The Visual Scoring of Sleep in Infants 0 to 2 Months of Age
The Visual Scoring of Sleep in Infants 0 to 2 Months of Age
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DOI：
10.5664/jcsm.5600
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发表时间：
2016-01-01
影响因子：
4.3
通讯作者：
Grigg-Damberger, Madeleine M.
中科院分区：
文献类型：
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作者：
Grigg-Damberger, Madeleine M.
2014年3月，美国睡眠医学学会（AASM）董事会要求评分手册编辑委员会根据1971年Anders， Emde和Parmelee《新生儿睡眠评分手册》，为出生至2个月的足月婴儿的睡眠/清醒状态评分制定规则、术语和技术规范。2015年7月1日，美国医学会（AASM）发布了0-2月龄婴儿睡眠评分规则。这篇基于证据的综述总结了评分手册编委会编写这些规则时提供的背景信息。《安德斯手册》只提供了婴儿多导睡眠图（PSG）生理和行为状态特征的编码标准，而将具体的睡眠评分标准留给了个体研究者。其他的婴儿评分标准已经公布，没有一个被广泛接受或使用。AASM评分手册婴儿评分标准包括现代概念，数字PSG记录技术，实用性和妥协。重要的原则是：(1)睡眠/觉醒应以30秒为一个周期进行评分，分别为清醒(W)、快速眼动、快速眼动(R)、非快速眼动、非快速眼动(N)和过渡(T)睡眠；(2)允许充分显示幼儿脑电图的脑电图蒙太奇为：F3-M2， F4-M1, C3-M2, C4-M1, O1-M2, O2-M1；此外，记录C3-Cz、Cz-C4有助于检测早期和异步睡眠纺锤体；(3)睡眠发作多为R睡眠，直到产后2-3个月；(4)嗜睡以目测为最佳特征（后期辅以视频复习）；(5)睁大眼睛是W的最关键决定因素；(6)呼吸规律（或不规则）是这个年龄段睡眠阶段评分中最有用的PSG特征；(7)微量交变（TA）是唯一比较明显的脑电图模式，具有N睡眠特征，通常在1个月后消失，取而代之的是高压慢变（HVS）；(8)睡眠纺锤波最早出现在受孕年龄（CA） 44 ~ 48小时，出现提示计分N时；(9)将某一时期的脑电活动评分为“连续”或“不连续”，以衡量评分者之间的信度；（10）如果出现以下四种或四种以上的情况，包括不规则呼吸和快速眼动，则得分为R: (a)下巴肌电图低（大部分时间）；(b)闭上眼睛，至少有一次快速眼球运动（同时低下巴）；(c)呼吸不规律；(d)口吐、吸吮、抽搐或短暂的头部运动；(e)脑电图呈连续模式，无睡眠纺锤波；（11）由于不是每一页都能看到快速眼动，如果脑电图连续，没有TA或睡眠纺锤波，颏肌张力在大部分时间低，则在没有快速眼动的情况下，在一个明确的R期之后的时期可以得分；没有中间的觉醒；（12）如果出现以下四种或四种以上的情况，包括正常呼吸，在大部分时间内为N分：(a)眼睛闭着，没有眼球运动；(b)颏肌电异常；(c)正常呼吸；(d)存在TA、HVS或睡眠纺锤波的脑电图模式；（13）如果一个epoch包含两个或两个以上不一致的PSG状态特征（三个NREM和两个REM特征或两个NREM和三个REM特征），则评分为T睡眠。这些0-2个月大的标准不仅仅代表婴儿的步伐。像所有其他的AASM手册规则和规范一样，没有一个是固定不变的，所有的规则和规范都是开放的，可以辩论、讨论和修订，其基本目标是为方法和结果的比较提供标准。
In March 2014, the American Academy of Sleep Medicine (AASM) Board of Directors requested the Scoring Manual Editorial Board develop rules, terminology, and technical specifications for scoring sleep/wake states in full-term infants from birth to 2 mo of age, cognizant of the 1971 Anders, Emde, and Parmelee Manual for Scoring Sleep in Newborns. On July 1, 2015, the AASM published rules for scoring sleep in infants, ages 0-2 mo. This evidence-based review summarizes the background information provided to the Scoring Manual Editorial Board to write these rules. The Anders Manual only provided criteria for coding physiological and behavioral state characteristics in polysomnograms (PSG) of infants, leaving specific sleep scoring criteria to the individual investigator. Other infant scoring criteria have been published, none widely accepted or used.The AASM Scoring Manual infant scoring criteria incorporate modern concepts, digital PSG recording techniques, practicalities, and compromises. Important tenets are: (1) sleep/wake should be scored in 30-sec epochs as either wakefulness (W), rapid eye movement, REM (R), nonrapid eye movement, NREM (N) and transitional (T) sleep; (2) an electroencephalographic (EEG) montage that permits adequate display of young infant EEG is: F3-M2, F4-M1, C3-M2, C4-M1, O1-M2, O2-M1; additionally, recording C3-Cz, Cz-C4 help detect early and asynchronous sleep spindles; (3) sleep onsets are more often R sleep until 2-3 mo postterm; (4) drowsiness is best characterized by visual observation (supplemented by later video review); (5) wide open eyes is the most crucial determinant of W; (6) regularity (or irregularity) of respiration is the single most useful PSG characteristic for scoring sleep stages at this age; (7) trace alternant (TA) is the only relatively distinctive EEG pattern, characteristic of N sleep, and usually disappears by 1 mo postterm replaced by high voltage slow (HVS); (8) sleep spindles first appear 44-48 w conceptional age (CA) and when present prompt scoring N; (9) score EEG activity in an epoch as "continuous" or "discontinuous" for inter-scorer reliability; (10) score R if four or more of the following conditions are present, including irregular respiration and rapid eye movement(s): (a) low chin EMG (for the majority of the epoch); (b) eyes closed with at least one rapid eye movement (concurrent with low chin tone); (c) irregular respiration; (d) mouthing, sucking, twitches, or brief head movements; and (e) EEG exhibits a continuous pattern without sleep spindles; (11) because rapid eye movements may not be seen on every page, epochs following an epoch of definite R in the absence of rapid eye movements may be scored if the EEG is continuous without TA or sleep spindles, chin muscle tone low for the majority of the epoch; and there is no intervening arousal; (12) Score N if four or more of the following conditions are present, including regular respiration, for the majority of the epoch: (a) eyes are closed with no eye movements; (b) chin EMG tone present; (c) regular respiration; and (d) EEG patterns of either TA, HVS, or sleep spindles are present; and (13) score T sleep if an epoch contains two or more discordant PSG state characteristics (either three NREM and two REM characteristics or two NREM and three REM characteristics).These criteria for ages 0-2 mo represent far more than baby steps. Like all the other AASM Manual rules and specifications none are fixed in stone, all open for debate, discussion and revision with the fundamental goal to provide standards for comparison of methods and results.