Sleepwatching India 3 · 2019-03-14 · Nov 2015. I am happy to present an interview with the...
25
Dear Members, I am extremely happy to announce the release of First Issue of the our Newsletter “SLEEP WATCHING INDIA’ this year. In fact this is the third issue since the inaugural issue in 2015.I hope you enjoyed reading the previous issues. We had some important feedbacks from the Readers, which inspire us. Dr Tripat has added two new features in this issue ‘Secrets in sleep’ and ‘Secrets in Polysomnography”. In future he is going to bring many interesting aspects of sleep science and sleep medicine. Indian Society for Sleep Research is going to celebrate its 25 th Anniversary in 2017 in Goa. We will be announcing the dates very soon. The ASRS2016 Congress(www.asrs2016.org/) is going to be held in Antalya, Turkey during October 1-5, 2016. Dr Murat Aksu extends a warm welcome to you to attend in Congress. ISSR is committed to the advancement of sleep science and sleep medicine by promoting training and education in sleep. Please keep an eye on our various programmes announced in the Newsletter as well as in the website. I take this opportunity to congratulate Dr Tripat for his enthusiasm and efforts to bring our Newsletter not only regularly but also with new feature. Sleep well, sleep on time. Dr. H.N. Mallick MD, PhD Message from President ISSR SleepWatching India Indian Society for Sleep Research (ISSR) Newsletter Issue 3 01/05/2016 From editors desk Pg2 ISSR Activities Pg3 List of WSF certified Physicians and technologist in India Pg4 9 th NSMC Guwahati 2015 Pg5 Events in the region and world Pg6 Sleep Labs in India Pg7-11 Personal Opinions of SleepWatcher Pg12 Board Review Corner Pg13- 19 Sleep Secrets Pg20-22 PSG Secrets Pg23-24 President Dr. H.N. Mallick Vice President Dr. V. Mohan Kumar General Secretary Dr. Bindu M Kutty Treasurer Dr. Kamalesh K Gulia Executive Members Dr. Manvir Bhatia Dr. Manjari Tripathi Dr. Preeti Devnani Dr. Usha Panjwani Newsletter Editor Dr. Tripat Deep Singh Executive Committee
Transcript of Sleepwatching India 3 · 2019-03-14 · Nov 2015. I am happy to present an interview with the...
DearMembers,IamextremelyhappytoannouncethereleaseofFirstIssueoftheourNewsletter“SLEEPWATCHINGINDIA’thisyear.Infactthisisthethirdissuesincetheinauguralissuein2015.Ihopeyouenjoyedreadingthepreviousissues.WehadsomeimportantfeedbacksfromtheReaders,whichinspireus.
DrTripathasaddedtwonewfeaturesinthisissue‘Secretsinsleep’and‘SecretsinPolysomnography”.Infutureheisgoingtobringmanyinterestingaspectsofsleepscienceandsleepmedicine.IndianSocietyforSleepResearchisgoingtocelebrateits25thAnniversaryin2017inGoa.Wewillbeannouncingthedatesverysoon.TheASRS2016Congress(www.asrs2016.org/)isgoingtobeheldinAntalya,TurkeyduringOctober1-5,2016.DrMuratAksuextendsawarmwelcometoyoutoattendinCongress.ISSRiscommittedtotheadvancementofsleepscienceandsleepmedicinebypromotingtrainingandeducationinsleep.PleasekeepaneyeonourvariousprogrammesannouncedintheNewsletteraswellasinthewebsite.ItakethisopportunitytocongratulateDrTripatforhisenthusiasmandeffortstobringourNewsletternotonlyregularlybutalsowithnewfeature.Sleepwell,sleepontime.
Dr.H.N.MallickMD,PhD
Message from President ISSR
SleepWatching India Indian Society for Sleep Research (ISSR) Newsletter Issue 3 01/05/2016
From editors desk Pg2
ISSR Activities Pg3
List of WSF certified Physicians and technologist in India Pg4
9th NSMC Guwahati 2015 Pg5
Events in the region and world Pg6
Sleep Labs in India Pg7-11
Personal Opinions of SleepWatcher Pg12
Board Review Corner Pg13-19 Sleep Secrets Pg20-22 PSG Secrets Pg23-24
President Dr. H.N. Mallick
Vice President Dr. V. Mohan Kumar
General Secretary Dr. Bindu M Kutty
Treasurer Dr. Kamalesh K Gulia
Executive Members Dr. Manvir Bhatia
Dr. Manjari Tripathi Dr. Preeti Devnani Dr. Usha Panjwani
Newsletter Editor Dr. Tripat Deep Singh
Executive Committee
2
From Editor’s D
esk
IamhappytogiveafreshlookandfeeltotheISSRnewsletter“SleepWatchingIndia”inthisissuetomakeitmoreinformativeandreaderfriendly.InthelastissuewesummarizedthedetailsofthesleeplabsinthedifferentpartsofIndia.InthisissuewesummarizethedetailsofthreemoresleeplabsoneeachfromSrinagar,BhopalandChennai.Iamthankfultothesethreelabsfor
sharingtheirdetailswithISSR.IwouldrequestothersleeplabstosharetheirdetailssoastoenableustoprepareacomprehensivelistofthesleeplabsinIndia.ISSRconductedthefirstSleeptechnologistcertificationexamgivenbyWSFinNov2015.Iamhappytopresentaninterviewwiththetopperoftheexaminthesection“PersonalopinionsofSleepWatcher”.IprefertocallSleeptechnologistas“SleepWatcher”sincetheyareobservingthepatientssleepandassociatedparametersduringsleepallthetime.Westarted“BoardReviewCorner”inthelastissuewith5questionseachonSleepMedicineandSleepTechnology.Dr.DeepakSrivastavavolunteeredthissection.ThemainideaofthissectionistomakeavailablestandardquestionsthatareaskedinvariouscompetitiveexaminationsinthefieldofSleepMedicineandSleepTechnologytothecandidateswhowishtotaketheseexams.Iamsurethereaderswouldfindthissectioninterestingespeciallyifyouareplanningtositforanycompetitiveexam.Wehavepublished10questionseachonsleeptechnologyandSleepMedicineinthisissueandalsowillbepublishingineachfutureissueofthenewsletter.Anotherhighlightofthissectionisdetailedanswersformostofthequestionswithreferencesforfurtherreading.Iamstartingtwonewsections“SleepSecrets”and“Polysomnography(PSG)Secrets”fromthisissueonwards.The“SleepSecrets”willdiscusstheveryessentialsofoneofthetopicsinSleepMedicineand“PSGSecrets“willdiscussessentialsofoneofthetopicsinSleepTechnologyinQ&Aformat.IhopethereadersfinditusefulandIlookforwardforyourfeedbacktoimproveandenhancethesesections.Ilookforwardforthereader’sfeedbackonthisissueandpastissuestoenablemedeliverthebestinSleepMedicineandSleepTechnologytoyou.Pleaseemailyourfeedbackonemailid:[email protected],
