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The Measurement of Sleep: The Measurement of Sleep: A Practical Workshop for InvestigatorsA Practical Workshop for Investigators
PolysomnographyPolysomnography
Patrick J. Strollo M.D.Patrick J. Strollo M.D.Martica Hall, Ph.D. Martica Hall, Ph.D. Neuroscience – Clinical & Translational Neuroscience – Clinical & Translational Research Center Laboratory TeamResearch Center Laboratory Team
Pittsburgh Mind-Body Center on Sleep WorkshopPittsburgh Mind-Body Center on Sleep WorkshopPittsburgh, PAPittsburgh, PAApril 11, 2008April 11, 2008
AgendaAgenda1.1. Brief review of polysomnography (PSG) Brief review of polysomnography (PSG)
Goal: Learn what is meant by poly (many) somnus (sleep) graphein Goal: Learn what is meant by poly (many) somnus (sleep) graphein (to write)(to write)
2.2. Tour of N-CTRC sleep laboratory Tour of N-CTRC sleep laboratory Goal: learn about the different types of studies that can be conducted Goal: learn about the different types of studies that can be conducted
in the N-CTRCin the N-CTRC3.3. Meet sleep technician and sleep study “participant” to see what’s Meet sleep technician and sleep study “participant” to see what’s
involved in using PSG to measure sleepinvolved in using PSG to measure sleep GGoal: learn what all of the electrodes & monitors measureoal: learn what all of the electrodes & monitors measure
4.4. Watch as signals are collected from participant and review how different Watch as signals are collected from participant and review how different signals change with behavior signals change with behavior Goal: learn what different signals look likeGoal: learn what different signals look like
5.5. Review examples of sleep pathologiesReview examples of sleep pathologies Goal: learn about some of the signals that indicate sleep pathologiesGoal: learn about some of the signals that indicate sleep pathologies
6.6. Review two kinds of advanced signal processingReview two kinds of advanced signal processing Goal: learn what is meant by spectral analysis of the EEG and EKG Goal: learn what is meant by spectral analysis of the EEG and EKG
during sleepduring sleep
Advanced Signal Processing Advanced Signal Processing Spectral analysis of signals collected during sleep studiesSpectral analysis of signals collected during sleep studies
What is spectral analysis? What is spectral analysis? Decompose a complex, multi-determined signal Decompose a complex, multi-determined signal
Move from time to frequency domain (power is variabilityMove from time to frequency domain (power is variability22)) Spectral analysis of the EEGSpectral analysis of the EEG
ExampleExample: EEG profile in patients with insomnia differs by gender : EEG profile in patients with insomnia differs by gender and across the nightand across the night
Spectral analysis of heart rate variabilitySpectral analysis of heart rate variability Example 1Example 1: Methods: Methods Example 2Example 2: Lab stressor affects HRV during sleep: Lab stressor affects HRV during sleep
Delta & REM Counts and vPSG Delta & REM Counts and vPSG Sleep HistogramSleep Histogram
Compute:Compute: Total powerTotal power Relative powerRelative powerFor:For: All NightAll Night Individual Sleep CyclesIndividual Sleep Cycles
Frequency (hz)
LN
(Me
an
Po
we
r)
0 10 20 30 40 50
-6-4
-20
24
NREM1 (#202433)
BetaBeta16 – 32 Hz.16 – 32 Hz.
QEEG BandwidthsQEEG BandwidthsDeltaDelta
.5 – 4 Hz..5 – 4 Hz.
ThetaTheta4 – 8 Hz.4 – 8 Hz.
AlphaAlpha8 - 12 Hz.8 - 12 Hz.
SigmaSigma12 - 16 Hz.12 - 16 Hz.
