Assessment of Human Sleep Depth Is Being De-Standardized by Recently Advised EEG Electrode Locations

Kemp, B.; Someren, Paul van; Roessen, Marco; Dijk, J. Gert van

doi:10.1371/journal.pone.0071234

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…The first explanation relates to the between-subject variations in slow wave amplitudes. While it has been well demonstrated that the F4-M1 derivation shows an average increase of 20% in slow wave amplitude compared to the C4-M1, 13 this does not necessarily translate to a reduction in N3 sleep in all patients. The criteria for N3 requires only six seconds of slow wave activity with an amplitude of 75 μV or greater across a 30-second epoch.…”

Section: Discussionmentioning

confidence: 91%

“…Kemp and colleagues have recently shown slow wave amplitudes in the Fz-Cz derivation to be approximately 60% to 65% of the slow wave amplitudes measured in the F4-M1 derivation. 13 This could lead to significant changes in the proportion of stage 3 sleep (N3) scored. The AASM acknowledged this issue in item V5 of their online FAQ, 10 and suggested using C4-M1 if using the recommended electrooculogram (EOG) placement and E1-Fpz if using the alternative EOG placement for the measurement of frontal activity.…”

Section: Journal Of Clinical Sleepmentioning

confidence: 99%

“…12 This is due to both the proximity of the electrode locations and the nature of differential amplifiers. Proximal electrodes will often receive similar potentials oriented in the same dipole, 13 leading the differential amplifier to cancel these potentials out.…”

mentioning

confidence: 99%

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The AASM Recommended and Acceptable EEG Montages are Comparable for the Staging of Sleep and Scoring of EEG Arousals

Duce

Rego

Milosavljevic

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objective: To examine the measurement differences in sleep and EEG arousal statistics between the American Academy of Sleep Medicine (AASM) recommended EEG montage (F4-M1, C4-M1, O2-M1) and acceptable EEG montage (Fz-Cz, C4-M1, Oz-Cz). Design: Prospective, blinded, randomized comparison. Setting: Australian clinical sleep laboratory in a tertiary hospital. Patients or Participants: 50 consecutive patients undertaking polysomnography (PSG) for the clinical suspicion of sleep disordered breathing. Interventions: N/A Measurements and Results: Patient EEGs were recorded using both the AASM recommended and acceptable EEG montages during the PSG. Two scorers were used to examine the difference in PSG statistics using the two EEG montages. The scorers analyzed the 50 studies using the two EEG montages. Ten of the studies were scored twice for each montage by each scorer to calculate intra-scorer and interscorer agreement. No statistically signifi cant differences were observed between the PSG statistics of the recommended and acceptable EEG montages. The recommended EEG montage had greater inter-scorer agreement but no difference in intrascorer agreement. Conclusions: This study demonstrates that the two EEG montages endorsed by the AASM Manual produce similar sleep and EEG arousal statistics. Keywords: EEG, recommended montage, acceptable montage, sleep staging, EEG arousal scoring, polysomnography, sleep apnea, inter-scorer agreement, intra-scorer agreement, kappa Citation: Duce B, Rego C, Milosavljevic J, Hukins C. The AASM recommended and acceptable EEG montages are comparable for the staging of sleep and scoring of EEG arousals. J Clin Sleep Med 2014;10(7):803-809.http://dx.doi.org/10.5664/jcsm.3880 S C I E N T I F I C I N V E S T I G A T I O N SA standard of clinical polysomnography (PSG) is the characterization of sleep and sleep fragmentation via the staging of sleep and scoring of EEG arousals.1 For a number of decades the staging of sleep was conducted according to the Rechtschaffen and Kales (R&K) criteria.2 This standard recommended a single central derivation, despite its apparent shortcomings. 3 In 2007 the American Academy of Sleep Medicine (AASM) published The AASM Manual for the Scoring of Sleep and Associated Events. 4 This was seen as a long-overdue update of the criteria, incorporating the evidence accumulated since the publication of R&K and recognizing the need to improve inter-scorer agreement. 5 Among the changes in the AASM manual was the increase to three derivations in the EEG montage as well as the provision of two different EEG montages. The introduction of two extra derivations into the EEG montage was based on evidence that regional differences in EEG morphology exist and may be important in describing sleep. [6][7][8][9] The two EEG montages allowed differ in the type of derivations that make up each montage. The recommended montage (M rec ) consists of all referential derivations, with negative input electrodes over the frontal, central, and occipital regions. The acceptable mo...