Dr.TripatDeepSingh
3
ISSR Activities
2013
2014
2015
2016
WSFExam15July2013OnlineExamNo.ofApplicants=5
WSFExam13July2014OnlineexamNo.OfApplicants=3
WSFExam26July2015OnlineExamNo.OfApplicants=5
WSFExam17-July2016,OnlineExamNo.OfApplicants=
NationalSleepMedicineCourse13-15Dec2013ChennaiNo.ofParticipants=100FacultyfromUSA,Japan,IndiaandSingapore
AsianSleepResearchSociety(ASRS)Conference22-24Sep2014Kovalam,Kerala,IndiaNo.ofParticipants=300
NationalSleepMedicineCourse5-6Dec2015Guwahati,AssamIndia
NationalSleepMedicineCourse2-4Dec2016Dehradun,UttarakhandIndia
2ndNationalSleepTechnologyCourse13Dec2013Chennai,IndiaNo.ofParticipants=60FacultyfromUSAandIndia
3rdNationalSleepTechnologyCourse26-27Sep2014Delhi,IndiaNo.ofParticipants=44FacultyfromUSA,IndiaandSingapore
4thNationalSleepTechnologyCourse9-10Dec2015AIIMSDelhi,India
5thNationalSleepTechnologyCourse29-30Nov2016AIIMSDelhi,India
WorkshoponSleepMedicineatAPICON19Nov2014Puri,Orissa,IndiaNo.ofParticipants=70
‘ImportanceofSleepinSchoolChildren’Program
WSFexamforSleepTechnologist31July2016AIIMSDelhi
InstitutedBudurKrishnaMurthyYoungInvestigatorandTravelaward
StartedNewsletter“SleepWatchingIndia”andLiteratureUpdates“SleepUpdateIndia”
Formoredetailsoneachactivitypleasevisitwww.issr.in
4
ISSR-WSF certified Physicians and Technologists in India
Sleep Medicine Doctor’s
2012
Dr. Tripat Deep Singh
Dr. Vikas Mittal
Dr. Teresa MPC Ferreira
Lt Col Dr Karuna Datta
Dr. Nitika Dang
2013
Dr. Pragati Agrawal
Dr. Pramod Krishnan
Dr. Haseeb Hasan
Dr. Kripesh Sarmah
Dr. Ravi Gupta
2014
Dr. Apar Jindal
Dr. Sujit Jagtap
Dr. Ghulam Hussain
2015
Dr. Sourav Das
Dr. Deepak Menon
Dr. Rajanish Sharma
Dr. Vivekananda Lahan
Dr. Hardeep Kumar
Sleep Technologists
2015
Mr. John Mohd Nengroo
Ms. Anubha Sharma
Mr. Utsah Mahamallick
Mr. Basharat Ahmad
Mr. Rahul Rawat
Mr. Adil Ahmad
Mr. Bharat Shah
Mr. Utsav Bansal
Mr. Yuvraj Kunwar
In2011,theIndianSocietyforSleepResearch(ISSR)constitutedatenmemberIndianBoardofSleepMedicine(IBSM)headedbyaChair.WorldSleepFederation(WSF)conducts“InternationalSleepSpecialist”examandcertifyingexamforSleepTechnologiststhroughIBSM.WSFhasconductedtheexamforSleepMedicinedoctor’s4timessince2012andonetimeforsleeptechnologistsstartingin2015.BelowisthelistofDoctor’sandSleeptechnologistsfromIndiawhohavequalifiedtheWSFexam.
5
1
NationalsleepmedicinecourseisaninitiativebyfacultiesfromIndia,USAandJapanwithIndiansocietyforsleepresearch.NSMC2015washeldinGuwahatiandorganisedbyDept.ofPulmonaryMedicine,GauhatiMedicalCollege,Guwahati.90doctorsandsleeptechniciansattendedthecoursefromdifferentpartsofcountryandabroad.ParticipantsfromBangladeshwereveryenthusiasticandtheyinteractedalotwithallthespeakers.DrDeepakShrivastavaandDrHNMallickdirectedthiscourseandtheyprovidedconstantguidanceateverysteptomakethisprogramasuccess.
Internationalfaculty-Dr.AnujChandra,Dr.RonDean(fromUSA),Dr.HimenderMakker(fromUK),Dr.TripatDeepSingh(fromSingapore),andNationalfaculty-Dr.VMohanKumar,Dr.JCSuri,Dr.BinduMKutty,Dr.RaviGupta,Dr.VKVijayan,Dr.GarimaShukla,Dr.ManvirBhatia,Dr.ManjariTripathi,Dr.KamaleshGulia,Dr.KarunaDatta,Dr.DhrubajyotiRoy,Dr.DipeshBhagawati-hadspendtheirvaluabletimeandsharedtheir
2
valuableknowledgewithparticipants.
WorkshoponPolysmnographyandNIVwasveryinteractiveundertheguidanceofDr.TripatDeepSingh,whichhastobeextendedbeyondtimeonparticipantsrequest.Theentirefacultyappreciatedtheparticipantsfortheirinterestineverexpandingfieldofsleepmedicine.Itwasagreatpleasureformeandmydepartmenttoorganisesuchanevent.Dr.KripeshRanjanSarmah,OrganizingSecretary,NSMC2015AssistantProfessor,Dept.ofPulmonaryMedicine,GauhatiMedicalCollege,Guwahati
9th National Sleep Medicine Course (NSMC), Guwahati, Assam 2015
6
Events in the region and World
July- Dec 2016
WSFexam,AIIMSDelhi,16July2016http://www.issr.in
RESPINA,JakartaIndonesia,24-27Aug2016http://respina.org/
23rdCongressoftheEuropeanSleepResearchSociety,BolognaItaly,Sep2016http://www.esrs-congress.eu/esrs2016/welcome/invitation-letter.html
ERSInternationalCongress,LondonUK,3-7Sep2016http://erscongress.org/88-congress-2016/354-ers-international-congress-2016.html
ASRS2016Congress,Antalya,Turkey,1-5Oct2016www.asrs2016.org/
SleepDownUnder,AdelaideAustralia,20-22Oct2016https://www.sleep.org.au/conferences/sleep-downunder-2016
SocietyofAnesthesiaandSleepMedicine(SASM)AnnualConference,ChicagoUS,20-21Oct2016
APSR,BangkokThailand,12-15Nov2016http://www.apsresp.org/congress/2016.html
NAPCON,MumbaiIndia,24-27Nov2016http://www.napcon2016.org/
OMICS:2ndInternationalConferenceonSleepDisordersandMedicineChicago,USA,November28-302016www.sleepmedicine.global-summit.comNationalSleepMedicineCourse(NSMC),DehradunIndia,2-3Dec2016http://www.issr.in
NationalSleepTechnologyCourse(NSTC),29-30NovAIIMSDelhi,http://www.issr.in
7
1.DateofStartofLab:March,20112.Servicesoffered:
Ø Atpresentonehospital-attendedPolysomnographydailyandonanaverage,twohome_basedsleepstudiesperday.
