Pulmonology Book



Aka: Polysomnogram, Polysomnography, Sleep Study, Obstructive Apnea, Obstructive Hypopnea, Upper Airway Resistance Syndrome, Respiratory Effort Related Arousal, Apnea and Hypopnea Index, Respiratory Disturbance Index, UARS, RERA, AHI, RDI
  1. Indications
    1. Sleep disorder diagnosis
      1. Sleep Apnea (Central Sleep Apnea, Obstructive Sleep Apnea)
        1. Diagnosis and CPAP/BiPAP titration
      2. Narcolepsy
      3. Parasomnia
      4. Periodic Limb Movement Disorder
      5. Rapid Eye Movement Sleep Behavior Disorder
      6. Sleep Related Seizure Disorder
    2. Sleep-related symptom evaluation
      1. Sleep maintenance Insomnia
      2. Snoring
      3. Daytime Sleepiness (unexplained)
  2. Definitions
    1. Obstructive Apnea
      1. Air flow decreases 70% for at least 10 seconds with persistent respiratory effort
    2. Obstructive Hypopnea
      1. Air flow decreases 30% for at least 10 seconds with oxygen desaturation >3%
    3. Upper Airway Resistance Syndrome (UARS)
      1. Variant of Obstructive Sleep Apnea
      2. Less airway collapse and less oxygen desaturation
      3. Frequent arousals occur as with OSA/H
    4. Respiratory Effort Related Arousal (RERA)
      1. Abnormal respiratory event associated with an arousal (e.g. gasping) per hour
    5. Apnea and Hypopnea Index (AHI)
      1. Number of Obstructive Apnea and Obstructive Hypopnea events per hour
    6. Respiratory Disturbance Index (RDI)
      1. Apnea and Hypopnea Index (AHI) and Respiratory Effort Related Arousal (RERA)
  3. Technique: Monitors
    1. Electro-oculogram (Eye movement)
    2. Electromyogram (Muscle activity)
    3. Electrocardiogram (EKG)
    4. Nasal pressure transducer
    5. Oronasal thermistor
    6. Oxygen Saturation
    7. Electroencephalogram (EEG)
      1. Sleep Stages
      2. Sleep latency
      3. Arousals from sleep
    8. Telemetry
      1. Heart Rate and rhythm
      2. Respiratory Rate
  4. Types
    1. Overnight Polysomnogram in sleep lab (monitored by attendant, preferred study)
      1. Full night study with subsequent study with NIPPV (CPAP or BiPap) OR
      2. Split-night study (typically diagnostic in first 2 hours with >20 events/h) and NIPPV trial same night
    2. Home study with portable monitors
      1. Precautions
        1. Not recommended for patients with comorbidities (e.g. vascular disease, lung disease)
        2. Less accurate (esp. for fewer channels, when compared with lab study)
          1. Accuracy increases with high pretest probability
      2. Type 2 monitor (7-16 channel)
        1. Test Sensitivity: 79% for AHI 15 (88% for AHI 5)
        2. Test Specificity: 71% for AHI 15 (36% for AHI 5)
      3. Type 3 monitor (4-6 channel)
        1. Test Sensitivity: 64% for AHI 15 (83% for AHI 5)
        2. Test Specificity: 41% for AHI 15 (48% for AHI 5)
      4. Type 4 monitor (2-3 channel)
        1. Test Sensitivity: 67% for AHI 15 (75% for AHI 5)
        2. Test Specificity: 50% for AHI 15 (43% for AHI 5)
      5. References
        1. Qaseem (2014) Ann Intern Med 161(3): 210-20 [PubMed]
  5. Grading
    1. Respiratory Disturbance Index (RDI) <5
      1. No Obstructive Sleep Apnea
      2. No treatment necessary except:
        1. Disruptive snoring
        2. Serious comorbidity (e.g. CHF)
        3. Upper Airway Resistance Syndrome
          1. Consider if significant Sleepiness and Fatigue
    2. Respiratory Disturbance Index (RDI) 5 to 15
      1. Mild Obstructive Sleep Apnea
      2. Diagnostic if symptoms or cardiovascular comorbidities
      3. Consider Upper Airway Resistance Syndrome
    3. Respiratory Disturbance Index (RDI) 16 to 30
      1. Moderate Obstructive Sleep Apnea
      2. Diagnostic for all patients regardless of symptoms or comorbidities
    4. Respiratory Disturbance Index (RDI) >30
      1. Severe Obstructive Sleep Apnea
  6. References
    1. Semelka (2016) Am Fam Physician 94(5): 355-60 [PubMed]

