What are the EEG waveform features of stage III and IV sleep?

Updated: May 15, 2018
  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
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SWS, or delta sleep, is characterized, as the name implies, by delta activity. This is typically generalized and polymorphic or semirhythmic. By strict sleep staging criteria on polysomnography, SWS is defined by the presence of such delta activity for more than 20% of the time, and an amplitude criterion of at least 75 µV is often applied.

The distinction between stage III and stage IV sleep is only a quantitative one that has to do with the amount of delta activity. Stage III is defined by delta activity that occupies 20-50% of the time, whereas in stage IV, delta activity represents greater than 50% of the time. Sleep spindles and K complexes may persist in stage III and even to some degree in stage IV, but they are not prominent.

Clinical correlation

As already mentioned, SWS is usually not seen during routine EEG, which is too brief a recording. However, it is seen during prolonged EEG monitoring. One important clinical aspect of SWS is that certain parasomnias occur specifically out of this stage and must be differentiated from seizures. These slow wave sleep parasomnias include confusional arousals, night terrors (pavor nocturnus), and sleepwalking (somnambulism).

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