Ø Actigraphyinselectedcasesofcircadianrhythmdisorders
Ø MultipleSleepLatency
Testing(selectedcasesonly)
Ø CognitiveBehavioralTherapyforinsomniacases.
Ø InvivoAllergytesting-This
treatmentmodalityisofspecialhelptothepatientsofsleepdisorderswithco-morbidallergieslikeallergicrhinitisandasthma
KASHMIR INSTITUTE OF ALLERGY AND SLEEP SCIENCES, Srinagar
3.TeamMembers:ThisincludesoneBoardCertifiedSleepSpecialist(DrGhulamHassan),ThreeBoardCertifiedSleepTechnologist,recentlypassedatAIIMSthroughtheWorldSleepFederationandIndianBoardofSleepMedicine.Oneofthem,Mr.Johntoppedthelist.
Contact Details:
Dr. Ghulam Hassan
KASHMIR INSTITUTE OF ALLERGY AND SLEEP SCIENCES Associated with New City Hospital, National Highway, Tengpora, Srinagar-190010, Jammu and Kashmir, India Phone: 0194-2484216, Fax: 0194-2484217, Mobile: 09419007335, 09419007775, 09596071320 Email: [email protected], [email protected], pulmocaresrinagargmail.com, [email protected]
Dr. Ghulam Hassan, MD, DTCD, DAA (Allergy), IBSM (Sleep Medicine) Consultant Internist, Pulmonologist, Allergist and Sleep Specialist, Govt. Medical College, Srinagar, Jammu and Kashmir
Sleep Labs in India
8
Sleep Labs in India
StateoftheartSleepLabwasinauguratedinPulmonaryMedicinewardatAIIMSbhopalon19June2015.Wehavepresentlyfourlevel1PSGLABS&twoportable(level2PSG)labswithus.Ourlabhashotellikeroomswhicharespacious(300sqfeeteach)andaresoundproof.Controloftemperatureandlightcanbedonebytechnicianswithoutdisturbingpatientssleep.Sleeproomshavebiwayconnectionforcommunicationwithtechniciansintechniciansroom.Wehavefacilityforetco2andtcCO2monitoring.Wearealsodoingactigraphyforchronicinsomnia&circadianrythmpatients.
Wedodiagnosisandtreatmentofvarioussleeprelateddisorderse.g.OSA,CSA,SleepRelatedMovementDisorders,Narcolepsy,Parasomnias,Circadianrhythmdisorders,Insomniase.t.cWearedoingmanualscoringandmanualtitrationwithCPAP,BilevelPAP,AVAPS,ASV.Manualscoringischeckedatthreestagesbythreeindependentdoctorsbeforedispatchingtheresult.Wearerunningsleepclinicinwhichdetailedhistory,examination,investigation(includingABG)aredonebeforegivingPSGdates.Aftercompletingstudiesreportsaregiventopatientsandvarioustherapyoptionsareexplainedtopt.
Sleep Lab, AIIMS Bhopal, Madhya Pradesh India
Dr. Abhishek Goyal MD, DM (Pulmonary and critical care Medicine) Assistant professor, Dept. of Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh India
Contact Details:
Dr. Abhishek Goyal MD, DM Dept. of Pulmonary Medicine, AIIMS Bhopal, Madhya Pradesh India Phone. No: :7747012055Emailid:[email protected]
9
Sleep Labs in India
Sleep Lab, AIIMS Bhopal, Madhya Pradesh India
TeamMembers:DrAbhishekGoyalDrAlkeshKhuranaSeniorresident:DrKamenderPawarSleeptech:SenthilkumarAmitkumarRanjitsinghOtherfacultymembersfromAIIMSBhopalassociatedwithsleeplab:ENTsurgeon:DrVikasGuptaMaxillofacialsurgeon:DrAnshulRai
WearerunningPAP-NAPservices,maskfittingclinic,grouptherapysessions,CPAPclinicalongwithsleepclinic.OurnextplanistostartPostDoctoralCertificateCourse(PDCC)inSleepMedicineandtechniciancourseinSleepMedicine.TrainingOpportunities:InterestedcandidatescancomeforobservershipbywritingamailtoinchargeofSleeplab-Dr.AbhishekGoyal.
10
Sleep Labs in India
Chennai Sleep Disorders Centre, Chennai
DiagnosticServicesinclude:Sleep facilities for: All types of sleep studies (Level 1---4) Multiple Sleep Latency test Actigraphy Various Options for titration are also available (CPAP/BIPAP/AVAPS/ASV) Electrophysiological tests facilities for: � Electroencephalography(EEG)� VideoEEG� EMG� NerveConductionStudies(NCS)� RepetitiveNerveStimulation(RNST)� VisualEvokedPotential(VEP)� BrainstemAuditoryEvokedPotential(BAER)� Somatosensory(SSEP)Regularsupportgroupmeetingsandpatienteducationprogramsareconducted.
TRAINING&FELLOWSHIPI. TheCentreisalsoaccredited
bytheISDAfora1) 1yearfellowshiponsleep
Medicine2) ISDArecognisedtechnician
Trainingcourse.
II. BharathUniversity,SreeBalajimedicalCollege&Hospital,DM(Neurology)Threeyear
III. DrMGRMedicalUniversityAccredited-BScNeuroscienceTechnology(3years)Includessleeptechnologyaswell.
Dr. Suresh Kumar MD, DM (Neurology), Fellowship in Sleep Medicine (ISDA)
Contact Details:
Vadapalani Centre:
Chennai Epilepsy and Sleep Disorders
Centre, Room No 1 & 2 , OPD Block
,Vijaya Health Centre, Vadapalani,
Chennai – 26.
Ph- 24800775, 23721835
Email:[email protected]
Mobile: 919841183019
Adyar Neurodiagnostic and Sleep Disorders Centre.
