0319 A Simplified Bipolar Frontal Montage for Recording and Staging Sleep
Naresh M. Punjabi, Peter W. Kaplan, Joseph B. Margolick, Rashmi Nisha Aurora · SLEEP · 2018
The montage recommended by the American Academy of Sleep Medicine (AASM) for recording sleep consists of referential derivations, with input electrodes over the frontal, central, and occipital regions. Monitors that only use frontal electrodes are becoming increasingly used due to their sophistication, simplicity of use, and lower susceptibility for contamination from pulse and sweat artifact. The overall objective of the present study was to compare the visually scored data derived from a bipolar frontal montage and the conventional montage as recommended by the AASM. Concurrent recordings of sleep were obtained using two Nox-A1 recording systems (Nox Medical) with independent electrode derivations. Both monitors were synchronized for simultaneous data collection. The first recorder was configured with the conventional AASM montage (F4-M1, C4, M1, and O2-M1). The second recorder was configured using a bipolar frontal montage (F4-E3, F4-F7, F3-F8, F3-E2, and Fpz-E3E4). Both recordings were scored for wake, NREM (1, 2, and 3) and REM sleep using the current AASM guidelines. Overall percent agreement for all sleep stages and percent agreement stratified by stage were determined at the epoch level. A total of 3461 recorded epochs derived from each monitor were scored in a blinded fashion. The distribution of sleep stages based on the conventional vs. bipolar montage was as follows: wake (7.9% vs. 7.6%), N1 (6.1% vs. 7.1%), N2 (41.1% vs. 40.8%), N3 (23.8% vs. 23.6%), and REM sleep (21.0% vs 20.8%). Overall percent agreement across all stages was 88.7% (95% CI: 0.88–0.90). Percent agreement by stage (using the conventional montage as the reference) was as follows: wake (90.5%; 95% CI: 0.87–0.94), N1 (77.8%; 95% CI: 0.72–0.83), N2 (88.8%; 95% CI: 0.87–0.90), N3 (87.7%; 95% CI: 0.85–0.90), and REM sleep (92.0%; 95% CI: 0.90–0.94). A frontal bipolar montage for recording and staging can sleep provide a high level of agreement for all sleep stages when compared to the conventional montage currently recommended by the AASM. Support (If Any):