Besides visual sleep stage scoring, it is possible to separate sleep stages by analyzing spatially distributed three-channel electroencephalogram (EEG) root mean square (RMS) amplitudes. This approach allows qualitative and quantitative evaluation of sleep architecture. The aim of this study was to analyze the effect of apnea–hypopnea index (AHI) and state of vigilance on the microstructure of cortical activity during sleep using EEG cluster analysis.
In 31 obstructive sleep apnea (OSA) patients, cortical EEG patterns were recorded during polysomnography and subjected to EEG cluster analysis. The results were subsequently correlated to AHI as well as to subjective (Epworth Sleepiness Scale) and objective (pupillographic sleepiness test) daytime sleepiness using linear regression. In 18/31 patients, cortical EEG patterns were recorded again the following night during continuous positive airway pressure (CPAP) titration and compared to the results of the first night.
Linear regression analyses revealed dependencies of specific cortical EEG patterns on AHI (intra-cluster distance of N2 [p = 0.019], N3 [p = 0.024]; inter-cluster distance of wake-N2 [p = 0.046], wake-N3 [p = 0.047], N2–N3 [p = 0.021]) and on objective daytime sleepiness (wake intra-cluster distance [p = 0.047], inter-cluster distance of wake-N3 [p = 0.042]), but not on subjective daytime sleepiness. Specifically, an increase in EEG pattern variability was found in patients with high AHI values, which could be reduced by CPAP therapy.
This new approach enables objective analysis and visualization of sleep macro- and microstructure. The variance of neuronal EEG signal patterns enables conclusions on the presence of pathological respiratory events and objectively measured daytime sleepiness.
Berry RB, Brooks R, Gamaldo CE et al (2012) The AASM manual for the scoring of sleep and associated events. Rules, terminology and technical specifications. American Academy of Sleep Medicine, Darien, Illinois
Dincer HE, O’neill W (2006) Deleterious effects of sleep-disordered breathing on the heart and vascular system. Respiration 73:124–130 CrossRef
Eckert DJ, Younes MK (1985) Arousal from sleep: implications for obstructive sleep apnea pathogenesis and treatment. J Appl Physiol 116:302–313 CrossRef
Epstein LJ, Kristo D, Strollo PJ Jr. et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276 PubMed
Fietze I, Quispe-Bravo S, Hansch T et al (1997) Arousals and sleep stages in patients with obstructive sleep apnoea syndrome: changes under nCPAP treatment. J Sleep Res 6:128–133 CrossRef
He K, Kapur VK (2017) Sleep-disordered breathing and excessive daytime sleepiness. Sleep Med Clin 12:369–382 CrossRef
Iber C, Ancoli-Israel S (2007) A‑IS, Chesson A, Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester (IL)
Krauss P, Metzner C, Schilling A et al (2018) A statistical method for analyzing and comparing spatiotemporal cortical activation patterns. Sci Rep 8:5433 CrossRef
Krauss P, Schilling A, Bauer J et al (2018) Analysis of multichannel EEG patterns during human sleep: a novel approach. Front Hum Neurosci 12:121 CrossRef
Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4:157–171 PubMed
Ludtke H, Wilhelm B, Adler M et al (1998) Mathematical procedures in data recording and processing of pupillary fatigue waves. Vision Res 38:2889–2896 CrossRef
Mayer G, Arzt M, Braumann B et al (2017) German S3 guideline nonrestorative sleep/sleep disorders, chapter “sleep-related breathing disorders in adults,” short version. Somnologie 21:290–301 CrossRef
Medicine Aa O (2014) International classification of sleep disorders-third edition (ICSD-3). American Academy of Sleep Medicine, Darien, IL
Parrino L, Thomas RJ, Smerieri A et al (2005) Reorganization of sleep patterns in severe OSAS under prolonged CPAP treatment. Clin Neurophysiol 116:2228–2239 CrossRef
Peppard PE, Young T, Barnet JH et al (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014 CrossRef
Tatum WO, Dworetzky BA, Schomer DL (2011) Artifact and recording concepts in EEG. J Clin Neurophysiol 28:252–263 CrossRef
Terzano MG, Parrino L, Boselli M et al (1996) Polysomnographic analysis of arousal responses in obstructive sleep apnea syndrome by means of the cyclic alternating pattern. J Clin Neurophysiol 13:145–155 CrossRef
Wilhelm H, Ludtke H, Wilhelm B (1998) Pupillographic sleepiness testing in hypersomniacs and normals. Graefes Arch Clin Exp Ophthalmol 236:725–729 CrossRef
Yamamoto K, Kobayashi F, Hori R et al (2013) Association between pupillometric sleepiness measures and sleep latency derived by MSLT in clinically sleepy patients. Environ Health Prev Med 18:361–367 CrossRef
Zhou J, Camacho M, Tang X et al (2016) A review of neurocognitive function and obstructive sleep apnea with or without daytime sleepiness. Sleep Med 23:99–108 CrossRef
Microstructure of cortical activity during sleep reflects respiratory events and state of daytime vigilance
An EEG cluster analysis
PD Dr. Maximilian Traxdorf
- Springer Medizin
Neu im Fachgebiet Neurologie
Meistgelesene Bücher in der Neurologie
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