NO 6 Kalyan Lakshmi Building ,2 nd Floor, Kasturba Nagar,
1 st main road , Adyar , Chennai -60020
Ph-42116529
11
Sleep Labs in India
Chennai Sleep Disorders Centre, Chennai Reviews
1) AyyarSSK,Sureshkumar,Sangeetha.SleepdisordersAnoverview.ReviewsinneurologycontinuingmedicaleducationprogramofIndianAcademyofneurology2002
Epidemiology
2) SureshKumar,SSKAyyar,SangeethaV.Knowledge,awarenessandattitudeofpeopletosleeprelateddisorders.Ahospitalbasedpilotsurvey.SleepMedicineVol6Suppl2S190.2005
PARKINSONsDisease&SleepDisorders
3) SureshKumar,MBhatia,MBehari:ExcessivedaytimesleepinessinParkinson’sDiseaseasassessedbyEpworthSleepinessscale.(ESS).SleepMed.2003Jul;4(4):339-42
4) SureshKumar,MBhatia,MBehari.SleepdisordersinParkinson’sdisease.MovementDisorders2002:17(4);755–781
REMBehavioralDisorders5) LenyThomas,SureshKumar,.Predictivevalueofmotorandnon
motorsymptomsfortheassesmentofdementiaandRBDinPDPatients(DrugNaïveandonMedication).BeingpresentedatMDScongressManilla2016
6) LenyThomas,Sureshkumar,.OccurrenceofREMSleepbehavioralDisorders(RBD)inParkinson’sDisease-Experiencefromatertiaryteachinghospital.MDSICON2016,PROCCEDINGSBOOK
RESTLESSLEGSYNDROME
7) Sureshkumar.LenyThomas.CanAkathisiaorrestlessLegsSyndromebedifferentiatedinParkinson`sDisease-Astudyfromtertiaryteachinghospital.MDSICON2016,PROCCEDINGSBOOK
PEDIATRICSLEEP
8) Sureshkumar,nithyaranklyn,Sheetalvmehta.PrevalanceofsleepdisordersandsleepwakepatterninanoutpatientpediatricpopulationattendingatertiaryteachinghospitalinChennai.Sleepmedicine2011.Vol12S1-S138,Supplement1
ChaptersandBookPublications
9) ExcessivedaytimeSleepiness:inDifferentialDiagnosisinNEUROLOGY,Eds2016SudeshPrabhaker,GagandeepSingh.JaypeeBrothersMedicalPublications
10) INOSAGuidelines2014IndianJMedResfirstedition11) ConsensusStatementontheManagementofInsomnia,Elsevier201512) Chapter7.Theinsomnias:HistoricalevolutionSureshKumarandSudhansu
ChokrovertyInSleepmedicine-Acomprehensiveguidetoitsdevelopment,clinicalMilestonesandadvancesintreatment.Springer2015.
12
Personal Opinions of SleepW
atcher
Mr. John Mohd Nengroo MSc IT, ISSR-WSF Certified Sleep Technologist (World Sleep Federation Program through ISSR)
Contact Details:
Kashmir Institute of Allergy and Sleep Sciences Associated with New City Hospital, National Highway, Tengpora, Srinagar-190010, Jammu and Kashmir, India Phone no’s:- 9596071320, 9419007775, E-mail id:- [email protected]
1.Whydidyouchoosetobecomeasleeptechnologist?IbecameSleepTechnologist,bychanceandbyluck,whenImetDr.GhulamHassan,BoardcertifiedSleepSpecialist.HesuggestedmetoselectSleepMedicineascareer.2.Whatisthemostchallengingaspectofbeingasleeptechnologist?MostChallengingaspectofbeingasleeptechnologististheconcernofimprovinghealthcare,throughappropriateuseofsleeptechnology,regardingallaspectsofpatientmotivation,educationandreliablediagnosisandmanagement.3. WhatarethecareeropportunitiesforsleeptechnologistsinIndia?SleepdisordersinIndiaareontherise,andobviouslycarrieropportunitiesofsleeptechnologistinIndiaaretremendous
4.WhatisrequiredtoimprovethequalityofsleeptechnologistsinIndia?ToimprovequalityofsleeptechnologistsinIndia,therequirementsare;Authentictraining,coveringallaspectsofsleeptechnology,duringspecifiedtimeperiodrequiredtomasterthesubject.TopreventmisuseofthisspecialityinIndia,asdealersareconductingsleepstudiesfurnishingautomaticallygeneratedreports,andpatientsarebeingmismanaged.ThismalpracticeneedstobestoppedandonlyboardcertifiedtechnologistsbeallowedtoscoreandfurnishreportsaspertheAmericanAcademyofSleepMedicineguidelines.5.WhatisyourfeedbackaboutvariousISSRprogramsthatarebeingruntoimprovethefieldofSleepMedicineandSleeptechnologyinIndia?VariousISSRprograms,conductedinIndiafocusmoreontheoreticalaspects,althoughNSMCdevotesonedaytotechnicalaspects.Thereshouldbeelaboratetrainingcoursescoveringallaspectsofthesubject.
13
Board Review Corner- Sleep
Technology
Dr. Deepak Shrivastava MD, FAASM, FACP, FCCP, RPSGT UC Davis School of Medicine, California, USA
ContactDetails:
DeepakShrivastava,MD500WestHospitalRoadFrenchCamp,CA95231209-468-6624(Office)209-986-3663(Cellular),Email:[email protected],[email protected]
1.Theuseof60HzfiltersduringaPSGisappropriateinwhichofthefollowingsituations?
a) Clearalltheartifactsb) Reducethefastmuscleactivity
signalsc) Improvethevisualizationof
seizureactivityd) Temporaryresolutionofthe
artifactuntilitcanbecorrected.
2.Adirectcurrent(DC)amplifierischaracterizedbywhichofthefollowing?
a) Absenceofalowfrequencyfilter
b) Abilitytoamplifyalternatingvoltages
c) Abilitytoprocessfastsignalfrequencies
d) Presenceofabothlowandhighfrequencyfilter
3. Whichofthefollowingfiltersettingshasthelongesttimeconstant?
a) 5.0Hz
b) 1.0Hz
c) 0.3Hz
d) 0.1Hz
4. AllofthefollowingarethecharacteristicsofN1sleepexcept:
a) SlowrollingEOG
b) LowvoltagemixedfrequencyEEG
c) DecreasedamplitudeandfrequencyofAlphaactivity
d) Rhythmic12-14Hzactivitylasting>0.5seconds
14
Board Review Corner- Sleep
Technology
5. Theelectrodeimpedanceshouldnotexceedwhichofthefollowing?
a) 1,000ohms
b) 5,000ohms
c) 10,000ohms
d) 15,000ohms
6. ComparedtoNon-REMsleepREMsleepleadstowhichofthefollowing?a) Decreaseinbloodpressureb) Decreaseinheartratec) Increaseinsympathetic
toned) Increaseinpulmonary
arterypressuree) Decreaseincardiacoutput
7. Whichofthefollowingisnotawakepromotingneurotransmitter?a) Glutamateb) Histaminec) GABAd) Dopaminee) Hypocretin
8. Theflip-flopmodelincludeswhichofthefollowingwakepromotingneurotransmitters?a) GABAandSerotoninb) Glutamateandadenosinec) DopamineandOrexind) MelatoninandOrexin
9. WhichofthefollowingconditionswillincreasetheAdenosinelevelsinthebraintothehighestvalue?
a) Aftersleepingfor7-9hoursb) After6hoursofawakeningfrom
sleepc) Justbeforethebedtimeatnight
afteralldayofawakeningd) Justbeforethebedtimewith2
hournapduringtheday
10. Non-benzodiazepinesGABA-
agonistsbindtowhichpartofGABAreceptor?
