The Sleep Fragmentation Index (SFI) is a quantitative polysomnographic metric used in sleep medicine to measure the degree of sleep discontinuity, reflecting the number of arousals and awakenings per hour of sleep. A high SFI indicates poor sleep quality, where the individual repeatedly shifts from deeper to lighter stages of sleep or wakes up briefly, even if they do not recall the events. This fragmentation prevents the sustained periods of deep, restorative sleep necessary for optimal hormonal secretion and metabolic regulation.
Origin
This term is derived from clinical sleep study analysis (polysomnography), where the need for a precise, objective measure of sleep disruption became apparent. It is an index calculated by dividing the total number of arousals and awakenings by the total sleep time, providing a standardized measure of sleep architecture instability. The SFI is a key diagnostic tool for conditions like sleep apnea and restless legs syndrome.
Mechanism
Sleep fragmentation is mechanically caused by brief, sub-cortical arousals that interrupt the normal progression of sleep stages without necessarily causing full wakefulness. These arousals are often triggered by physiological stressors, such as the effort required to overcome an obstructed airway in sleep apnea or the nocturnal limb movements in periodic limb movement disorder. Each fragmentation event causes a momentary surge of sympathetic nervous system activity and cortisol release, chronically disrupting the nocturnal hormonal milieu and reducing the proportion of deep, restorative slow-wave sleep.
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