A patient with unrefreshing sleep
Contributed by Patrick Strollo, MD
Figure A is a 30 sec epoch displaying the full montage of a polysomnogram from a patient complaining of unrefreshing sleep. Figure B is the same epoch with only the EEG, EOG, and EMGchin displayed. The watermark N indicates that the record has not been scored and the height of the ruler in the vertical direction correlates with 75 microvolts and the length in the horizontal direction correlates with 10 seconds.
Questions: Figure A is a 30 sec epoch displaying the full montage of a polysomnogram.
- What stage of sleep shown in the epoch?
- What is the characteristic polysomongraphic finding?
- Non-REM Stage 3/4
- The EEG reveals alpha-delta sleep that is frequently seen in fibromyalgia and chronic fatigue syndrome. This is best seen in Figure B with only the EEG, EOG, and EMGchin displayed. The alpha rhythm of 8-13 Hz (red arrows) is super imposed upon the delta waveforms (0.5 – 2 Hz with an amplitude of at least 75 microvolts; pink arrows). This finding may also be seen in patients with chronic pain. This finding usually correlates with complaints of non-restorative sleep.
Reference:
- Afari N, Buchwald D. Chronic Fatigue Syndrome: A Review. Am J Psychiatry 2003; 160:221–236
