Abstract
The assessment and management of sleep are increasingly recommended in the clinical practice. Polysomnography (PSG) is considered the gold standard test to monitor sleep objectively, but some practical and technical constraints exist due to environmental and patient considerations. Bispectral index (BIS) monitoring is commonly used in clinical practice for guiding anesthetic administration and provides an index based on relationships between EEG components. Due to similarities in EEG synchronization between anesthesia and sleep, several studies have assessed BIS as a sleep monitor with contradictory results. The aim of this study was to evaluate objectively both the feasibility and reliability of BIS for sleep monitoring through a robust methodology, which included full PSG recordings at a baseline situation and after 40 h of sleep deprivation. Results confirmed that the BIS index was highly correlated with the hypnogram (0.89 ± 0.02), showing a progressive decrease as sleep deepened, and an increase during REM sleep (awake: 91.77 ± 8.42; stage N1: 83.95 ± 11.05; stage N2: 71.71 ± 11.99; stage N3: 42.41 ± 9.14; REM: 80.11 ± 8.73). Mean and median BIS values were lower in the post-deprivation night than in the baseline night, showing statistical differences for the slow wave sleep (baseline: 42.41 ± 9.14 vs. post-deprivation: 39.49 ± 10.27; p = 0.02). BIS scores were able to discriminate properly between deep (N3) and light (N1, N2) sleep. BIS values during REM overlapped those of other sleep stages, although EMG activity provided by the BIS monitor could help to identify REM sleep if needed. In conclusion, BIS monitors could provide a useful measure of sleep depth in especially particular situations such as intensive care units, and they could be used as an alternative for sleep monitoring in order to reduce PSG-derived costs and to increase capacity in ambulatory care.
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The authors thank the staff at the Centre d’Investigació de Medicaments de l’Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau for their technical assistance during data collection. The present research complies with the Spanish Law.
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This study was supported in part by the Ministerio de Economía y Competividad, under contract DPI2011-22680 and DPI2014-59049R. CIBER-BBN and CIBERSAM are an initiative of the Instituto de Salud Carlos III, Spain. The authors declare that there is no conflict of interest arising from this study.
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Sandra Giménez and Sergio Romero have contributed equally to this work.
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Giménez, S., Romero, S., Alonso, J.F. et al. Monitoring sleep depth: analysis of bispectral index (BIS) based on polysomnographic recordings and sleep deprivation. J Clin Monit Comput 31, 103–110 (2017). https://doi.org/10.1007/s10877-015-9805-5
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DOI: https://doi.org/10.1007/s10877-015-9805-5