a) GABAAGammasubunitb) GABAADeltasubunitc) GABABBetasubunitd) GABABAlphasubunit
15
Answ
ers for Board Review Corner-
Sleep Technology
1.Answer:D.IntheUnitedStatesACfrequencyistypicallyat60Hz,whereasinothercountriesthefrequencyofACcurrentmaybe50Hz.60Hzfiltersseverelyattenuate(I.e,highroll-off)frequenciescenteredat60Hz,butmaynotcompletelyfilterthemout.60Hzfiltersshouldnotbeusedroutinely,becausethepresenceofa60-Hzartifactcanrepresentausefulwarningsigntotheastutetechnologist.Theappearanceofa60-Hzartifactshouldwarnthetechnologistofthepossibilityofunequalimpedancebetweenelectrodes(e.g.,lossofelectrodecontactorsweating)orincorrectinputselectio
2.Answer:A.DCamplifiersareusedforrecordingslow-frequencysignals(e.g.,respiration,pressure,oximetry,respiratoryeffort),alowfilterisnotincluded,althoughahigh-frequencyfilterispresent
3.Answer:D.Thefalltimeconstantreferstothetimerequiredforthecurrentfromasquarewavevoltagetodecayto37%ofitspeakamplitude.Timeconstant=resistanceXcapacitance).Thelow-frequencyfiltersettingandthetimeconstantareinverselyrelated.Theshorterthetimeconstantthehigherthelow-frequency-filtersetting.Thelongerthetimeconstantthelowerthelow-frequencyfiltersetting.4.Answer:D.Rhythmic12-14Hzactivitylasting>0.5secondsdefinesfeaturesofaspindle,generallysignifiesN2stage.5.Answer:B.Lowimpedancewillresultinahigh-qualityphysiologicsignalthroughimprovementsinthesignal-to-noiseratio.Conversely,highimpedancewillresultinalow-qualitysignalthroughreductionsinthesignal-to-noiseratio.Impedancesunder5,000ohmsareidealtooptimizethecollectionofACsignals.Recommendedreading:WHATEVERYCLINICIANSHOULDKNOWABOUTPOLYSOMNOGRAPHY.RespirCare2010;55(9):1179–1193.ChokrovertyS.Polysomnographictechnique:Anoverview.In:Sleepdisordersmedicine,2nded.Boston:ButterworthHeinemann;1999:158.Butkov,N.AtlasofClinicalPolysomnography.SynapseMedia:Ashland,OR,1996.6.Answer:C7.Answer:C8.Answer:C9.Answer:C10.Answer:D
16
Board Review Corner-
Sleep Medicine
1.InpatientswithParkinson’swhatmayRBD(REMsleepbehaviordisorder)predict?
a) Cognitiveimpairmentb) Lossofsmellc) Poorresponsetodopamine
agonistsd) Alowerriskofobstructive
sleepapnea
2.Whatisrecommendeddoseofmelatonintotreatcircadianrhythmdisorder(delayedsleepphasetype)?
a) 0.5-1mg30minbeforebedtime
b) 0.5-1mg6hoursbeforebedtime
c) 3-12mg30minbeforebedtime
d) 3-12mg5-6hoursbeforebedtime
3.A6yearoldchildhadaadenotonsillectomyduetosnoringandfallsasleepintheschool.HisAHIis1.2.Accordingtothecurrentguidelineswhichofthefollowingshouldbedone?
a) PostoperativePSGnotindicated
b) PostoperativePSGisindicatedc) PostoperativePSGisindicated
ifhetakesoccasionalnapduringtheday
d) PostoperativePSGisindicatedifhecontinuestofallsasleepatschool
4.A54yearoldmanwithOSAhasbeensuccessfullytreatedwithCPAPfor2yearswithresolutionofsymptomsofsnoringandsleepiness.Hehasgained60lbsweightwithgreaterthan10%changeinBMI.Whichofthefollowingisappropriate?
a) RepeatCPAPtitrationifsymptomsrecur
b) RepeatCPAPtitrationduetogreaterthan10%changeinBMI
c) EmpiricincreaseinCPAPpressureby2-5cmH2O
d) CPAPtitrationplusMSLTtodetermineifsleepinessispresent
5.WhatistherecommendeddoseofModafiniliseffectiveinthemanagementofnarcolepsy?
a) 400mginthemorningb) 200mgat7AMand12PMc) 200mginthemorningd) 100mginthemorning
6.Whatchangesinthesleeparchitecturetakeplacewithacuteorchronicpartialsleepdeprivationstudies?
a) AllsleepstagesarereducedexceptREM
b) N2andREMarereducedbutN1andN3areincreased.
c) N1andN2arereducedbutREMandN3areincreased.
d) AllstagesarereducedexceptN3.
17
Board Review Corner-
Sleep Medicine
7.Whichofthefollowingmedicationsismosteffectiveinthetreatmentofrecurrenthypersomina?
a) Modafanilb) Methylphenidatec) Lithiumcarbonated) Methamphetamine
8.Whichoneofthefollowingpolysomnographicfindingsisconsistentwithperiodiclimbmovementduringsleep(PLMS)?
a) Repetitiveepisodesofmusclecontractionof0.5to5secondsindurationseparatedbyanintervalof5to90seconds.
b) Repetitiveepisodesofmusclecontractionsof15to25secondsindurationseparatedbyanintervalof5to90seconds.
c) Repetitiveepisodesofmusclecontractionof0.5to5secondsindurationseparatedbyanintervaloflessthan5seconds.
d) Repetitiveepisodesofmusclecontractionsof15to25secondsindurationseparatedbyanintervaloflessthan5seconds.
