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The Measurement of Sleep: A Practical Workshop for Investigators Polysomnography

The Measurement of Sleep: A Practical Workshop for Investigators Polysomnography. Patrick J. Strollo M.D. Martica Hall, Ph.D. Neuroscience – Clinical & Translational Research Center Laboratory Team Pittsburgh Mind-Body Center on Sleep Workshop Pittsburgh, PA April 11, 2008. Agenda.

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The Measurement of Sleep: A Practical Workshop for Investigators Polysomnography

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  1. The Measurement of Sleep: A Practical Workshop for InvestigatorsPolysomnography Patrick J. Strollo M.D. Martica Hall, Ph.D. Neuroscience – Clinical & Translational Research Center Laboratory Team Pittsburgh Mind-Body Center on Sleep Workshop Pittsburgh, PA April 11, 2008

  2. Agenda • Brief review of polysomnography (PSG) • Goal: Learn what is meant by poly (many) somnus (sleep) graphein (to write) • Tour of N-CTRC sleep laboratory • Goal: learn about the different types of studies that can be conducted in the N-CTRC • Meet sleep technician and sleep study “participant” to see what’s involved in using PSG to measure sleep • Goal: learn what all of the electrodes & monitors measure • Watch as signals are collected from participant and review how different signals change with behavior • Goal: learn what different signals look like • Review examples of sleep pathologies • Goal: learn about some of the signals that indicate sleep pathologies • Review two kinds of advanced signal processing • Goal: learn what is meant by spectral analysis of the EEG and EKG during sleep

  3. Advanced Signal Processing • Spectral analysis of signals collected during sleep studies • What is spectral analysis? • Decompose a complex, multi-determined signal • Move from time to frequency domain (power is variability2) • Spectral analysis of the EEG • Example: EEG profile in patients with insomnia differs by gender and across the night • Spectral analysis of heart rate variability • Example 1: Methods • Example 2: Lab stressor affects HRV during sleep

  4. Delta & REM Counts and vPSG Sleep Histogram Compute: Total power Relative power For: All Night Individual Sleep Cycles

  5. QEEG Bandwidths Delta .5 – 4 Hz. Theta 4 – 8 Hz. Alpha 8 - 12 Hz. Sigma 12 - 16 Hz. Beta 16 – 32 Hz.

  6. Delta Power and VPSG Sleep Histogram Compute: Total power Relative power For: All Night Individual Sleep Cycles Example…

  7. Frequency and time domain analysis of EEG power during NREM sleep in primary insomniaSupported by MH24652, RR024153, RR00052 (D. Buysse, PI) • Insomnia is a clinical disorder with sleep and waking symptoms • Etiology uncertain, but hyperarousal often felt to be a critical component • Subjective symptoms • Hypothalamic-pituitary-adrenal axis • Functional neuroanatomy using FDG PET studies • Beta power in quantitative EEG during NREM • Krystal SLEEP 2002; Perlis Sleep Med Rev 2001, Perlis J Sleep Res 2001; Merica Eur J Neurosci 1998)

  8. Participants • General • PI and GSC recruited in 3:1 ratio • Age 20-50 years, men and women • Medical history, psychiatric history (SCID), sleep disorders history, screening PSG (AHI, PLMAI < 15) • PI (n = 48) • DSM-IV Primary Insomnia • PSQI ≥ 7 • No specific quantitative criteria by diary or PSG • GSC (n = 25) • No sleep disorder • PSQI ≤ 5 • Equated for age and sex with PI

  9. Power-frequency plots: Whole night

  10. Power-frequency plots by NREM period: Women

  11. Power-frequency plots by NREM period: Men

  12. Heart Rate Variability: What is it? • Heart rate is rhythmic and varies dynamically in response to intrinsic and extrinsic inputs and demands (CNS activity, mechanical changes, reflex-related changes, behavior, psychological stress, affect). • Interbeat intervals (IBIs) refer to milliseconds between beats. Evaluate in the time domain or frequency domain. • Two main components of HRV • Low frequency changes (~3-9 cycles/min.) • Multiply-determined: input from PNS and SNS • High frequency changes (9-24 cycles/min.) • Related to PNS (‘vagal’ ‘RSA’) • Low-to-High frequency ratio • Index of sympatho-vagal activity

  13. Frequency Domain Estimates of HRV (QEKG) 60-minute IBI sequence 10 (shaded) minute IBI sequence Power spectral estimates of variability in 10-minute IBI epoch (raw, smoothed) IBI variability is partitioned along a frequency spectrum using frequency-modeling techniques (e.g., fast Fourier Transformations (FFTs), autoregressive spectral analyses). Amount of variability (spectral power) is estimated for given frequency components (bandwidths). Low Frequency = .05-.149 Hz, High Frequency = .15 - .40 Hz Slide courtesy of Julian F. Thayer

  14. Sleep SCORE: Study Protocol (HL076379, Investigators: K. Matthews, M. Hall, D. Buysse, P. Strollo, T. Kamarck, S. Reis) DAILY: Fill out Sleep Diary and Wear Wrist Actigraph PSG Sleep Study (2 nights) Ambulatory BP (48 hours) DAY 1 DAY 10 EEG, EMG, EOG, EKG GNT GMT SCORING PSG visual sleep stage scoring in 20 second epochs EKG HRV processing in 2-minute epochs

  15. Heart rate variability: Processing & linking HRV and vPSG data HRV records processed: 101 (Night 2) Mean sleep duration: 7 hours (420 minutes)  210 (2-minute) epochs  total number of epochs (101 x 210)  > 21,120 HRV Output: LF power, HF power, LF:HF Ratio, Respiration Rate, etc. vPSG HRV W W W W W W 2 3 3 4 4 3 WAKE NREM

  16. NREM differs from Wakefulness & REM HF Power LF:HF

  17. How Many HF HRV Epochs During NREM Sleep Are Enough? Number of HF HRV epochs during NREM for G = 0.8 NREM Whole Night = 5; NREM 1 = 7; NREM 2 = 7, NREM 3 = 6, NREM 4 = 3

  18. How Many LF:HF HRV Epochs During NREM Sleep Are Enough? Number of LF:HF HRV epochs during NREM for G = 0.8 NREM Whole Night = 13; NREM 1 = 13; NREM 2 = 15, NREM 3 = 17, NREM 4 = 7

  19. Does HF HRV During NREM Sleep Change Across The Night? Time F (3,100) = 2.43, p < .07 Time F(3,100)=2.43, p < .07 Time F(3,100)=2.43, p < .07

  20. Does LF:HF HRV During NREM Sleep Change Across The Night? Time F (3,99) = 3.99, p < .02

  21. STUDY 1: Acute Laboratory Stress Ambient Stress Acute Stress Heart Period Variability Sleep Quality Experimental Manipulation Sleep 8:00 p.m. a.m. SUBJECTS: 59 healthy undergraduate men and women (50% female, mean age = 19.6 years). Hall et al., Psychosomatic Medicine, 2004

  22. Parasympathetic Activity During NREM and REM Sleep NREM REM • Parasympathetic Activity = high frequency bandwidth (0.15-0.4 Hz)

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