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".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Lettieri CJ, Eliasson AH, Andrada T, et al. Does zolpidem enhance the yield of polysomnography? J Clin Sleep Med 2005; 1:129.
- US Food and Drug Adminstration Drug Safety Communication 5/14/2013: FDA approves new label changes and dosing for zolpidem products and a recommendation to avoid driving the day after using Ambien CR. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm352085.htm (Accessed on June 27, 2014).
- Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28:499.
- Khawaja IS, Olson EJ, van der Walt C, et al. Diagnostic accuracy of split-night polysomnograms. J Clin Sleep Med 2010; 6:357.
- Deutsch PA, Simmons MS, Wallace JM. Cost-effectiveness of split-night polysomnography and home studies in the evaluation of obstructive sleep apnea syndrome. J Clin Sleep Med 2006; 2:145.
- Kapur VK, Sullivan SD. More isn't always better: cost-effectiveness analysis and the case for using a split-night protocol. J Clin Sleep Med 2006; 2:154.
- Patel NP, Ahmed M, Rosen I. Split-night polysomnography. Chest 2007; 132:1664.
- Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5:263.
- Berry RB, Brooks R, Gamaldo CE, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, version 2.4, American Academy of Sleep Medicine, Darien IL 2017.
- Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8:597.
- Vandenbussche NL, Overeem S, van Dijk JP, et al. Assessment of respiratory effort during sleep: Esophageal pressure versus noninvasive monitoring techniques. Sleep Med Rev 2015; 24:28.
- Redline S, Budhiraja R, Kapur V, et al. The scoring of respiratory events in sleep: reliability and validity. J Clin Sleep Med 2007; 3:169.
- Bonnet MH, Doghramji K, Roehrs T, et al. The scoring of arousal in sleep: reliability, validity, and alternatives. J Clin Sleep Med 2007; 3:133.