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Epileptic Disorders : International... Sep 2016The high temporal resolution of neurophysiological recordings makes them particularly suited to faithfully describing the time course of rapid events such as myoclonus... (Review)
Review
The high temporal resolution of neurophysiological recordings makes them particularly suited to faithfully describing the time course of rapid events such as myoclonus and to precisely measure its time relationship with other related activities. In progressive myoclonus epilepsies (PMEs) polygraphy with simultaneous EMG-EEG recordings is a crucial tool for defining the characteristic of myoclonic jerks their topography over different muscles (namely antagonists), their time course and relationship with vigilance muscle activation and stimulations. Moreover on polygraphic recordings it is possible to detect EEG activities associated to myoclonic jerks and define their time relationship with myoclonus thus differentiating cortical types of myoclonus from subcorticallly generated ones. Tanks to the back averaging technique non obvious time-locked EEG potentials can be detected on polygraphy , furthermore in stimulus sensitive myoclonus the analysis can include the potential evoked by the somatosensory stimulus (SEP). The polygraphic recording also gives information on muscle activity suppression occurring after jerk or as pure negative myoclonus. Besides the time domain analysis, techniques based on frequency analysis have been developed to evaluate EEG-EMG coherence. The neurophysiological techniques provide investigators and clinicians with an invaluable information to define the type of myoclonus and its generating circuitry thus substantially contributing in the diagnosis and management of PMEs.
Topics: Electroencephalography; Electromyography; Humans; Myoclonic Epilepsies, Progressive; Myoclonus
PubMed: 27702708
DOI: 10.1684/epd.2016.0835 -
Sleep Medicine Aug 2020Currently, obstructive sleep apnea syndrome (OSAS) management in Robin sequence (RS) infants has not been standardized. Sleep laboratory polysomnography (PSG) is the...
OBJECTIVE/BACKGROUND
Currently, obstructive sleep apnea syndrome (OSAS) management in Robin sequence (RS) infants has not been standardized. Sleep laboratory polysomnography (PSG) is the gold standard for OSAS diagnosis, however, access is restricted. This study aimed to compare the respiratory indexes measured in a sleep laboratory using PSG as well as a possible alternative, polygraphy (PG).
PATIENTS/METHODS
This retrospective study was conducted between 2015 and 2017 in a tertiary hospital. PSG performed in RS infants in the sleep laboratory was analysed by a single reviewer. After sleep data removal, anonymized raw data were analysed to obtain only PG data. Respiratory indexes were compared for (i) PSG and PG and (ii) patients with or without OSAS clinical signs.
RESULTS
Among the 20 RS (median [IQR] age: 43 [25-114] days at evaluation), 70% of the patients had OSAS clinical signs but all of them had severe OSAS. The median mixed obstructive apnea hypopnea index was not significantly different between PSG and PG (27/h [18-38] versus 26/h [18-56], p = 0.43). The median obstructive apnea index was higher with no significant difference between PG and PSG (19/h [15-31] versus 7/h [4-25], p = 0.05). The median obstructive hypopnea index was significantly lower on PG than on PSG (2/h [0-3] versus 8/h [8-19], p = 0.01). No difference on PSG or PG was observed for patients with and without clinical signs of OSAS.
CONCLUSION
Although PSG remains the gold standard for OSA evaluation, a PG seems to be a useful alternative to measure OSA in RS infants because of their OSAS severity. This evaluation should be recommended in all RS infants, even in the absence of OSAS clinical signs.
CLINICAL TRIAL REGISTRATION
Not applicable.
Topics: Adult; Humans; Infant; Laboratories; Polysomnography; Retrospective Studies; Sleep; Sleep Apnea, Obstructive
PubMed: 32554055
DOI: 10.1016/j.sleep.2020.03.003 -
Methods and Protocols Jan 2021Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab...
Validity and Cost-Effectiveness of Pediatric Home Respiratory Polygraphy for the Diagnosis of Obstructive Sleep Apnea in Children: Rationale, Study Design, and Methodology.
