Welcome Southeast Alaska Clinicians!

The sleep study we perform in the hospital is called polysomnography (PSG).  Also called an “attended sleep study,” this test is widely considered the most comprehensive analysis of a persons sleep.  During PSG, we monitor brain waves (EEG), heart patterns (EKG), eye movements (EOG), several muscle groups (EMG), and many respiratory components.  An attended sleep study is advantageous because it allows precise measurement of sleep and relevant cardiorespiratory and neurologic behaviors and allows for immediate therapeutic intervention by an experienced sleep specialist.  Though sleep apnea is the most common thing we see, the PSG can detect a myriad of sleep disorders.  Disadvantages of PSG include patient inconvenience, a foreign sleep environment, and expenses due to highly trained personnel and technology.

Additional information about attended sleep studies:

The ordering clinician may request the addition of end-tidal carbon dioxide (EtCO2) for any patient they suspect is retaining CO2.

The ordering clinician may request the addition of arm EMG leads for any patient they suspect of a REM behavior disorder.

The ordering clinician may request a full EEG during the sleep study for any patient suspected of nocturnal seizures. 

Zolpidem is available to all patients over 18 years old, within the guidelines of the sleep lab policies and discretion of staff.  

The MSLT is an objective measure of a persons ability to fall asleep. It is used to diagnose narcolepsy and idiopathic hypersomnia.  The MSLT is performed immediately following an overnight attended sleep study.  

The MWT is an objective measure of a persons ability to stay awake. It is typically used to demonstrate a persons ability to stay awake during regular intervals in a dark quiet room.  Persons with a diagnosed sleep disorder, such as OSA, may be required to do an MWT if their professional license requires medical certification (FAA, DOT, Coast Guard, etc.)

Additional ordering information about narcolepsy.  Please document the following:

1. The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least three months, and
2. The presence or absence of cataplexy.

A Home Sleep Test (HST),  also called Home Sleep Apnea Test (HSAT) can sometimes be used as an alternative to the in-hospital sleep testing (polysomnography) we do.  Also called “unattended sleep studies,” the HSAT is for medically uncomplicated patients that are likely to only have sleep apnea.  Sleep apnea is the only disorder the HSAT device can pick up.  We utilize the WatchPAT One and WatchPAT 300. The HSAT is about 80% as accurate at catching sleep apnea as the in-lab test.

Here are the contraindications to the HSAT:

• Under 18 years old.
• COPD.
• CHF.
• Cognitive impairment resulting in the inability to use the equipment
  (when no one else is available).
• Physical impairment
• Central Sleep Apnea
• Narcolepsy
• Nocturnal seizures
• Other parasomnia
• An implanted pacemaker
• A previous failed HSAT, or suspected false-negative HSAT

These are general guidelines and the medical director can make exceptions for extreme circumstances. 

Patients with a moderate to high probability of OSA and a false-negative HSAT, will likely result in the patient having an attended sleep study.

We accept patients as young as 6 months old. We routinely monitor end-tidal carbon dioxide (EtCO2) for patients under 18 years old. Patients under the age of 18 require a parent or guardian to accompany them for the attended sleep study. Home Sleep Apnea Testing is contraindicated for pediatric patients.

Adenotonsillectomy is the usual recommendation for pediatric OSA.  In some cases where surgical intervention does not completely resolve the obstruction, CPAP is still warranted and FDA approved for children who weigh more than 11 pounds and are over a year old.