Polysomnography in the evaluation of parasomnias and epilepsy
- Jennifer L DeWolfe, DO
Jennifer L DeWolfe, DO
- Associate Professor of Neurology
- UAB Epilepsy Center
- University of Alabama at Birmingham
Nocturnal behaviors can be complex and potentially injurious, and nocturnal video polysomnography (PSG) with extended electroencephalography (EEG) is often indicated to establish a definitive diagnosis, particularly when such behaviors arise in adulthood or when there is uncertainty about the etiology of the behaviors.
Common etiologies of nocturnal behaviors include non-rapid eye movement sleep (NREM) arousal parasomnias such as sleepwalking and confusional arousals, rapid eye movement sleep (REM) parasomnias, sleep-related seizures, sleep-related psychiatric events, and post-arousal behaviors associated with other primary sleep disorders (eg, obstructive sleep apnea) . (See "Approach to abnormal movements and behaviors during sleep".)
This topic reviews the PSG monitoring techniques used to diagnose REM sleep behavior disorder (RBD), NREM arousal parasomnias, and epileptic seizures during sleep. The clinical features, evaluation, diagnosis, and management of parasomnias in children and adults are presented separately. (See "Sleepwalking and other parasomnias in children" and "Disorders of arousal from non-rapid eye movement sleep in adults" and "Rapid eye movement sleep behavior disorder" and "Sleep-related epilepsy syndromes".)
Additional considerations on PSG technique in infants and children are also reviewed separately. (See "Overview of polysomnography in infants and children".)
TECHNIQUE AND SPECIFICATIONS
Digital specifications and settings — The American Academy of Sleep Medicine (AASM) manual for scoring sleep and associated events outlines the digital specifications for polysomnography (PSG) recordings . The recommended minimal digital resolution is 12 bits per sample (with the exception of the body position channel), and the maximum recommended electrode impedance for electroencephalography (EEG) and electrooculography (EOG) is 5 kilo-ohms. The latter should be re-evaluated when the recording appears artifactual.
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- TECHNIQUE AND SPECIFICATIONS
- Digital specifications and settings
- EEG derivations
- - Sleep staging
- - Extended EEG during PSG
- EOG derivations
- EMG derivations
- Resources and role of technologist
- Patient safety
- FINDINGS AND INTERPRETATION
- NREM parasomnias
- REM sleep behavior disorder
- Sleep-related epilepsy
- - Epileptiform discharges and seizures
- - Normal variants
- - EEG artifacts
- - Troubleshooting EEG