Obstructive sleep apnea (OSA) in children is a prevalent, albeit largely undiagnosed disease associated with a large spectrum of morbidities. Overnight in-lab polysomnography remains the gold standard diagnostic approach, but is time-consuming, inconvenient, and expensive, and not readily available in many places. Simplified Home Respiratory Polygraphy (HRP) approaches have been proposed to reduce costs and facilitate the diagnostic process. However, evidence supporting the validity of HRP is still scarce, hampering its implementation in routine clinical use. The objectives were: Primary; to establish the diagnostic and therapeutic decision validity of a simplified HRP approach compared to PSG among children at risk of OSA. Secondary: (a) Analyze the cost-effectiveness of the HRP versus in-lab PSG in evaluation and treatment of pediatric OSA; (b) Evaluate the impact of therapeutic interventions based on HRP versus PSG findings six months after treatment using sleep and health parameters and quality of life instruments; (c) Discovery and validity of the urine biomarkers to establish the diagnosis of OSA and changes after treatment.
PubMed: 33477929
DOI: 10.3390/mps4010009 -
The American Journal of Medicine Apr 2023Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or... (Review)
Review
Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or procedures that fall outside of the scope of current evidence-based guidelines. Estimating risk and providing guidance for these requests can be challenging due to limited available evidence. This review focuses on some of these unique requests, each of which are real examples encountered in our practice. We offer guidance by synthesizing the available medical literature and formulating recommendations on topics such as the initiation of testosterone and erectile dysfunction therapy, SCUBA and skydiving, polygraphy, and electroconvulsive therapy.
Topics: Male; Humans; Cardiovascular Diseases; Risk Factors; Erectile Dysfunction; Testosterone; Heart Disease Risk Factors; Risk Assessment
PubMed: 36566899
DOI: 10.1016/j.amjmed.2022.12.003 -
Sleep & Breathing = Schlaf & Atmung Sep 2014Portable polysomnography (PSG) and cardiorespiratory polygraphy are increasingly being used in the assessment of sleep-disordered breathing (SDB) in heart failure... (Comparative Study)
Comparative Study
PURPOSE
Portable polysomnography (PSG) and cardiorespiratory polygraphy are increasingly being used in the assessment of sleep-disordered breathing (SDB) in heart failure patients. Scoring of SDB from cardiorespiratory polygraphy recordings is based only on respiratory signals, while electroencephalographic, electrooculographic and electromyographic channels are taken into account when using PSG recordings. The aim of this study was to assess the agreement between these two scoring methods.
METHODS
An overnight sleep study was performed in 67 heart failure patients using a standard portable polysomnograph. Each recording was scored twice, once using all acquired signals (PSG mode) and, after a median of 64 days, using only respiratory signals (cardiorespiratory mode). Agreement was assessed by Bland-Altman analysis and Cohen's kappa.
RESULTS
We found that (1) more respiratory events were detected using cardiorespiratory analysis [median (25th percentile, 75th percentile), 75 (39, 200) events] compared to analysis of portable PSG [69 (29, 173) events, p < 0.0001], the extra events being, for the vast majority, central in origin; (2) the apnea/hypopnea index (AHI) estimated by cardiorespiratory polygraphy [11.9 (5.7, 30.8)/h] showed a negligible negative bias relative to portable PSG [15.1 (5.7, 33.6)/h; bias, -0.8 (-2.9, 0.4)/h, p = 0.0002]; (3) limits of agreement between the two systems (-6.2/h, 1.7/h) were much smaller than those previously observed between two nights using the same scoring modality; and (4) the kappa coefficient using categorised AHI was 0.89 (95% confidence interval (CI) 0.82, 0.96).
CONCLUSIONS
We found a high degree of agreement between the AHIs obtained from the two scoring methods, thus suggesting that cardiorespiratory polygraphy may be used as an alternative to portable PSG in the assessment of SDB in heart failure patients.
