Periorbital Integrated Potentials: Useful phasic REM sleep markers

Although mentioned as one of the rapid eye movement (REM) sleep phasic events in the 1970s [1-3], periorbital integrated potentials (PIPs) have generally escaped the attention of contemporary sleep clinicians. There are certain situations where it is difficult to identify the classical REM sleep physiologic criteria (REM atonia, rapid eye movements [REMs] and desynchronized EEG with or without saw tooth waves). Such situations include inadequate impedance reduction in chin EMG making it difficult to identify muscle atonia or hypotonia, REM sleep behavior disorder (RBD), REM without atonia (RWA), status dissociatus, parasomnia overlap disorder, agrypnia excitata and in patients on antidepressants (eg., selective serotonin and norepinephrine reuptake inhibitors [ SSRIs and SNRIs]).

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