PSG
PSG
Disclaimer
I have no conflicts of interest and receive no compensation from any sleep equipment manufacturers
Historical Perspectives
1928 Berger placed electrodes on brain in a patient who had a missing skull 1937 Loomis suggested first EEG classification (A-E) 1953 Aserinsky and Kleitman discovered REM sleep 1963 Rechtschaffen & Kales manual 2007 AASM publishes the new manual
AASM Manual
Iber C, Ancoli-Israel S, Chesson A, Quan SF for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Ist Ed.: Westchester, Illinois: American Academy of Sleep Medicine, 2007
Recording System
Oscilloscope to paper, to computer
Electrode placement Jack box or head box, montage selector Amplifiers (amplification, filters, calibration) Computer was revolutionary!!!
From nasion to inion, preauricular points, and top of the head Odd numbers are on the left side, Even on the right
Changes in Montage
Reference electrodes (Just terminology) Number of EEG channels; Add Frontal leads (three channels and three backup channels) Alternative channels EOG electrodes EMG electrodes
A1
A2
changed to
changed to
M1
M2
EEG - AASM
Backup channels
Amplifiers
Alternating Current
fast frequencies EEG, EMG, EOG, EKG (has both HFF and LFF)
Direct Current
slow frequencies oximeter, CPAP, position (does not have LFF)
CMRR =
Differential AC Amplifiers
(C3)
G1 -70 V
AMP
-60 V
(A2) G2 -10 V
Amplifiers
Amplification of signals
Filters
Calibration
Amplification
Gain, not really relevant in the computer environment
Sensitivity
Sensitivity
Measure of OUTPUT of an input voltage The amount of voltage needed to deflect the recording pen a given distance Voltage= uV (microvolts) or mV (millivolts) Pen deflection= mm or cm
Sensitivity
Voltage Pen deflection
Sensitivity
EEG CALIBRATION
Standard calibration 50 uV/cm (digital world 70 or 100 uv/cm) More deflection: Pen blocking artifacts Less deflection: Difficult to see low amplitude waveforms
1.5
Amplitude
0.5
0 100 50 25
V/cm
Sampling Rates
Sample at 200 to 500 hz ???????????????????? Number of data points gathered per second
Filters
Helpful in removing unwanted noise/artifacts
1. 2. 3. 4.
Low frequency filter High frequency filter Notch filter ECG filter (during scoring)
EEG Filters
Variable reduction in amplitude 80% 70% 50% Progressive decrease in amplitude below (LFF) or above HFF) the cut off frequency
LFF
0.3 Hz
LFF = None
LFF = 0.1
LLF = 0.3
Notch filter
Notch filters are designed to sharply attenuate a narrow frequency bandwidth within the range of 50 or 60 Hz. Notch filters are also known as 60Hz filters. These filters are used to eliminate the noise from electric power lines.
Filter Settings
EEG EOG EMG Snoring ECG Respiration Low 0.3 Hz 0.3 Hz 10 Hz 10 Hz 0.3 Hz 0.1 Hz High 35 Hz 35 Hz 100 Hz 100 Hz 70 Hz 15 Hz
Sampling Rates
Important in the computer age AASM suggests 500 hz for EEG/EOG/EMG/ECG Minimal 200 hz acceptable
EMG
Recorded as the potential between two surface electrodes placed several centimeters apart Typically, the chin (submental) muscle is used because it exhibits large differences during sleep, aiding in the identification of stages Wake - high activity Sleep - lower activity REM sleep - paralysis of skeletal muscles
EMG AASM
Three electrodes should be placed a. one in midline 1 cm above the inferior edge of the mandible b. one 2 cm below the inferior edge of the mandible and 2 cm to the right of midline c. one 2 cm below the inferior edge of the mandible and 2 cm to the left of midline
EMG
REM versus NREM Snoring
Swallowing
Bruxism GERD
EOG
The eyeball is a dipole where the cornea is positive and the retina is negative.
EOG
The electrode close to the retina will pick up a positive potential (down going wave).
EOG
V
Conjugate eye movements Out of phase pen deflections
EOG Placement
Usually from ROC and LOC
EOG-AASM
Nomenclature is different ROC now E2, LOC E1 Reference electrodes placement (Additional ref now mandatory) Reference electrodes nomenclature now Ms Alternative electrodes
E2-M1
E2 is placed 1 cm superior to the right outer canthus
EOG
EOG records voltage changes caused by eye movement; EOG changes with sleep stage Wake: random, high amplitude: Stage 1: slow rolling:
ARTIFACTS
Eye movements should be out of phase K-complexes should be in-phase Channels should not block
60 Hz Muscle tension Electrode popping ECG
Questions ?