Polysomnography (C0162701)

Definition (MSH) Simultaneous and continuous monitoring of several parameters during sleep to study normal and abnormal sleep. The study includes monitoring of brain waves, to assess sleep stages, and other physiological variables such as breathing, eye movements, and blood oxygen levels which exhibit a disrupted pattern with sleep disturbances.
Definition (NCI_CDISC) Measurement of physiologic parameters during sleep.
Definition (NCI_NCI-GLOSS) A group of recordings taken during sleep that shows brain wave changes, eye movements, breathing rate, blood pressure, heart rate, and the electrical activity of the heart and other muscles. A polysomnogram may be used to help diagnose sleep disorders.
Definition (NCI) Measurement of physiologic parameters during sleep.
Definition (PSY) Simultaneous recording of electrophysiologic activity during sleep.
Definition (CSP) simultaneous and continuous monitoring of relevant normal and abnormal physiological activity during sleep.
Concepts Diagnostic Procedure (T060)
MSH D017286
ICD9 89.17
ICD10 12203-00, 1828
SnomedCT 60554003, 164773008
CPT 95811, 95783, 95808, 95782, 95810, 1013314
LNC LP32261-7
English Monitoring, Sleep, Somnography, Polysomnographies, Somnographies, POLYSOMNOGR, SOMNOGR, PSG, polysomnography (procedure), sleep study, sleep study (procedure), sleep testing, sleep testing (procedure), polysomnography, Sleep study, polysomnograms, monitor sleep, sleep studies, sleep test, sleeping studying, sleep tests, study sleep, sleep measurement, Sleep Study, polysomnogram, Full sleep study, Polysomnogram, Sleep studies, Polysomnography (procedure), Sleep studies (procedure), Polysomnography, NOS, Polysomnogram, NOS, Polysomnography, Sleep Monitoring, Sleep recording
Italian Esame del sonno, Sonnografia, Monitoraggio del sonno, Polisomnografia
Dutch polysomnografie, slaaponderzoek, Polysomnografie, Slaapmonitoring, Somnografie
Portuguese Polisomnografia, Estudo do sono, Monitoramento do Sono, Sonografia, Polissonografia
Japanese 睡眠検査, 睡眠ポリグラフ, スイミンケンサ, スイミンポリグラフ, 監視-睡眠, 睡眠ポリグラフィー, ソムノグラフィー, 睡眠監視, ポリソムノグラフィー, モニタリング-睡眠, 睡眠モニタリング
Swedish Sömnövervakning
Czech polysomnografie, Polysomnografie, Vyšetření spánku, spánková laboratoř
Finnish Unipolygrafia
French Somnographie, Polysomnographie, Polygraphie du sommeil, Monitorage du sommeil, Etude du sommeil
Polish Somnografia, Polisomnografia, Monitorowanie snu
Hungarian Polysomnographia, Alvás vizsgálat
Norwegian Polysomnografi, Søvnovervåkning, Somnografi, Søvnovervåking
Spanish Monitorización del Sueño, estudios del sueño (procedimiento), estudios del sueño, polisomnografía (procedimiento), polisomnografía, SAI, polisomnografía, polisomnograma, Estudio de sueño, Monitoreo del Sueño, Polisomnografía, Somnografía
German Schlafstudie, Monitoring, Schlaf-, Polysomnographie, Schlafmonitoring, Somnographie, Schlafüberwachung
Derived from the NIH UMLS (Unified Medical Language System)

polysomnography: apnea-hypopnea index (C2111846)

Concepts Finding (T033)
LNC LP145624-5, MTHU043210
English apnea-hypopnea index, polysomnography: apnea-hypopnea index (procedure), polysomnography: apnea-hypopnea index, Apnea hypopnea index
Derived from the NIH UMLS (Unified Medical Language System)

polysomnography: respiratory disturbance index (C2111853)

Concepts Finding (T033)
English respiratory disturbance index, polysomnography: respiratory disturbance index (procedure), polysomnography: respiratory disturbance index
Derived from the NIH UMLS (Unified Medical Language System)

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