Journal
SLEEP
Volume 26, Issue 8, Pages 1042-1047Publisher
AMER ACADEMY SLEEP MEDICINE
DOI: 10.1093/sleep/26.8.1042
Keywords
arousals; nasal pressure; sleep apnea
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Study Objective: To describe the whole spectrum of electroencephalo-graphic (EEG) transients associated with the termination and recovery of obstructed respiratory events and, thus, widen the recognized spectrum of arousal phenomena from sleep. Design: Retrospective review of diagnostic polysomnograms. Setting: American Academy of Sleep Medicine (AASM)-accredited multi-disciplinary sleep disorders center. Patients: 17 patents with obstructive sleep-disordered breathing. Interventions: None. Measurements and Results: Nasal airflow using a nasal-cannula-pressure-transducer system and oral flow by a thermistor were used to score apneas and hypopneas; the latter included flow-limitation events. The EEG patterns that crested or occurred within 2 to 3 seconds of respiratory recovery were recorded, and posthoc categories were created for the purpose of tabulation ranging from an AASM 3-second arousal to a single K-complex with no electromyographic increase. Chi-square statistic was calculated to assess the difference in EEG patterns at event termination between apneas and hypopneas. Score-rescore agreement was tested. Apneas were significantly more likely to be associated with a 3-second arousal than were hypopneas, but all types of EEG change were seen with both types of events. Spindles were rarely seen with arousal-linked K-complexes. The majority of events in rapid eye movement sleep were terminated with visible electromyography tone increase. Conclusions: The spectrum of EEG change associated with the termination of respiratory events identified by using a nasal-cannula-pressure-transducer system is wider than that recognized as arousal phenomena by the 1992 AASM criteria. Scoring arousals with the 3-second rule may falsely minimize the apparent impact of abnormal breathing on sleep. The time may be right to update arousal recognition rules.
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