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Section: Discussionmentioning

confidence: 91%

Section: Journal Of Clinical Sleepmentioning

confidence: 99%

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The AASM Recommended and Acceptable EEG Montages are Comparable for the Staging of Sleep and Scoring of EEG Arousals

Duce

Rego

Milosavljevic

et al. 2014

Journal of Clinical Sleep Medicine

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“…Recently, Kemp et al . () showed that the forehead derivation shows an average increase of 20% in slow‐wave amplitude compared with central derivation. In the present study, excellent PPV for N3 scored using the forehead EEG electrode set was found (Table ).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the suitability of using a forehead EEG electrode set and chin EMG electrodes for sleep staging in polysomnography

Myllymaa

Muraja-Murro

Westerén-Punnonen

et al. 2016

Journal of Sleep Research

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Summary Recently, a number of portable devices designed for full polysomnography at home have appeared. However, current scalp electrodes used for electroencephalograms are not practical for patient self‐application. The aim of this study was to evaluate the suitability of recently introduced forehead electroencephalogram electrode set and supplementary chin electromyogram electrodes for sleep staging. From 31 subjects (10 male, 21 female; age 31.3 ± 11.8 years), sleep was recorded simultaneously with a forehead electroencephalogram electrode set and with a standard polysomnography setup consisting of six recommended electroencephalogram channels, two electrooculogram channels and chin electromyogram. Thereafter, two experienced specialists scored each recording twice, based on either standard polysomnography or forehead recordings. Sleep variables recorded with the forehead electroencephalogram electrode set and separate chin electromyogram electrodes were highly consistent with those obtained with the standard polysomnography. There were no statistically significant differences in total sleep time, sleep efficiency or sleep latencies. However, compared with the standard polysomnography, there was a significant increase in the amount of stage N1 and N2, and a significant reduction in stage N3 and rapid eye movement sleep. Overall, epoch‐by‐epoch agreement between the methods was 79.5%. Inter‐scorer agreement for the forehead electroencephalogram was only slightly lower than that for standard polysomnography (76.1% versus 83.2%). Forehead electroencephalogram electrode set as supplemented with chin electromyogram electrodes may serve as a reliable and simple solution for recording total sleep time, and may be adequate for measuring sleep architecture. Because this electrode concept is well suited for patient's self‐application, it may offer a significant advancement in home polysomnography.

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“…Using a bipolar montage reduces the overall EEG amplitude compared to the referential montage. This reduction significantly impacts SW activity, with the potential for an up to 75% decrease in the Fz-Cz channel compared to C4-M1 (Kemp et al, 2013). As a result, we adjusted the amplitude detection criteria for SW events as done in our previous work (Latreille and Avigdor et al,2023).…”

Section: Slow Wave Detectormentioning

confidence: 99%

Intracerebral dynamics of sleep arousals: a combined scalp-intracranial EEG study

Wang,

Avigdor,

Hannan

et al. 2024

J. Neurosci.

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As an intrinsic component of sleep architecture, sleep arousals represent an intermediate state between sleep and wakefulness and play an important role in sleep-wake regulation. They have been defined in an all-or-none manner, whereas they actually present a wide range of scalp-electroencephalography (EEG) activity patterns. It is poorly understood how these arousals differ in their mechanisms. Stereo-EEG (SEEG) provides the unique opportunity to record intracranial activities in superficial and deep structures in humans. Using combined polysomnography and SEEG, we quantitatively categorized arousals in non-rapid eye movement sleep into slow wave (SW) and Non-SW arousals based on whether they co-occurred with a scalp-EEG SW event. We then investigated their intracranial correlates in up to 26 brain regions from 26 patients (12 females). Across both arousal types, intracranial theta, alpha, sigma, and beta activities increased in up to 25 regions (p<0.05,d=0.06-0.63), while gamma and high frequency (HF) activities decreased in up to 18 regions across five brain lobes (p<0.05,d=0.06-0.44). Intracranial delta power widely increased across five lobes during SW arousals (p<0.05 in 22 regions,d=0.10-0.39), while it widely decreased during Non-SW arousals (p<0.05 in 19 regions,d=0.10-0.30). Despite these main patterns, unique activity was observed locally in some regions such as the hippocampus and middle cingulate cortex, indicating spatial heterogeneity of arousal responses. Our results suggest that Non-SW arousals correspond to a higher level of brain activation than SW arousals. The decrease in HF activities could potentially explain the absence of awareness and recollection during arousals.Significance StatementIntrinsic to sleep architecture, sleep arousals play an important role in sleep-wake regulation. They are defined in an all-or-none manner, whereas they actually present various scalp electroencephalography (EEG) patterns. Using simultaneous scalp and intracranial EEG in humans, we analyzed the intracranial activity during two types of arousals marked on scalp EEG, quantitatively categorized by whether they co-occurred with a scalp-EEG slow wave (SW). Non-SW arousals present prevalent low-voltage fast activity, while SW arousals exhibit high-voltage slow waves alongside fast activities. This work represents the first intracranial study of different types of NREM sleep arousals and provides a comprehensive description of local brain activities during both arousal types, serving as a foundation for future studies investigating regional behaviors during sleep-wake transition.

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Assessment of Human Sleep Depth Is Being De-Standardized by Recently Advised EEG Electrode Locations

Cited by 4 publications

References 9 publications

The AASM Recommended and Acceptable EEG Montages are Comparable for the Staging of Sleep and Scoring of EEG Arousals

The AASM Recommended and Acceptable EEG Montages are Comparable for the Staging of Sleep and Scoring of EEG Arousals

Assessment of the suitability of using a forehead EEG electrode set and chin EMG electrodes for sleep staging in polysomnography

Intracerebral dynamics of sleep arousals: a combined scalp-intracranial EEG study

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