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Microsleep episodes in the borderland between wakefulness and sleep


Hertig-Godeschalk, Anneke; Skorucak, Jelena; Malafeev, Alexander; Achermann, Peter; Mathis, Johannes; Schreier, David R (2019). Microsleep episodes in the borderland between wakefulness and sleep. Sleep:zsz163.

Abstract

STUDY OBJECTIVES:
The wake-sleep transition zone represents a poorly defined borderland, containing e.g. microsleep episodes (MSEs) which are of potential relevance for diagnosis and may have consequences while driving. Yet, the scoring guidelines of the American Academy of Sleep Medicine (AASM) completely neglect it. We aimed to explore the borderland between wakefulness and sleep by developing the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring, focusing on MSEs visible in the electroencephalogram (EEG), as opposed to purely behaviour- or performance-defined MSEs.
METHODS:
Maintenance of Wakefulness Test (MWT) trials of 76 randomly selected patients were retrospectively scored according to both the AASM and the newly developed BERN scoring criteria. The visual scoring was compared with spectral analysis of the EEG. The quantitative EEG analysis enabled a reliable objectification of the visually scored MSEs. For less distinct episodes within the borderland, either ambiguous or no quantitative patterns were found.
RESULTS:
As expected, the latency to the first MSE was significantly shorter in comparison to the sleep latency, defined according to the AASM criteria. In certain cases, a large difference between the two latencies was observed, and a substantial number of MSEs occurred between the first MSE and sleep. Series of MSEs were more frequent in patients with shorter sleep latencies, while isolated MSEs were more frequent in patients who did not reach sleep.
CONCLUSION:
The BERN criteria extend the AASM criteria and represent a valuable tool for in-depth analysis of the wake-sleep transition zone, particularly important in the MWT.

Abstract

STUDY OBJECTIVES:
The wake-sleep transition zone represents a poorly defined borderland, containing e.g. microsleep episodes (MSEs) which are of potential relevance for diagnosis and may have consequences while driving. Yet, the scoring guidelines of the American Academy of Sleep Medicine (AASM) completely neglect it. We aimed to explore the borderland between wakefulness and sleep by developing the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring, focusing on MSEs visible in the electroencephalogram (EEG), as opposed to purely behaviour- or performance-defined MSEs.
METHODS:
Maintenance of Wakefulness Test (MWT) trials of 76 randomly selected patients were retrospectively scored according to both the AASM and the newly developed BERN scoring criteria. The visual scoring was compared with spectral analysis of the EEG. The quantitative EEG analysis enabled a reliable objectification of the visually scored MSEs. For less distinct episodes within the borderland, either ambiguous or no quantitative patterns were found.
RESULTS:
As expected, the latency to the first MSE was significantly shorter in comparison to the sleep latency, defined according to the AASM criteria. In certain cases, a large difference between the two latencies was observed, and a substantial number of MSEs occurred between the first MSE and sleep. Series of MSEs were more frequent in patients with shorter sleep latencies, while isolated MSEs were more frequent in patients who did not reach sleep.
CONCLUSION:
The BERN criteria extend the AASM criteria and represent a valuable tool for in-depth analysis of the wake-sleep transition zone, particularly important in the MWT.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Pharmacology and Toxicology
07 Faculty of Science > Institute of Pharmacology and Toxicology

04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
04 Faculty of Medicine > The KEY Institute for Brain-Mind Research
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Uncontrolled Keywords:microsleep, wake-sleep transition zone, AASM scoring criteria, Maintenance of Wakefulness Test, electroencephalography, sleepiness, sleep, wakefulness
Language:English
Date:22 July 2019
Deposited On:11 Nov 2019 10:55
Last Modified:29 Feb 2020 08:16
Publisher:American Academy of Sleep Medicine
ISSN:0161-8105
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/sleep/zsz163
PubMed ID:31328230
Project Information:
  • : FunderSNSF
  • : Grant ID32003B_176323
  • : Project TitleEEG based microsleep episode detection in the maintenance of wakefulness test and the driving simulator using a machine learning approach

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Embargo till: 2021-01-13