Download - Basics of Sleep Staging-09
-
8/3/2019 Basics of Sleep Staging-09
1/24
Sleep Staging Basics
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
2/24
The following presentation is being provided for informational and
educational purposes only. While Compumedics endeavors to ensure
the validity and accuracy of the information within, we cannot be held
responsible for inaccuracies, opinions or practices that often varybetween various experts or are without established acceptable medical
standards. Please consult your own medical director for clarification or
for policies that are specific to your facility.
We welcome your comments, suggestions and corrections. Please
e-mail your comments to: [email protected]
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
3/24
Sleep Staging Variables
Electroencephalogram (EEG) - acquired by surface
electrodes on the scalp at standardized locations (10-20
system)
Electrooculogram (EOG) - acquired by surface
electrodes placed at the outer canthus of each eye
Electromyogram (EMG) - acquired by surface electrodes
placed on the chin muscle (sub-mental)
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
4/24
Sleep Staging Channels
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
5/24
EEG
Frequency and amplitude change with sleep stage:
Wake: high frequency
Stage N1and REM: low amplitude, mixedfrequency (vertex waves may be in N1)
Stage N2: spindles, k-complexes
Stage N3: delta waves ( 75 uV, 2 Hz) Standard sleep epoch is 30 seconds
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
6/24
EOG EOG records voltage changes caused by eye movement; EOG
changes with sleep stage
Wake: random, high amplitude:
Stage 1: slow rolling:
REM: very flat with occasional rapid eye movements:
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
7/24
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
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
8/24
Sleep Stage Criteria
Awake
Alpha or faster > 50% of
epoch
Many eye movements
High EMG
Stage N1
Alpha or faster < 50 % ofepoch
Increasing theta activity
Slow rolling eyes
Vertex sharp waves
ALPHA WAVESALPHA WAVES
THETA WAVESTHETA WAVES
VERTEX WAVEVERTEX WAVE
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
9/24
Sleep Staging Criteria Stage N2
Sleep Spindles
12-14 cps 0.5 second duration orlonger
and/or
K-complexes
Sharp negative deflection
followed by nearly equalpositive deflection
At least 0.5 seconds induration
Sleep SpindleSleep Spindle
K-complexK-complex
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
10/24
Sleep Staging Criteria
Stage N3 - Delta Waves (75uV) 20%
of epoch
DELTA WAVESDELTA WAVES
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
11/24
Sleep Staging Criteria REM
Lowest EMG
Rapid Eye Movements (REMs) Saw-tooth EEG
Low-amplitude, mixed frequency EEG similarto stage 1
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
12/24
Stage: Awake
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
13/24
Stage N1 Sleep
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
14/24
Stage N2 Sleep
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
15/24
Stage N3 Sleep
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
16/24
Stage REM Sleep
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
17/24
Stage REM Sleep
Sawtooth waveform pattern seen in REM sleep.
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
18/24
Infant Sleep Patterns
Circadian rhythm not established prior to week 10 or 11from birth.
Consolidation of sleep usually occurs by week 16-17.
Between 24-36 weeks Active-Quiet Sleep pattern isestablished.
At 5-6 months R&K rules can be applied.
Age is corrected for normal gestational age.
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
19/24
Changing Sleep Patterns With Age
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
20/24
Active Sleep - Infant
Continuous cycling of wakefulness-active sleep (REM)
and quiet sleep(NREM).
Sleep onset is usually to active sleep (REM)
Mixed, low-voltage, irregularEEG
Suppressed EMG
Intermittent REMs Frequent muscle twitches and body movements
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
21/24
Active Sleep - Infant
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
22/24
Quiet Sleep - Infant
High voltage, slow-wave EEG activity
Trace alternant, 3-8 sec. burst of high voltage slow
waves, alternating with 4-8 seconds of low voltage mixed
freq. waves
EMG tonic
Eye movements absent
Minimal body movement
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
23/24
Quiet Sleep - Infant
Copyright 2009 Compumedics Ltd.
-
8/3/2019 Basics of Sleep Staging-09
24/24
Infant Sleep Staging
Wake, Active (REM) Sleep, Quiet (NREM) Sleep,
Indeterminate, Movement orArtifact.
If an epoch can not be staged as Wake, Active or Quiet,
it is Indeterminate.
Crying is considered awake.
Artifact is scored if one minute or more of recording is
unscorable.
Copyright 2009 Compumedics Ltd.