9.Cataplexymanifestsitselfwithvariabilityofexpressioninnarcolepticpatientsandmaybenefitfromtherapeuticintervention.WhichoncethefollowingmedicationisNOTspecificallyusedtotreatcataplexy?
a) Clomipramineb) Modafinilc) Imipramined) Fluoxetinee) Venlafaxine
10.Whichoneofthefollowingstatementsregardingmultiplesleeplatencytests(MSLT)innarcolepticsisNOTtrue?
a) Theaveragesleeplatencyisusuallylessthan10minutes
b) NapswithsleeponsetREMshouldbeallowedtocontinuefor15minutesaftertheonsetofREMsleep
c) MSLTshouldbeprecededbyovernightpolysomnography
d) MSLTconsistsoffourorfivenapsspacedapartintervalsofabout2hours
18
1.Answer:AInParkinson’sdiseasepatient,thepresenceofRBDmaypredictcognitiveimpairmentinupto40%ofpatientswithLewybodydementia(DLB).RBDpatientsshowedvisual-spatialandconstructionalabnormalitiesdespitenootherneurologicdisorderaccordingtoastudybyFermanT,etal.94%ofsubjectshadcognitivedecline.
BestPracticeguidefortheTreatmentofREMsleepBehaviorDisorder(RBD).JournalofClinicalSleepMedicine.6;1:2010.2.Answer:DMelatoninisusedtoshiftthecircadianrhythm,manifestedbytheDimLightMelatoninOnset(DLMO)andcorebodytemperature.Theexacttimeanddoseisnotknown,butingenerallowerdosesaremoreeffective.Typicaltimingis6hours.3.AnswerB.PostoperativePSGIsindicatedafteradenotonsillectomyafteraperiodofrecoverytoallowforcompletehealingandresolutionoftissueedema.4.Answer:BRe-titrationIsIndicatedaftersubstantialweightlossorgain(10%ofbodyweight),obstructivesleepapneasymptomsdespitetheuseofCPAPandwhenclinicalresponseisinsufficient.5.Answer:CTheFDAapprovedandrecommendeddoseis200mgdailyinthemorning.Fortheshiftworkersifneededtherecommendeddoseis200mgorallydailyonehourpriortothestartoftheworkshift.Splitdosesandhigherdoseshavebeenfoundtobemoreeffectivee.g.200mgat7AMand200mgat12PMor400mginAMand200mgat12PM.PracticeParametersforthetreatmentofNarcolepsyandotherHypersomniasofCentralOrigin.Sleep.30;12:2007.6.Answer:D.Regardlessofacuteorchronicpartialsleepdeprivation,EEGstudieshaveshownarelativelypreservedN3sleepwithareductioninallotherstagesofsleep.Thisshouldnotbeconfusedwiththerecoverysleepafterthesleepdeprivation.7.Answer:C.Recurrenthypersominatypicallyresolvesspontaneouslyinadulthood.MosteffectivemedicationfortreatmenthasbeenLithiumcarbonate.Modafanil,methylphenidate,andmethamphetamineareCNSstimulantmedicationusefulintreatingnarcolepsy.8.Answer:A.Repetitiveepisodesofmusclecontractionof0.5to5secondsindurationseparatedbyanintervalof5to90seconds.Patientswithperiodiclimbmovementdisordercanpresentwithcomplaintsofinsomniaorexcessivedaytimesleepiness.Someofthepatientscanbeasymptomatic.Usuallythebedpartnernoticesthemovements.Thelimbmovementsareusuallyhighlystereotypedmovements.Inthelowerextremities,theremovementsarecharacterizedbyextensionofthebigtoeincombinationwithpartialflexionoftheankle,knee,andsometimeship.Eachcontractionslastsfor0.5to5seconds.
Answ
ers for Board Review Corner-
Sleep Medicine
19
Theintervalbetweenthesemovementsistypically20to40seconds.Themovementsseparatedbyanintervaloflessthan5ormorethan90secondsarenotcountedwhendeterminingthetotalnumberofmovementsormovementindices.ForthemovementstobecountedasPLMS,thereshouldbethepresenceoffourormoreconsecutivemovements.9.Answer:B.ModafinilCataplexyischaracterizedbyasuddenandreversiblechangeinmuscletone.Thischangecanbeadecreaseintoneonlyoracompletelossofposturaltone.Itmaybeprecipitatedbyemotionsuchaslaughter,anger,orsurprise.Morethan2/3ofpatientswithnarcolepsyalsohavecataplexy.ThepathophysiologyofcataplexymaybeassociatedwithaninhibitionofboththemonosynapticH-reflexandthemultisynaptictendonreflexes.DuringREMsleeptheH-reflexactivityisfullyrepressed.ThemayexplaintherelationshipofcataplexytoREMsleepinnarcolepsy.Muscariniccholinergicregionsoftheponsandbasalforebrainareinvolvedinaffectingtheinhibitionoflowermotorneuronpathwaysandcataplexymanifestations.Trycyclicantidepressantshavenorepinephrinereuptakeinhibitionthatisusefulincataplexytreatment.Drugsinthisclassincludeclomipramineandprotriptyline.Eventhoughthisdrugclassisusefulforcataplexytreatment,theyarelimitedattimesduetoanticholinergicsideeffects.Serotoninreuptakeinhibitors,asinfluoxetineorthenon-trycyclicserotonin-norepinephrinereuptakeinhibitor,venlafaxine,havebeenhelpfulinsomepatientswithlesssideeffects.ModafinilisastimulantmedicationusedfornarcolepsytoreverseorimproveEDS.Itisnotusedtotreatcataplexysymptomsofnarcolepticpatients.10.Answer.B.NapswithsleeponsetREMshouldbeallowedtocontinuefor15minutesaftertheonsetofREMsleepExcessivedaytimesleepiness(EDS)ofuncertainetiologycanbestudiedbyamultiplesleeplatencytestbutitisimportanttoruleoutotherknowncauses.Examplesaresleepdeprivation,useofsedativemedications,obstructivesleepapnea,centralsleepapneaandmyoclonussyndromethatneedexcludedbeforeperforminganMSLTtoavoidfalsepositivetests.Patientsshouldcompleteadetailedsleeplogforatleast2weeksbeforethetest.OvernightpolysomnographyshouldbeperformedpriortotheMSLTtodocumentanadequateamountofsleepandtoexcludeothercausesofexcessivedaytimesleepiness.Allmedicationsthatcanaffectsleepshouldbediscontinued,suchassedative-hypnotics,sedatingantidepressants,andotherCNSdepressants.AnMSLTconsistsoffournaps,butafifthnapisneededifasinglesleep-onsetREMperiodoccurs.Atthebeginningofeachnap,thepatientisaskedtosleepinaquiet,darkroom.WithnoREMsleep,thenapsareterminated15minutesaftersleeponset.Ifthepatientcannotsleep,thenapsareterminatedafter20minutes.Trialsareusuallyseparatedbyabout2hoursandduringthisperiod,patientsareaskedtostayawake.Sleeplatencyisdefinedasthelengthoftimefromlightsoutuntilthefirstepochofanysleep.IfthepatientachievesasleeponsetREMperiod,thetechnologistawakensthepatientandaskshimorhertostayawakeuntilthenextschedulednap.Inpatientswithnarcolepsy,theaveragesleeplatencyisoftenlessthan5minutesandtherearetwosleeponsetREMperiods.
