Imaging
Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.
The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.
Medical Image of the Week: Alpha Intrusion into REM Sleep
Figure 1. 30-second epoch during NREM sleep (Stage N3). The red arrows show alpha waves (8-12 Hz frequency) on delta waves (0.5-2 Hz), most prominently seen in the frontal and central EEG leads.
Figure 2. 30 second epoch during REM sleep showing bursts of alpha activity during REM sleep (red arrow) with hypersynchronous theta wave activity (4-7 Hz) (blue arrow).
A 45-year-old woman with a past medical history of hypertension and chronic headaches was referred to the sleep laboratory for high clinical suspicion for sleep apnea based on a history of snoring, witnessed apnea and excessive daytime sleepiness. An overnight sleep study was performed. Images during N3 Sleep and REM sleep are shown (Figures 1 and 2).
Alpha intrusion in delta sleep is seen in patients with fibromyalgia, depression, chronic fatigue syndrome, anxiety disorder, and primary sleep disorders like psychophysiological insomnia, obstructive sleep apnea, circadian disorders and narcolepsy (1).
Bursts of alpha waves during REM sleep may be more common during phasic REM than tonic REM. The REM alpha bursts (alpha activity lasting at least 3 seconds without an increase in EMG amplitude) may represent microarousals (2).
Hypersynchronous theta activity should be differentiated from the spike and waveform activity seen in seizures.
Safal Shetty MD, Tam Le, MD
Banner University Medical Center
Tucson, AZ
References
- Jaimchariyatam N, Rodriguez CL, Budur K. Prevalence and correlates of alpha-delta sleep in major depressive disorders. Innov Clin Neurosci. 2011;8(7):35-49. [PubMed]
- Cantero JL, Atienza M. Alpha burst activity during human REM sleep: descriptive study and functional hypotheses. Clin Neurophysiol. 2000;111(5):909-15. [CrossRef] [PubMed]
Cite as: Shetty S, Le T. Medical image of the week: alpha intrusion into REM sleep. Southwest J Pulm Crit Care. 2015;11(6):273-4. doi: http://dx.doi.org/10.13175/swjpcc126-15 PDF
Medical Image of the Week: DBS Polysomnogram Artifact
Safal Shetty, MD
Kenneth S. Knox, MD
Pulmonary, Allergy, Critical Care & Sleep Medicine
Banner University Medical Center
Tucson, AZ
Figure 1. Thirty second epoch showing DBS artifact obscuring all recording channels except flow, efforts belts and the EKG channels.
Figure 2. Ten second epoch showing the electrical artifact due to DBS.
A 79-year-old man with known Parkinson’s disease and status post deep brain stimulator (DBS) implantation underwent an overnight polysomnogram for clinical suspicion of obstructive sleep apnea. Artifact was seen on the polysomnogram recording (Figures 1 & 2).
Patient-related electrical artifacts may be seen from devices such as pacemakers, deep brain stimulators and vagal nerve simulators. Abrupt discontinuation of DBS is associated with a high likelihood of worsening of symptoms in patients with Parkinson’s disease (1). Patients with DBS are most commonly programmed in monopolar mode. Bipolar configuration, forms a short electrical dipole that affects a relatively smaller volume of tissue and generates far less artifact, suggesting that this may be an effective option in a Parkinsonian patient with indications for polysomnography (2).
References
- Chou KL, Siderowf AD, Jaggi JL, Liang GS, Baltuch GH. Unilateral battery depletion in Parkinson's disease patients treated with bilateral subthalamic nucleus deep brain stimulation may require urgent surgical replacement. Stereotact Funct Neurosurg. 2004;82(4):153-5. [CrossRef] [PubMed]
- Frysinger RC, Quigg M, Elias WJ. Bipolar deep brain stimulation permits routine EKG, EEG, and polysomnography. Neurology. 2006;66(2):268-70. [CrossRef] [PubMed]
Cite as: Shetty S, Knox KS. Medical image of the week: DBS polysomnogram artifact. Southwest J Pulm Crit Care. 2015;11(4):151-2. doi: http://dx.doi.org/10.13175/swjpcc096-15 PDF