Polysomnography (PSG) is a multi-parameter type of sleep study and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς (polus for "many, much", indicating many channels), the Latin somnus ("sleep"), and the Greek γράφειν (graphein, "to write"). Type I polysomnography is a sleep study performed overnight with the patient continuously monitored by a credentialed technologist. It records the physiological changes that occur during sleep, usually at night, though some labs can accommodate shift workers and people with circadian rhythm sleep disorders who sleep at other times. The PSG monitors many body functions, including brain activity (EEG), eye movements (EOG), muscle activity or skeletal muscle activation (EMG), and heart rhythm (ECG). After the identification of the sleep disorder sleep apnea in the 1970s, breathing functions, respiratory airflow, and respiratory effort indicators were added along with peripheral pulse oximetry. Polysomnography no longer includes NPT monitoring for erectile dysfunction, as it is reported that all male patients will experience erections during phasic REM sleep, regardless of dream content. Limited channel polysomnography, or unattended home sleep tests, are called Type II–IV channel polysomnography. Polysomnography should only be performed by technicians and technologists who are specifically accredited in sleep medicine. However, at times nurses and respiratory therapists perform polysomnography without specific knowledge and training in the field. Polysomnography data can be directly related to sleep onset latency (SOL), REM-sleep onset latency, number of awakenings during the sleep period, total sleep duration, percentages and durations of every sleep stage, and number of arousals. It may also record other information crucial for diagnostics that are not directly linked with sleep, such as movements, respiration, and cardiovascular parameters. In any case, through polysomnographic evaluation, other information (such as body temperature or esophageal pH) can be obtained according to the patient's or the study's needs. Video-EEG polysomnography, which combines polysomnography with video recording, has been described as more effective than polysomnography alone for the evaluation of sleep troubles such as parasomnias, because it allows easier correlation of EEG and polysomnography with bodily motion.
Medical uses Polysomnography is used to diagnose or rule out many types of sleep disorders, including narcolepsy, idiopathic hypersomnia, periodic limb movement disorder (PLMD), REM behavior disorder, parasomnias, and sleep apnea. Although it is not directly useful in diagnosing circadian rhythm sleep disorders, it may be used to rule out other sleep disorders. The use of polysomnography as a screening test for persons with excessive daytime sleepiness as their sole presenting complaint is controversial.
Mechanism
A polysomnogram will typically record a minimum of 12 channels, requiring a minimum of 22 wire attachments to the patient. These channels vary in every lab and may be adapted to meet the doctor's requests. A minimum of three channels are used for the EEG, one or two measure airflow, one or two are for chin muscle tone, one or more for leg movements, two for eye movements (EOG), one or two for heart rate and rhythm, one for oxygen saturation, and one each for the belts, which measure chest wall movement and upper abdominal wall movement. The movement of the belts is typically measured with piezoelectric sensors or respiratory inductance plethysmography. This movement is equated to effort and produces a low-frequency sinusoidal waveform as the patient inhales and exhales.
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