Compute:Compute: Total powerTotal power Relative powerRelative powerFor:For: All NightAll Night Individual Sleep CyclesIndividual Sleep Cycles
Delta Power and VPSG Sleep Delta Power and VPSG Sleep HistogramHistogram
Example…Example…
Frequency and time domain analysis of EEG Frequency and time domain analysis of EEG power during NREM sleep in primary insomniapower during NREM sleep in primary insomnia
Supported by MH24652, RR024153, RR00052 (D. Buysse, PI)Supported by MH24652, RR024153, RR00052 (D. Buysse, PI)
Insomnia is a clinical disorder with sleep and waking Insomnia is a clinical disorder with sleep and waking symptomssymptoms
Etiology uncertain, but Etiology uncertain, but hyperarousalhyperarousal often felt to be a often felt to be a critical componentcritical component– Subjective symptomsSubjective symptoms– Hypothalamic-pituitary-adrenal axisHypothalamic-pituitary-adrenal axis– Functional neuroanatomy using FDG PET studiesFunctional neuroanatomy using FDG PET studies– Beta power in quantitative EEG during NREMBeta power in quantitative EEG during NREM
- Krystal SLEEP 2002; Perlis Sleep Med Rev 2001, Krystal SLEEP 2002; Perlis Sleep Med Rev 2001, Perlis J Sleep Res 2001; Merica Eur J Neurosci Perlis J Sleep Res 2001; Merica Eur J Neurosci 1998)1998)
ParticipantsParticipants GeneralGeneral
– PI and GSC recruited in 3:1 ratioPI and GSC recruited in 3:1 ratio– Age 20-50 years, men and womenAge 20-50 years, men and women– Medical history, psychiatric history (SCID), sleep Medical history, psychiatric history (SCID), sleep
disorders history, screening PSG (AHI, PLMAI < 15)disorders history, screening PSG (AHI, PLMAI < 15) PI (n = 48)PI (n = 48)
– DSM-IV Primary InsomniaDSM-IV Primary Insomnia– PSQI PSQI ≥ 7≥ 7– No specific quantitative criteria by diary or PSGNo specific quantitative criteria by diary or PSG
GSC (n = 25)GSC (n = 25)– No sleep disorderNo sleep disorder– PSQI ≤ 5PSQI ≤ 5– Equated for age and sex with PIEquated for age and sex with PI
Power-frequency plots: Whole nightPower-frequency plots: Whole nightWhole Night
Frequency
0 5 10 15 20 25 30
LN
(Po
we
r)
-6
-4
-2
0
2
4
6
Control (n=25)Insomnia (n=48)
Whole Night
Frequency
0 5 10 15 20 25 30
F R
ati
o
0
2
4
6
8
Whole Night Men
Frequency
0 5 10 15 20 25 30
LN
(Po
we
r)
-6
-4
-2
0
2
4
6
Control (n=10)Insomnia (n=19)
Whole Night Women
Frequency
0 5 10 15 20 25 30
LN
(Po
we
r)
-6
-4
-2
0
2
4
6
Control (n=15)Insomnia (n=29)
Whole Night Men
Frequency
0 5 10 15 20 25 30
F R
ati
o
0
2
4
6
8
Whole Night Women
Frequency
0 5 10 15 20 25 30
F R
ati
o0
2
4
6
8
Power-frequency plots by NREM period: WomenPower-frequency plots by NREM period: Women
NREM1
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=15)Insomnia (n=29)
NREM1
Frequency
0 5 10 15 20 25 30
F R
atio
02468
1012141618
NREM2
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=15)Insomnia (n=29)
NREM3
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=15)Insomnia (n=29)
NREM4
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=12)Insomnia (n=28)
NREM2
Frequency
0 5 10 15 20 25 30
F R
atio
02468
1012141618
NREM3
Frequency
0 5 10 15 20 25 30
F R
atio
02468
1012141618
NREM4
Frequency
0 5 10 15 20 25 30
F R
atio
02468
1012141618
Power-frequency plots by NREM period: MenPower-frequency plots by NREM period: Men
NREM1
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=9)Insomnia (n=18)
NREM1
Frequency
0 5 10 15 20 25 30
F R
atio
0
2
4
6
8
NREM2
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=9)Insomnia (n=19)
NREM3
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=10)Insomnia (n=18)
NREM4
Frequency
0 5 10 15 20 25 30
LN
(Po
wer
)
-6
-4
-2
0
2
4
6Control (n=9)Insomnia (n=17)
NREM2
Frequency
0 5 10 15 20 25 30
F R
atio
0
2
4
6
8
NREM3
Frequency
0 5 10 15 20 25 30
F R
atio
0
2
4
6
8
NREM4
Frequency
0 5 10 15 20 25 30
F R
atio
0
2
4
6
8
Heart Rate Variability: What is it? Heart Rate Variability: What is it? Heart rate is rhythmic and varies dynamically in response to intrinsic and extrinsic inputs and Heart rate is rhythmic and varies dynamically in response to intrinsic and extrinsic inputs and
demands demands (CNS activity, mechanical changes, reflex-related changes, behavior, psychological stress, (CNS activity, mechanical changes, reflex-related changes, behavior, psychological stress, affect).affect).
