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Slow wave amplitudes are critical to determining Stage N3 sleep yet ECG artifact frequently interferes with accurate amplitude measurement. This artifact may be lessened by using a combined M1-M2 reference however theoretically this may decrease the amplitude due to shorter inter-electrode distance (predicted 27% loss). The AASM Scoring Manual recommends scoring slow wave activity using F4-M1 channel or alternatively F3-M2, but does not recognize a combined reference. This study measures the differences in slow wave amplitude using contralateral versus combine reference. Methods 12 polysomnograms were randomly selected for analysis of amplitude of slow wave using contralateral and combined reference channels. Six separate EEG channels (F3-M1, F3-M2, F3-M1+M2, F4-M1, F4-M2, and F4-M1+M2) were used to analyze 25 different slow waves from each polysomnogram. Individual slow waves from Stage N3 sleep were analyzed using the Natus Sleepworks Amplitude Measurement Tool if their peak and trough were free EKG artifact. Averages and standard deviations of the waveforms were calculated for each patient and channel. Differences were normalized by dividing by the amplitude of the original wave using the contralateral reference. Results Subjects age ranged from 30–69 yrs, with 6 being females. Mean amplitudes were as follows: F3-M2 was 131.75µV, F3-M1+M2 125.84 µV, F4-M1 130.57 µV, and F4-M1+M2 128.22µV. The overall average difference of F4-M1 to F4-M1+M2 was 0.92% and the average difference of F3-M2 to F3-M1+M2 was 3.52% with the average standard deviation of 8.47%. Conclusion This study shows the average loss in amplitude of converting F4-M1 to F4-M1+M2 was less than 1% and 3.5% for F3-M2 to F3-M1+M2. Combining M1M2 reference may be a valuable alternative to reduce EKG artifact. Support None

0061 Does Combining M1 M2 Reference Influence Amplitude of Slow Waves?