2004;  62 46-50
    CrossrefPubMedGoogle Scholar
  • 40 Doghramji K, Mitler M M, Sangal R B et al.. A normative study of the maintenance of wakefulness test (MWT).  Electroencephalogr Clin Neurophysiol. 1997;  103 554-562
    PubMedGoogle Scholar
  • 41 Mitler M M, Walsleben J, Sangal R B, Hirshkowitz M. Sleep latency on the maintenance of wakefulness test (MWT) for 530 patients with narcolepsy while free of psychoactive drugs.  Electroencephalogr Clin Neurophysiol. 1998;  107 33-38
    PubMedGoogle Scholar

Charles J BaeM.D. 

Department of Neurology, Section of Sleep Medicine, Cleveland Clinic Foundation

9500 Euclid Avenue, S51

Cleveland, OH 44195

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