Interbeat intervals (IBIs) refer to milliseconds between beats. Evaluate in the Interbeat intervals (IBIs) refer to milliseconds between beats. Evaluate in the time domaintime domain or or frequency domainfrequency domain..
Two main components of HRVTwo main components of HRV Low frequency changes (~3-9 cycles/min.) Low frequency changes (~3-9 cycles/min.)
Multiply-determined: input from PNS and SNSMultiply-determined: input from PNS and SNS High frequency changes (9-24 cycles/min.) High frequency changes (9-24 cycles/min.)
Related to PNS (‘vagal’ ‘RSA’)Related to PNS (‘vagal’ ‘RSA’) Low-to-High frequency ratioLow-to-High frequency ratio
Index of sympatho-vagal activityIndex of sympatho-vagal activity
60-minute IBI sequence 60-minute IBI sequence
IBI variability is partitioned along a frequency spectrum using frequency-IBI variability is partitioned along a frequency spectrum using frequency-modeling techniques (e.g., fast Fourier Transformations (FFTs), autoregressive modeling techniques (e.g., fast Fourier Transformations (FFTs), autoregressive spectral analyses).spectral analyses).Amount of variability (spectral power) is estimated for given frequency Amount of variability (spectral power) is estimated for given frequency components (bandwidths).components (bandwidths).Low Frequency = .05-.149 Hz, High Frequency = .15 - .40 HzLow Frequency = .05-.149 Hz, High Frequency = .15 - .40 Hz
10 (shaded) minute IBI sequence10 (shaded) minute IBI sequence
Power spectral estimatesPower spectral estimatesof variability in 10-minuteof variability in 10-minuteIBI epoch (raw, smoothed) IBI epoch (raw, smoothed)
Slide courtesy of Julian F. ThayerSlide courtesy of Julian F. Thayer
Frequency Domain Estimates of HRV (QEKG)Frequency Domain Estimates of HRV (QEKG)
Sleep SCORE: Study Sleep SCORE: Study ProtocolProtocol(HL(HL076379, Investigators: K. Matthews, M. Hall, 076379, Investigators: K. Matthews, M. Hall, D. Buysse, P. Strollo, T. Kamarck, S. Reis)D. Buysse, P. Strollo, T. Kamarck, S. Reis)
DAY 1 DAY 1
DAILY: Fill out Sleep Diary and Wear Wrist ActigraphDAILY: Fill out Sleep Diary and Wear Wrist Actigraph
PSG Sleep PSG Sleep Study Study
(2 nights)(2 nights)
DAY 10DAY 10
Ambulatory Ambulatory BP BP
(48 hours)(48 hours)
EEG, EMG, EOG, EKG EEG, EMG, EOG, EKG
SCORINGSCORING PSGPSG visual sleep stage scoring in 20 second epochsvisual sleep stage scoring in 20 second epochsEKG EKG HRV processing in 2-minute epochsHRV processing in 2-minute epochs
GNTGNT GMT GMT
Heart rate variability: Processing & linking Heart rate variability: Processing & linking HRV and vPSG dataHRV and vPSG data
HRV records processedHRV records processed: : 101 (Night 2)101 (Night 2)
Mean sleep durationMean sleep duration:: 7 hours (420 minutes)7 hours (420 minutes)
210 (2-minute) epochs210 (2-minute) epochs total number of epochs (101 x 210) total number of epochs (101 x 210) > 21,120> 21,120
HRV OutputHRV Output:: LF power, HF power, LF:HF Ratio, Respiration Rate, etc.LF power, HF power, LF:HF Ratio, Respiration Rate, etc.
