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Clinical Trial
. 2016 Dec;25(6):625-635.
doi: 10.1111/jsr.12417. Epub 2016 Jun 2.

Comparison of a single-channel EEG sleep study to polysomnography

Brendan P Lucey  1   2 , Jennifer S Mcleland  1 , Cristina D Toedebusch  1 , Jill Boyd  1 , John C Morris  1   2   3 , Eric C Landsness  1 , Kelvin Yamada  1   2 , David M Holtzman  1   2   3
Affiliations
Clinical Trial

Comparison of a single-channel EEG sleep study to polysomnography

Brendan P Lucey et al. J Sleep Res. 2016 Dec.

Abstract

An accurate home sleep study to assess electroencephalography (EEG)-based sleep stages and EEG power would be advantageous for both clinical and research purposes, such as for longitudinal studies measuring changes in sleep stages over time. The purpose of this study was to compare sleep scoring of a single-channel EEG recorded simultaneously on the forehead against attended polysomnography. Participants were recruited from both a clinical sleep centre and a longitudinal research study investigating cognitively normal ageing and Alzheimer's disease. Analysis for overall epoch-by-epoch agreement found strong and substantial agreement between the single-channel EEG compared to polysomnography (κ = 0.67). Slow wave activity in the frontal regions was also similar when comparing the single-channel EEG device to polysomnography. As expected, Stage N1 showed poor agreement (sensitivity 0.2) due to lack of occipital electrodes. Other sleep parameters, such as sleep latency and rapid eye movement (REM) onset latency, had decreased agreement. Participants with disrupted sleep consolidation, such as from obstructive sleep apnea, also had poor agreement. We suspect that disagreement in sleep parameters between the single-channel EEG and polysomnography is due partially to altered waveform morphology and/or poorer signal quality in the single-channel derivation. Our results show that single-channel EEG provides comparable results to polysomnography in assessing REM, combined Stages N2 and N3 sleep and several other parameters, including frontal slow wave activity. The data establish that single-channel EEG can be a useful research tool.

Keywords: ambulatory; inter-rater agreement; sleep stage scoring.

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Figures

Figure 1
Figure 1
A. Sleep Profiler with electrode strip flipped out 180 degrees. Each electrode location is labeled (Fz, Fp1, and Fp2) B. Sleep Profiler in use. (Used with permission from Advanced Brain Monitoring, Carlsbad, CA).
Figure 2
Figure 2
6-second epochs comparing waveforms from different sleep stages recorded from the single-channel EEG (SP) and polysomnography (PSG). Vertical lines on the x-axis are 0.5-second intervals. Horizontal +/-30 μV reference lines are shown on all channels. A. Vertex wave (black bar). B. K-complex and sleep spindle. C. Delta waves. D. Sawtooth waves (black bar). Fp: frontopolar; F: frontal; C: central; O: occipital; M: mastoid.
Figure 3
Figure 3
Comparison of total sleep time (A, D), sleep efficiency (B, E), and wake after sleep onset (C, F) from the single-channel EEG (SP1) and polysomnography (PSG1) scored by scorer 1. A-C are scatter plots with linear regression line and 95% confidence intervals and D-F are Bland-Altman plots. For the Bland-Altman plots, difference was determined by subtracting the sleep parameter determined by single EEG from PSG. Average sleep parameter is the mean of the single EEG and PSG measurements. The mean difference is shown with the solid line, one standard deviation with small dotted lines, and two standard deviations with large dotted lines.
Figure 4
Figure 4
Comparison of sleep latency (A, C) and REM onset latency (B, D) from the single-channel EEG (SP1) and polysomnography (PSG1) scored by scorer 1. A-B are scatter plots with linear regression line and 95% confidence intervals and C-D are Bland-Altman plots. For the Bland-Altman plots, difference was determined by subtracting the latency determined by single EEG from PSG. Average latency is the mean of the single EEG and PSG measurements. The mean difference is shown with the solid line, one standard deviation with small dotted lines, and two standard deviations with large dotted lines.
Figure 5
Figure 5
Comparison of stage N1 (A, D), combined stages N2 and N3 (B, E), and REM (C, F) from the single-channel EEG (SP1) and polysomnography (PSG1) scored by scorer 1. A-C are scatter plots with linear regression line and 95% confidence intervals and D-F are Bland-Altman plots. For the Bland-Altman plots, difference was determined by subtracting the sleep stage time determined by single EEG from PSG. Average sleep stage time is the mean of the single EEG and PSG measurements. The mean difference is shown with the solid line, one standard deviation with small dotted lines, and two standard deviations with large dotted lines.
Figure 6
Figure 6
Slow wave activity (SWA) and hypnogram in a single participant as measured by the single-channel EEG (A) and Polysomnography (B). SWA is expressed as a percentage of mean SWA for the entire night. Sleep stages: W = wake; N1 = NREM stage N1; N2 = NREM stage N2; N3 = NREM stage N3; R = REM sleep.
Figure 7
Figure 7
For each participant, slow wave activity (SWA) during the first twenty minutes of the first NREM period (A) and last NREM period (B) of the night was normalized to the all-night average SWA. Linear regression and 95% confidence intervals are shown. PSG1: SP1: single EEG studies scored by Scorer 1.Polysomnography (PSG) studies scored by Scorer 1.
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