Overview of polysomnography in adults
- Naomi R Kramer, MD
Naomi R Kramer, MD
- Assistant Professor of Medicine
- Warren Alpert Medical School of Brown University
- Richard P Millman, MD
Richard P Millman, MD
- Professor of Medicine and Pediatrics
- Warren Alpert Medical School of Brown University
In-laboratory, attended polysomnography (PSG) is a diagnostic test for sleep-related breathing disorders, and it is also used in conjunction with the clinical history and other tests to diagnose a variety of additional sleep disorders, including narcolepsy, sleep-related movement disorders, and certain parasomnias. During PSG, the patient sleeps while connected to a variety of monitoring devices that record physiologic variables. Patterns of physiologic abnormalities during sleep may be diagnostic of sleep-disordered breathing as well as many other sleep disorders.
In selected patients, the diagnostic evaluation for obstructive sleep apnea (OSA) may be performed at home without a technician in attendance. Home sleep apnea testing is only useful for the diagnosis of OSA in selected patients; it is not a substitute for PSG when other sleep disorders are suspected. (See "Home sleep apnea testing for obstructive sleep apnea in adults".)
This topic provides an overview of the performance of in-laboratory PSG in adults with suspected sleep disorders. The diagnosis of specific sleep disorders, and the role of PSG in the diagnostic evaluation of sleep disorders, is covered in individual disease-based topic reviews. An overview of PSG in infants and children is presented separately. (See "Overview of polysomnography in infants and children".)
Preparation — Consumption of alcohol or caffeine prior to polysomnography (PSG) may alter the nature and severity of the underlying sleep disorder that is being measured by PSG. As examples, alcohol may exacerbate obstructive sleep apnea (OSA) and alter sleep architecture, while caffeine may contribute to insomnia and sleep fragmentation.
Patients should abstain from caffeine in the afternoon and evening of the day on which PSG is planned. Alcohol is a more complex issue when PSG is being performed for suspected OSA because the absence of alcohol on the night of PSG could yield a false negative result if the patient habitually consumes alcohol in the evening. Ultimately, however, it is neither safe nor practical to encourage patients to consume alcohol prior to presenting to the sleep laboratory. Portable monitoring may be an option for some patients if alcohol is felt to be a significant factor in their clinical presentation and the use of alcohol is unlikely to change. (See "Home sleep apnea testing for obstructive sleep apnea in adults".)
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