Answ
ers for Board Review Corner-
Sleep Medicine
20
1.Whichneuralstructuresalongwiththeirneuro-transmittersproducethestateofWakefulness?Activitiesinbrainstemreticularandbasalforebrainactivatingsystemproducethestateofarousal.TheAscendingReticularActivatingSystem(ASRS)alongwithitsimbeddedneurotransmitterssystemsprojectwidelytothecortexembracingthalamus,hypothalamusandbasalforebrainontheway.ThedorsalASRSpathwayoriginatesinponsandmidbrainreticularformationfromLDT/PPTcholinergicandglutamatergicneuronsandwhichprojecttocortexthroughnonspecificintralaminarandmidlinethalamicnuclei.TheventralASRSoriginatesinpontineandmidbrainregionsandprojectstothelateralandtuberomammillary(TMN)nucleiofthalamusaswellasthebasalforebrain.
Sleep Secrets Nonadrenergicneuronsofthe
locuscoeruleusandserotonergicneuronsofthedorsalraphecontributetobothpathwaysandsenddirectprojectiontocortexasdoTMNhistaminergicandLHorexinergicneurons2.WhatistheroleofOrexin/hypocretininsleep-wakefulnesscycle?a.Consolidatewakefulness(Increasedurationoflongwakingbouts)-StimulatesLC,DRN,TMN.b.InhibitREMSleepc.Increasewakefulnessinperiodsofstarvation3.HowdoessuprachaismaticnucleusinteractwithSleeppromotingcentrestopromotewakefulness?SuprachiasmaticnucleusviadorsomedialhypothalamussendsGABAergic(inhibitoryneurotransmitter)projectionstoVentrolateralPre-opticarea
Neurophysiology of Sleep
Dr. H N Mallick MD, PhD, FAMS Professor Physiology AIIMS Delhi, India
ContactDetails:
Dept.ofPhysiologyAIIMSDelhiEmailid:[email protected]:+91-9810755486
21
Sleep Secrets
4.Whichneuralstructuresalongwiththeirneuro-transmittersproducethestateofNREMSleep?VentrolateralPreopticArea(VLPO).ItreleasesGABAandGalaninandinhibitsLC,DRN,TMNandOrexinergicneurons.(Flip-FlopModel)5.Whichneuralstructureisresponsibleforgeneratingsleepspindlesanddeltawaves?SpindlesaregeneratedbyactivityofGABAergicReticularandperigeniculatenucleusofThalamus.Deltawavesaregeneratedbyactivityofthalamocorticalneurons.6.WhichSleepfactorisimplicatedinHomeostatictheoryofSleep?Adenosine.
7.WhichtheoreticalmodelshavebeenproposedtoexplaintheREMandNREMSleep?
a. McCarleyandHobsonmodel-ReciprocalinhibitionbetweenCholinergicandAminergicgroupofneurons
b. McCarleyandMassaquoiModel(LimitcycleModel)-incorporatestheCircadianinfluenceonREMoscillatorandGABAergicREM-onandREM-offneuronsinadditiontoreciprocalinhibitionbetweenCholinergicandAminergicgroupofneurons.
c. Lu&Saperetalmodel(REMFlip-FlopModel)-InvolvesonlyGABAergicandGlutamatergicneurons
d. Luppietalmodel-InvolvesGABA,Glutamate,aminergic/orexin/MCHneurons.
*LuetalandLuppietalmodelsdoesnotexplainhowachangeinstateisachievedoranyexplanationhowNREM-REMtransitionsoccur.8.Whichneuro-transmitterisresponsibleforproducingmuscleatoniainREMSleep?GlycineasoriginallyproposedandnowGABAtoo.9.Whichneuro-transmitterisresponsibleforproducingEEGdesynchronizationinREMsleep?Acetylcholine.
*Adenosinecausespre-synapticinhibitoryeffectsonglutamergiccorticalneurons,wakeactivecholinergicandorexinneuronsandonGABAergicprojectionsonVLPO.*AdenosinemeditaesitssleeppromotingeffectsthroughbothA1andA2Areceptors.*StimulantssuchascaffeineandTheophyllinecounteractthesleeppromotingeffectsofadenosinebyservingasantagonistsatbothA1andA2Areceptors.*SleepdeprivationcauseupregulationofA1receptors.
22
Sleep Secrets
10.Which neural structure is responsible for PGO wave generation during REM Sleep? Synchronizedelectricfiledpotentialsinthepons,lateralgeniculatenucleusandoccipitalcortexoccurathighamplitudeintheperiodimmediatelyprecedingtheonsetofREMsleep.TheponineoriginatorlieswithinLDT/PPT,(subcoereleusincatandparabrachialareasinrats). 11. Which neural structure is responsible for rapid eye movements generation during REM Sleep? Paramedian Reticular Formation. *REM-on neurons (Glutamatergic- Paramedian Reticular Formation and Cholinergic- LDT/PPT) project to paramedian reticular formation saccade generators, which project to Colliculus to generate rapid eye movements. 12. Which neural structure is responsible for penile erections during REM Sleep? According to only two available reports lateral preoptic area-lateral septal network is responsible for penile erection during REM sleep. 13.Which neural structure is responsible for muscle atonia during REM Sleep? PerilocusCeruleusalpha(SubsetofSubcoeruleusarea).*InratssubcoeruleusregioniscalledSublaterodorsalnucleus.
14.What is the role of Melanin Concentrating Hormone (MCH) in REM Sleep?
MCH decreases REM sleep
15.Whichneuralstructuresalongwiththeirneuro-transmittersproducethestateofREMSleep?
PPT/LDT-ReleaseAcetylcholine.
16.Whichinflammatorymediatorspromotesleep?IL-1,TNF-α,PGD2*SomnogeniceffectsofIL-1andTNF-αaremediatedthroughIL-1type1receptorandTNF55-kDAreceptorrespectively.17.WhatistheroleofMelatonininSleep-Wakecycle?
Promotessleep.Usedtotreatadvancedanddelayedsleepphasesyndromebyshiftingbiologicalnight.