Topics: Adult; Aged; Female; Heart Failure; Humans; Male; Middle Aged; Point-of-Care Systems; Polysomnography; Predictive Value of Tests; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 24242991
DOI: 10.1007/s11325-013-0908-2 -
Chest Mar 2007To determine the utility and reliability of a respiratory polygraphy (RP) device with actigraphy (Apnoescreen II; Erich Jaeger GMBH & CoKg; Wuerzburg, Germany) in the... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
To determine the utility and reliability of a respiratory polygraphy (RP) device with actigraphy (Apnoescreen II; Erich Jaeger GMBH & CoKg; Wuerzburg, Germany) in the diagnosis of sleep apnea-hypopnea syndrome (SAHS).
DESIGN
A prospective randomized study with blinded analysis.
PATIENTS
Sixty-two patients with suspected SAHS.
MEASUREMENTS
the following two RP studies were performed: one in the sleep laboratory (sleep laboratory RP [LRP]), simultaneously with polysomnography; and the other at home (home RP [HRP]). To study the interobserver reliability of RP, two manual analyses were carried out by two different researchers.
RESULTS
In LRP, when the respiratory disturbance index was calculated using the total sleep time estimated by actigraphy (RDI) as a denominator, the sensitivity ranged between 94.6% and 100%, and the specificity between 88% and 96.7% for the different cutoff points of the apnea-hypopnea indexes studied. When the respiratory disturbance index was calculated according to the total recording time (RDITRT), the sensitivity was slightly lower (91.6 to 96.9%) and the specificity was similar (92 to 96.7%). In HRP, the sensitivity of the RDI ranged between 83.8% and 95.8%, and the specificity between 92% and 100%, whereas, when the RDITRT was used, the sensitivity was between 83.8% and 87.5%, and the specificity was between 94.7% and 100%. With regard to interobserver reliability, the intraclass correlation coefficient for the RDI of the two analyses of the RP was 0.99 for both LPR and HPR.
CONCLUSION
HPR is an effective and reliable technique for the diagnosis of SAHS, although it is less sensitive than LRP. Wrist actigraphy improves the results of HRP only slightly.
Topics: Adult; Aged; Equipment Design; Female; Humans; Male; Middle Aged; Monitoring, Ambulatory; Observer Variation; Polysomnography; Prospective Studies; Pulmonary Ventilation; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Sleep Apnea, Obstructive; Software; Statistics as Topic
PubMed: 17356086
DOI: 10.1378/chest.06-1604 -
Casopis Lekaru Ceskych 2019Epidemiologic studies show that both atypical sleep time and obstructive sleep apnea (OSA) are independently associated with higher risk of metabolic disease...
Epidemiologic studies show that both atypical sleep time and obstructive sleep apnea (OSA) are independently associated with higher risk of metabolic disease development, particularly obesity and type 2 diabetes mellitus (T2DM). OSA is an independent risk factor for cardiovascular mortality, which is amongst the most common causes of death in T2DM. It is advisable to screen patients for OSA due to the high prevalence of the disease in T2DM patients. For screening are recommended questionnaires and home sleep monitoring. OSA diagnosis is then verified by home sleep apnea testing (using polygraphy) or by polysomnography. Positive airway pressure (PAP) is a gold standard in the treatment of moderate and severe OSA. PAP prevents hypoxia and sleep fragmentation, eliminating excessive daytime sleepiness and decreasing the risk of cardiovascular diseases. Studies have not yet shown an effect of PAP treatment on T2DM compensation and glucose metabolism. Despite this a positive effect of PAP on insulin resistance and glucose tolerance has been proven in patients with prediabetes. PAP therapy is advised in obese patients of the central type with OSA, bariatric surgery has been proven to decrease the severity of OSA.
Topics: Diabetes Mellitus, Type 2; Humans; Insulin Resistance; Obesity; Polysomnography; Sleep Apnea, Obstructive
PubMed: 31703530
DOI: No ID Found -
Thorax Jul 2011Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography for the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS), but stronger... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography for the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS), but stronger evidence is needed. Normally, patients transport HRP equipment from the hospital to home and back, which may create difficulties for some patients.
OBJECTIVES
To determine both the diagnostic efficacy and cost of HRP (with and without a transportation service moving the device and telematic transmission of data) in a large sample compared with in-hospital polysomnography.
