Polysomnography in the evaluation of sleep-disordered breathing in adults
- David Schulman, MD, MPH, FCCP
David Schulman, MD, MPH, FCCP
- Associate Professor of Medicine
- Associate Division Director for Education Pulmonary, Allergy, Critical Care and Sleep Medicine
- Emory University School of Medicine
Sleep-disordered breathing consists of several separate disorders, including obstructive sleep apnea (OSA), central sleep apnea (CSA), Cheyne-Stokes respiration, and sleep-related hypoventilation, in which abnormal breathing events during sleep are associated with adverse clinical outcomes. While each of these disorders has a characteristic presentation, history and physical examination alone are insufficient to make a definitive diagnosis, and formal sleep testing is required for diagnosis [1,2].
The current reference standard for formal evaluation of sleep-disordered breathing is attended polysomnography (PSG). Rules governing the performance and scoring of PSG are published and reviewed on an ongoing basis by the American Academy of Sleep Medicine (AASM), and accredited sleep laboratories are required to follow these guidelines .
This topic will review the technical specifications, scoring, and summary terms used to characterize sleep-disordered breathing in adults undergoing attended PSG. The clinical features and diagnosis of sleep-related breathing disorders are reviewed separately. (See "Clinical presentation and diagnosis of obstructive sleep apnea in adults" and "Central sleep apnea: Risk factors, clinical presentation, and diagnosis" and "Clinical manifestations and diagnosis of obesity hypoventilation syndrome".)
Home sleep apnea testing and the role of PSG for the evaluation of nonrespiratory sleep disturbances are also reviewed separately. (See "Home sleep apnea testing for obstructive sleep apnea in adults" and "Polysomnography in the evaluation of abnormal movements during sleep" and "Polysomnography in the evaluation of parasomnias and epilepsy".)
The performance of polysomnography (PSG) requires monitoring of a number of physiologic signals, all of which are relevant in the assessment of sleep-disordered breathing (table 1). These signals are typically displayed in an organized montage for ease of viewing during study review (waveform 1).
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- RECORDED SIGNALS
- Sleep staging
- Respiratory airflow
- Respiratory effort
- Pulse oximetry
- Cardiac rhythm
- IDENTIFICATION AND SCORING OF EVENTS
- General principles
- Respiratory effort-related arousals
- Cheyne-Stokes respiration
- INTERPRETATION AND SUMMARY MEASURES
- Measures of sleep quality
- Measures of sleep-disordered breathing severity
- - Apnea-hypopnea index
- - Respiratory disturbance index
- - Degree of hypoxemia
- Presentation of summary data