Week 2:
The Gold Standard

June 18, 2022

This week was all about preparing for the assessment of REM sleep without atonia (RSWA) scoring from polysomnograms (PSGs). The Gold Standard is an assessment used to judge readiness to score patient PSGs to determine RSWA severity for the analysis we are doing between narcolepsy and RSWA.

In preparation for the Gold Standard, we used training files of varying difficulties. Some had a lot of interference with the muscle signals while others had a lot of information that had to be discarded due to sleep apnea and waking up in the night. These training files helped us to see all the situations we may encounter while scoring. Training file 4 was particularly difficult, with everyone, including Dr. St. Louis marveling at how ugly the signals were.

The long hours of scoring each day led to the Gold Standard, which we took on Friday. While all of us scored well on the assessment, the criteria used to score RSWA today is different from how the Gold Standard is scored. Our supervisor Paul Timm and the student intern overseeing the project, Olivia, worked to score our tests individually to see if we had any recurring mistakes that needed attention. Next week we should get the Gold Standard finished and move into our actual project; Dr. St. Louis will give us more information about that next week as well!

While practicing for the Gold Standard was most of the time spent in the week, our time was split up into other disciplines of life at Mayo. I participated in my first journal club at Mayo. We read about diagnostic and prognostic biomarkers (tests and indicators of further REM sleep behavior disorder-related ailments). Dr. St. Louis led it with questions to the student interns. 

All the interns also got access to Epic, the medical record database. Not only is this a positive step (as previous years have struggled with getting access for everyone), but as one of the research assistants was giving us a brief tutorial on how to use it, we got to go over a patient’s file. To complete our project, we will have to use Epic to access patients’ medical charts to ensure that any other sleep ailment they have is accounted for in our methods.

My favorite thing during the week was going over a patient’s case that Dr. St. Louis suspected had multiple system atrophy (MSA). He showed us their PSG, some video of key characteristics he looks for in MSA, and where there was some doubt about the diagnosis. It was almost like a mini-shadow experience but more behind-the-scenes work.

As with the first week, Dr. St. Louis went over lectures with us about his atlas of sleep medicine, a book with a lot of information on sleep and sleep disorders still used today. We also began lectures about other sleep disorders and things we may run into scoring patient PSGs, including sleep apnea.

I also got to experience a bit of Rochester’s culture this week. Thursdays Downtown is an event that closes some of the streets in downtown Rochester. There are food stalls and vendors selling some cool items like fresh fudge or hand-made pop-up cards. They even have a live band/musicians perform at certain times of the day. All the interns like myself ate lunch in that environment, making a mental note to not pack lunch next Thursday to try some of the delicious looking street tacos.  

On Friday, the sleep lab intern staff also went to ThaiPop, a Thai restaurant downtown, to unwind after a long week of RSWA scoring and information. I had some coconut curry brisket that was as delicious as it looked.

 I also reached out to a couple of physicians for shadowing, including trauma surgery and cardiologists/cardiovascular surgery. A cardiac surgeon already responded, and I am scheduled to shadow next Friday!  I am excited to begin work on our project next week, as well as experience shadowing for the first time.