WAKEWAKE NREM NREM
WW W W W W W 2 W W W W W 2 3 3 4 4 3 3 3 4 4 3vPSGvPSG
HRVHRV
NREM differs from Wakefulness & REMNREM differs from Wakefulness & REM
HF PowerHF Power LF:HFLF:HF
Number of HF HRV epochs during NREM for Number of HF HRV epochs during NREM for G = 0.8G = 0.8 NREM Whole Night = NREM Whole Night = 55; NREM 1 = ; NREM 1 = 77; NREM 2 = ; NREM 2 = 77, NREM 3 = , NREM 3 = 66, NREM 4 = , NREM 4 = 33
Number of 2-Minute Epochs
0 5 10 15 20 25 30
G C
oef
fici
ent
0.4
0.6
0.8
1.0
NREM Whole NightNREM1NREM2NREM3NREM4
How Many HF HRV Epochs During NREM Sleep Are How Many HF HRV Epochs During NREM Sleep Are Enough?Enough?
Number of LF:HF HRV epochs during NREM for Number of LF:HF HRV epochs during NREM for G = 0.8G = 0.8NREM Whole Night = NREM Whole Night = 1313; NREM 1 = ; NREM 1 = 1313; NREM 2 = ; NREM 2 = 1515, NREM 3 = , NREM 3 = 1717, NREM 4 = , NREM 4 = 77
Number of 2-Minute Epochs
0 5 10 15 20 25 30 35 40
G C
oef
fici
ent
0.2
0.4
0.6
0.8
1.0
NREM Whole NightNREM1NREM2NREM3NREM4
How Many LF:HF HRV Epochs During NREM Sleep How Many LF:HF HRV Epochs During NREM Sleep Are Enough?Are Enough?
NREM Period
1 2 3 4
Lo
g(H
F)
4.0
4.2
4.4
4.6
4.8
5.0
5.2
5.4
Does HF HRV During NREM Sleep Change Does HF HRV During NREM Sleep Change Across The Night?Across The Night?
TimeTime F (3,100) = 2.43, p < .07 F (3,100) = 2.43, p < .07
Does LF:HF HRV During NREM Sleep Change Does LF:HF HRV During NREM Sleep Change Across The Night?Across The Night?
TimeTime F (3,99) = 3.99, p < .02 F (3,99) = 3.99, p < .02
STUDY 1: Acute Laboratory StressSTUDY 1: Acute Laboratory Stress
Ambient Stress Acute Stress Heart Period Variability Sleep QualityAmbient Stress Acute Stress Heart Period Variability Sleep Quality
SleepSleepExperimentalExperimentalManipulationManipulation
8:00 p.m.8:00 p.m. a.m.a.m.
SUBJECTS:SUBJECTS:59 healthy undergraduate men and women (50% female, mean age = 19.6 years).59 healthy undergraduate men and women (50% female, mean age = 19.6 years).
Hall et al., Psychosomatic Medicine, 2004Hall et al., Psychosomatic Medicine, 2004
Parasympathetic Activity During Parasympathetic Activity During NREM and REM SleepNREM and REM Sleep
0 1 2 3
Pa
rasy
mp
ath
etic
Act
ivity
0
1000
2000
3000
4000
5000
6000
7000
ControlStress
NREM REMNREM REMParasympathetic Activity = high frequency bandwidth Parasympathetic Activity = high frequency bandwidth (0.15-0.4 Hz)(0.15-0.4 Hz)