METHODS
Patients suspected of having SAHS were included in a multicentre study (eight hospitals). They were assigned to home and hospital protocols in random order. Receiver operating characteristic curves were constructed for manual respiratory polygraphy scoring protocol and different polysomnographic cut-off points. Diagnostic efficacies for several polysomnographic cut-off points were explored and costs for two equally effective alternatives were calculated.
RESULTS
Of 366 randomised patients, 348 completed the protocol. The best receiver operating characteristic curve was obtained with a polysomnographic cut-off of the apnoea-hypopnoea index (AHI)≥5. The sensitive HRP AHI cut-off point (<5) had a sensitivity of 96%, a specificity of 57% and a negative likelihood ratio (LR) of 0.07; the specific cut-off (>10) had a sensitivity of 87%, a specificity of 86% and a positive LR of 6.25. The cost of HRP was half that of polysomnography. Telematic transmission costs were similar if the patients' costs were taken in to account.
CONCLUSION
HRP is an alternative to polysomnography in patients with suspected SAHS. Telematic procedures may help patients with limited mobility and those who live a long way from the sleep centre.
Topics: Adolescent; Adult; Aged; Cost-Benefit Analysis; Epidemiologic Methods; Female; Health Care Costs; Home Care Services, Hospital-Based; Humans; Male; Middle Aged; Polysomnography; Sleep Apnea Syndromes; Telemetry; Transportation; Young Adult
PubMed: 21602541
DOI: 10.1136/thx.2010.152272 -
Behavioral Sciences & the Law Dec 2020A review of empirical studies of offenders-particularly sex offenders, and more particularly those who offend against children-demonstrates that denial of offenses and... (Review)
Review
A review of empirical studies of offenders-particularly sex offenders, and more particularly those who offend against children-demonstrates that denial of offenses and minimization of offending behavior are quite common at every stage of the criminal justice process. This is true during police interviews, during pretrial and presentencing mental health evaluations, among incarcerated offenders, among offenders seeking treatment, among offenders facing parole review, and among offenders already released into the community. This review highlights gaps in the research literature arising from inconsistencies in the definitions and measurement of denial and minimization, from the stage of adjudication or treatment at which measurements are made, and from the use of polygraphy to increase disclosures. Despite these limitations on the generalizability of empirical findings, it appears beyond dispute that many sex offenders maintain their innocence in the face of evidence to the contrary or even criminal conviction, and that many are able to recite additional crimes they have committed when they believe it is in their self-interest to do so.
Topics: Child; Crime; Criminals; Humans; Police; Sex Offenses; Surveys and Questionnaires
PubMed: 33230865
DOI: 10.1002/bsl.2493 -
Advances in Respiratory Medicine 2021Obstructive sleep apnea (OSA) is a disease of significant importance, which may lead to numerous severe clinical consequences. The gold standard in the diagnosis of this...
Obstructive sleep apnea (OSA) is a disease of significant importance, which may lead to numerous severe clinical consequences. The gold standard in the diagnosis of this sleep-related breathing disorder (SRBD) is polysomnography (PSG). However, due to the need for high expertise of staff who perform this procedure, its complexity, and relatively low availability, some simpler substitutes have been developed; among them is polygraphy (PG), which is most widely used. Also, there is a variety of questionnaires suitable to assess the pre-test probability and severity of OSA. The most frequently used ones are the STOP-BANG questionnaire (SBQ), NoSAS questionnaire, and Berlin questionnaire (BQ). However, they have different sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) when being used in various populations. The aim of this study is to provide a concise and clinically-oriented review of the most frequently used questionnaires, with special attention to its strengths and limitations. Moreover, we discuss whether PSG or PG would be more preferred for confirming OSA diagnosis with the highest likelihood.
Topics: Humans; Mass Screening; Polysomnography; Severity of Illness Index; Sleep Apnea, Obstructive; Surveys and Questionnaires
PubMed: 33966264
DOI: 10.5603/ARM.a2021.0038