Microsleep episodes in the borderland between wakefulness and sleep.

Hertig-Godeschalk, Anneke; Skorucak, Jelena; Malafeev, Alexander; Achermann, Peter; Mathis, Johannes; Schreier, David R. (2020). Microsleep episodes in the borderland between wakefulness and sleep. Sleep, 43(1) Oxford University Press 10.1093/sleep/zsz163

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STUDY OBJECTIVES The wake-sleep transition zone represents a poorly defined borderland, containing e.g. microsleep episodes (MSEs) which are of potential relevance for diagnosis and may have consequences while driving. Yet, the scoring guidelines of the American Academy of Sleep Medicine (AASM) completely neglect it. We aimed to explore the borderland between wakefulness and sleep by developing the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring, focusing on MSEs visible in the electroencephalogram (EEG), as opposed to purely behaviour- or performance-defined MSEs. METHODS Maintenance of Wakefulness Test (MWT) trials of 76 randomly selected patients were retrospectively scored according to both the AASM and the newly developed BERN scoring criteria. The visual scoring was compared with spectral analysis of the EEG. The quantitative EEG analysis enabled a reliable objectification of the visually scored MSEs. For less distinct episodes within the borderland, either ambiguous or no quantitative patterns were found. RESULTS As expected, the latency to the first MSE was significantly shorter in comparison to the sleep latency, defined according to the AASM criteria. In certain cases, a large difference between the two latencies was observed, and a substantial number of MSEs occurred between the first MSE and sleep. Series of MSEs were more frequent in patients with shorter sleep latencies, while isolated MSEs were more frequent in patients who did not reach sleep. CONCLUSION The BERN criteria extend the AASM criteria and represent a valuable tool for in-depth analysis of the wake-sleep transition zone, particularly important in the MWT.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Godeschalk, Anneke Grietje Elizabeth; Mathis, Johannes and Schreier, David Raphael


600 Technology > 610 Medicine & health




Oxford University Press




Chantal Kottler

Date Deposited:

11 Nov 2019 15:29

Last Modified:

23 Jul 2020 02:30

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

AASM scoring criteria Microsleep electroencephalography maintenance of wakefulness test sleep sleepiness wake-sleep transition zone wakefulness





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