18.WhatistheroleofNitricOxide(NO)inSleep?*NOpromotesNREMSleep*NOproducedbyiNOSpromotesNREMSleep*NOpromotesNREMSleepbyreleaseofAdenosineFurtherReading:RitchieEBrownetal.ControlofSleepandWakefulness.PhysiolRev92:1087-1187.2012
23
Whatisadifferentialamplifier?Itisaspecifictypeofelectronicamplifier,whichmultipliesthedifferencebetweentwoinputsbyacommonfactorcalledthedifferentialgain.IfinputatexploringelectrodeisG1andatreferentialelectrodeisG2,then-
OutputVoltage=G1-G2
WhatisthemaindifferencebetweenACandDCamplifier?DCamplifiersareusedforrecordingslow-frequencysignals(e.g.,respiration,pressure,oximetry,respiratoryeffort),alowfilterisnotincluded,althoughahigh-frequencyfilterispresent.ACamplifierisusedforrecordingfastsignalsanditincludesbothhighandlowfrequencyfilter.WhatisthefunctionofHighfrequencyfilter(HFF)?HFFdeterminestheupperlimitoffrequenciesthatachannelwilldisplayatfullamplitude.HFFisalsocalledLowPassFilter(LPF).
PSG Secrets
WhatisthefunctionofLowfrequencyfilter(LFF)?LFFdeterminesthelowerlimitoffrequenciesthatachannelwilldisplayatfullamplitude.LFFisalsocalledHighPassFilter(HPF).AASMrecommendedvaluesforHFFandLFFinPSGare-Channel HFF LFFEEG 35hz 0.3hzEOG 35hz 0.3hzEMG 100hz 10hzECG 70hz 0.3hzAirflow 15hz 0.1hzRespiratoryeffort
15hz 0.1hz
WhatisNyquisttheorem?Itstatesthatsamplingratemustbeatleasttwicethefrequencyoffastestsignalofinteresttominimizethedistortionofdigitizedsignal.Whatisfrequencyaliasing?Alowersamplingratethantwicethefrequencyoffastestsignalresultsindistortionoforiginalsignal,referredtoasaliasing.
Basics of Electronics in Polysomnography (PSG)
ContactDetails:
[email protected]:+91-8826093001
Ms. Anubha Sharma Staff Nurse Neurosurgery AIIMS Delhi ISSR-WSF Certified Sleep Technologist (World Sleep Federation Program through ISSR)
24
WhatarethesamplingratesfordifferentPSGchannelsasrecommendedbyAASM?Channel SamplingRate Max MinEEG 500hz 200hzEOG 500hz 200hzEMG 500hz 200hzECG 500hz 200hzSnoring 500hz 200hzAirflow 100hz 25hzEffort 100hz 25hzOximetry 25hz 10hzBodyPosition 1hz 1hzWhatisCommonModeRejectionRatio(CMRR)?WhatisitsnormalrecommendedvalueforPSG?CMRRmeasurestheabilityofamplifiertorejectinputsignalsthatarecommontobothinputs.MostamplifiershaveCMRRvaluesof5000to10,000.HighertheCMRR,bettertheamplifierWhatisGain?HowdoeschangingGainaffectthesignal?Gainmeanshowmanytimestheamplitudeofwavehasbeenmultiplied.Ifweincreasegain,amplitudeofwaveincreasesandviceversa.WhatisSensitivity?HowdoeschangingSensitivityaffectthesignal?Sensitivitymeansno.ofmicrovoltspermmverticallydisplayedonchannel.Increasingthesensitivitywilldecreasetheamplitudeofthewaveandviceversa.Whatisimpedance?WhatshouldbethemaximumimpedanceforEEGchannelstogetagoodsignal?Impedanceistheresistancetotheflowofelectricalsignal.TheimpedanceofEEGleadsshouldbelessthan5Kohmstogetagoodqualitysignal.
PSG Secrets
Whatisthefunctionofgroundlead?Thedifferentialamplifierusesthegroundleadasacommonreferenceforallelectrodestodomeasurementsofvoltagedifference.Whatis60hzfilter?DeviceusedtodecreasepowerlinesignalsobscuringtheEEGsignalsis60hzfilter.ItisalsocalledNotchfilter.WhatisDecaytimeconstant(TC)andriseTC?Decay/FallTimeconstantisdefinedastimeinsecondsforasquarewavetodecayto37%ofitsoriginalamplitude.DecayTCperformssamefunctionasLFF.AhigherLFFresultsinshorterTCandviceversa.RiseTCisdefinedastimeinsecondsforsignaltoattain63%ofitspeakamplitude.Whatisancillaryequipment?ThedevicesattachedtoPSGmachinetoobtainadditionaldataarecalledancillaryequipmenteg:capnometer,oximeter,PAPdevices,pHmeter,esophagealmanometry.FurtherReading:Books
1. PolysomnographyfortheSleepTechnologist-Instrumentation,Monitoringandrelatedprocedures.Author:BonnieRobertson,BuddyMarshalandMargaret-AnnCarno.Elsevierpublications.
2. EssentialsofPolysomnography.2ndedn.Authors:WilliamHSpriggs.JonesandBartletpublication
ISSR Membership
The Indian Society of Sleep Research (ISSR) works to protect sleep health and promote high quality patient care. These goals are dependent on the support of the professionals working in the field. Membership with the ISSR funds the activities executed for the benefit of all who practice sleep medicine or conduct sleep research. The ISSR works to improve sleep health through advocacy, education, and strategic research and practice standards. The Society will have Life members, Regular members and Corresponding members. In addition to membership the members will receive subscription to-
1. Journal of Sleep and Biological Rhythm 2. ISSR News letter 3. ISSR Literature Updates
We encourage you to become member of ISSR and members to renew their membership so that we have your support in continuation of the field of Sleep Medicine. For more details on membership please visit www.issr.in
Professional Sleep Societies and Web links American Academy of Sleep Medicine (AASM)
www.aasmnet.org
American Association of Sleep Technologist (AAST) www.aastweb.org American Board of Sleep Medicine (ABSM) www.absm.org World Association of Sleep Medicine (WASM) www.wasmonline.org World Sleep Federation (WSF) www.worldsleepfederation.org European Sleep Research Society (ESRS) www.esrs.eu Australasian Sleep Association www.sleep.org.au Asian Sleep Research Society (ASRS) www.asrsonline.org Indian Sleep Disorder Association (ISDA) www.isda.co.in Indian Society of Sleep Research (ISSR) www.issr.in Board of Registered Polysomnography Technologists (BRPT)
www.brpt.org
Letter to the Editor: Dr. Tripat Deep Singh MBBS, MD(Physiology), RPSGT, RST International Sleep Specialist (World Sleep Federation Program) Our readers are invited to write to the editor regarding their views on the published material and also to contribute interesting content or updates in the field. Email us on [email protected]
