Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.
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Method Article
Multi-Modal Home Sleep Monitoring in Older Adults
* These authors contributed equally
In This Article
Summary
Abstract
The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.
Introduction
The relationship between sleep and Alzheimer's disease (AD) is a growing area of research with sleep disturbances hypothesized to have a role in both AD pathogenesis and as a biomarker for AD pathology1,2. In order to study the relationship between sleep and AD biomarkers, cognitively normal or very mildly impaired participants aged ≥65 years old are recruited from a longitudinal study of aging at the Knight Alzheimer's Disease Research Center (ADRC) at Washington University School of Medicine. Although this study was focused on AD research, the methods presented here have broad applicability to ....
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Protocol
This protocol was approved by the Washington University Human Research Protection Office.
Instructions were written specific to commercially available devices and their related software for data collection (see Table of Materials).
1. Set up of the sleep monitoring devices prior to the participant visit
- Connect a fully charged actigraphy device to the docking station and open the actigraphy software. Initialize actigraphy device to record for the desired timeframe14. Use the following parameters.
- Select the 30 second epoch length from the drop-down menu for epoch du....
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Results
Single-channel EEG
At the start of the study, an acceptable overnight recording with the single-channel EEG device was defined as 1) aligning with the sleep period defined by sleep log and/or actigraphy device, and 2) <10% of the recording unscorable due to movement, myogenic, electrode, or other artifacts. Each participant needed at least 2 nights meeting these criteria. Prior to the implementation of the single-channel EEG manual, 14 participants wore the single-.......
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Discussion
This protocol is the novel application of instructional manuals in conjunction with participant education for in-home ambulatory sleep monitoring. Based on the results, the implementation of the protocol with instruction manuals improves the feasibility of in-home sleep testing in older adults. In-lab polysomnography remains the gold standard for sleep monitoring but may be limited by cost as well as disrupted sleep due to the new environment (i.e., the "first night" effect19). This protoc.......
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Disclosures
CDT, JSM, CMS, IRB, JB, and BPL: Authors have nothing to disclose.
DMH co-founded and is on the scientific advisory board of C2N Diagnostics. DMH consults for Genentech, AbbVie, Proclara, and Denali. Washington University receives research grants to the lab of DMH from C2N Diagnostics, AbbVie, and Denali.
Neither Dr. Morris nor his family owns stock or has equity interest (outside of mutual funds or other externally directed accounts) in any pharmaceutical or biotechnology company. Dr. Morris is currently participating in clinical trials of antidementia drugs from Eli Lilly and Company and Biogen. He receives research support from Eli Lilly/Avid Radiopharmaceuticals and is funded by NIH grants # P50AG005681; P01AG003991; P01AG026276 and UF01AG032438.
Acknowledgements
We thank the participants for their time.
Funding: This study was supported by the following grants from the National Institutes of Health: P01 AG03991; P01 AG026276; P50 AG05681; K76 AG054863; UL1 TR000448; KL2 TR000450. The Ellison Medical Foundation and a Physician Scientist Training Award from the American Sleep Medicine Foundation also supported this study. The funding sources had no role in the study design, data collection, management, analysis, interpretation of the data, or manuscript preparation.
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Materials
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| Actigraph | Phillips Respironics | 1048090 | Actiwatch 2 |
| Actiware site license | Phillips Respironics | 1114828 | Actigraphy software |
| Actigraphy docking station | Phillips Respironics | 1048092 | Actiwatch charger |
| Home Sleep Test (HST) | Phillips Respironics | 1043941 | Alice PDX device |
| Sleepware G3 software | Phillips Respironics | 1082462 | Alice PDX software |
| CPAP titration kit | Pro-tech | P1391 | Connects PAP to HST |
| 3-foot SpO2 Extension Cable (Nonin) | Phillips Respironics | 927-3 | Oximeter cable for HST |
| SpO2 Sensor (Nonin) | Phillips Respironics | 936 | Oximeter finger clip for HST |
| SD Card Reader | Phillips Respironics | 1047300 | card reader for HST |
| EXG yoke | Phillips Respironics | 1040808 | HST cable for leg leads |
| Dual Snap Leg Lead Wires | MVAP | TLC0048 | leg leads for HST |
| Small Foam Electrodes | MVAP | 5000ZT | electrodes for leg leads |
| Thermistor Airflow Sensor | Pro-tech | P1388 | HST thermoistor |
| Oral/Nasal Air flow Pressure Cannula | Saltar Labs | 5760-7 | Pressure Transducer |
| Zrip DuraBelt kit | Phillips Respironics | P1837 | HST Thoracic and Abdominal belt kit |
| Single-channel EEG | Advanced Brain Monitoring | SP40-1001 | Sleep Profiler device |
| SP Sensor EEG kit | Advanced Brain Monitoring | SP40-4225.1 | Sleep Profiler electrodes |
| CPAP masks | Resmed | 62925, 63504, 63506, 63507, 63445, 63446, 63447 |
References
- Ju, Y. -E., Lucey, B. P., Holtzman, D. M. Sleep and Alzheimer disease pathology-a bidirectional relationship. Nature Reviews Neurology. 10 (2), 115-119 (2014).
- Musiek, E. S., Holtzman, D. M. Mechanisms linking circadian clocks, sleep, and neurodegeneration. Science
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