AASM: Sleep Staging Rules (for adults)
Actual Exam Study Questions with
100% Correct Answers Already
Graded A+
1. Arousal - ANSWER An awakening or lightening of sleep.
2. Amplitude - ANSWER The magnitude of a signal, measured from the top
most point (zenith) to the lowest point (nadir).
3. Alpha Rhythm - ANSWER Sinusoidal EEG activity in the range of 8-13 Hz
highest in the occipital channel.
4. Alternating Leg Muscle Activation (ALMA) - ANSWER Consist of brief
activation of the anterior tibial in one leg alternating with similar activation
in the other leg during sleep or arousals from sleep. There is frequently no
reported movement but ALMA is recorded as an incidental finding on
polysomnography
5. EEG (electroencephalogram) - ANSWER The electroencephalogram or
electrical recording of the brain.
6. EMG (electromyogram) - ANSWER The electromyogram or electrical
recording of the muscles. There are 2 EMG signals in the standard
polysomnogram: the chin EMG and the leg EMG. The chin EMG is used to
differentiate waking (high chin EMG's) from R (low chin EMG). The leg
EMGs are used to score movements during sleep.
,7. End-tidal CO2 (ETCO2) - ANSWER Measurement of carbon dioxide at the
end of exhalation.
8. EOG (electrooculogram) - ANSWER Movement of the eyes
9. Epochs - ANSWER A set period of time. The epoch for scoring sleep stages
is 30 seconds
10.Fibrillation - ANSWER Rapid, irregular contraction of muscles, especially
the muscles of the heart.
11.Frequency - ANSWER The number of cycles of signal in a fixed period of
time (usually 1 second) the number of cycles per second is the frequency in
Hz (in honor of heinrich hertz)
12.Esophageal Manometer - ANSWER A device used to measure the pressure
in the esophagus.
13.High Frequency Filter - ANSWER A filter to reduce the amount of fast
frequency noise in order to see slower frequency activity more clearly.
14.Excessive Fragmentary Myoclonus - ANSWER Limb electromyography
(EMG) activity characterized by small movements of the corners of the
mouth, fingers or toes, or by no visible movement at all. The incidental
polysomnographic finding is associated with no known clinical
consequence.
15.Excessive Sustained Muscle Activity (tonic activity) in REM - ANSWER
An epoch of stage R sleep with at least 50% of the duration of the epoch
having a chin electromyography (EMG) amplitude at least two times greater
, than the stage R sleep atonia level (or lowest amplitude in NREM sleep: if
no stage R sleep atonia is present.) Multiple segments may contribute to the
total duration, but each segment must be greater than 5 seconds.
16.Excessive Transient Muscle Activity (phasic activity) in REM - ANSWER
In a 30 second epoch of stage R sleep divided into sequential 3-second min-
epochs, at least 5 (50%) of the mini-epochs contain bursts of transient
muscle activity in the chin or limb electromyography (EMG). In REM sleep
with our atonia, excessive transient muscle activity bursts are 0.1-5.0
seconds in duration and at least two times as high in amplitude as the stage R
sleep atonia level
17.Eye Blinks - ANSWER Conjugate vertical eye movements at a frequency of
0.5-2 Hz present in wakefulness with eyes open or closed
18.Any Chin Electromyography (EMG) Activity - ANSWER Activity with a
minimum amplitude two times greater than the stage R sleep atonia level (or
lowest amplitude in NREM sleep, if no stage R sleep atonia is present)
without regard to the duration of the activity (including bursts of 5 to 15
seconds).
19.Apnea - ANSWER Classified as obstructive, mixed, or central based on the
pattern of respiratory effort
20.Apnea Hypopnea Index (AHI) - ANSWER Total number of apneas and
hypopneas scored x 60 divided by total sleep time (TST).
21.Asystole - ANSWER An interruption of cardiac rhythm lasting more than 3
seconds for ages 6 years through adulthood
, 22.Atrial Fibrillation - ANSWER Irregularly irregular QRS complexes
associated with replacement of consistent P waves by rapid oscillations that
vary in size, shape and timing.
23.Beta Waves - ANSWER an electroencephalography (EEG) rhythm
consisting of >13Hz activity
24.Bradycardia or Sinus Bradycadia (during sleep) - ANSWER A sustained
(>30seconds) sinus heart rate ages 6 years through adulthood
25.Bruxism - ANSWER teeth grinding
26.Cardiac Pacemaker Rhythm - ANSWER Sharp vertical spikes either
immediately preceding the onset of P wave (atrial pacing) or QRS complex
(ventricular pacing) or both on the electrocardiography (ECG).
27.Central Apnea - ANSWER a type of apnea with no airflow and no effort to
breathe.
28.Central Hypopnea - ANSWER A respiratory event meeting all criteria for a
hypopnea and during which there is no evidence of snoring, increased
inspiratory flattening of the nasal pressure or PAP device flow signal
compared to baseline breathing.
29.Cheyne-Stokes Breathing - ANSWER A breathing rhythm with a specified
crescendo and decrescendo change in breathing amplitude separating central
apneas or hypopneas
30.Chronological Age - ANSWER time elapsed since birth
Actual Exam Study Questions with
100% Correct Answers Already
Graded A+
1. Arousal - ANSWER An awakening or lightening of sleep.
2. Amplitude - ANSWER The magnitude of a signal, measured from the top
most point (zenith) to the lowest point (nadir).
3. Alpha Rhythm - ANSWER Sinusoidal EEG activity in the range of 8-13 Hz
highest in the occipital channel.
4. Alternating Leg Muscle Activation (ALMA) - ANSWER Consist of brief
activation of the anterior tibial in one leg alternating with similar activation
in the other leg during sleep or arousals from sleep. There is frequently no
reported movement but ALMA is recorded as an incidental finding on
polysomnography
5. EEG (electroencephalogram) - ANSWER The electroencephalogram or
electrical recording of the brain.
6. EMG (electromyogram) - ANSWER The electromyogram or electrical
recording of the muscles. There are 2 EMG signals in the standard
polysomnogram: the chin EMG and the leg EMG. The chin EMG is used to
differentiate waking (high chin EMG's) from R (low chin EMG). The leg
EMGs are used to score movements during sleep.
,7. End-tidal CO2 (ETCO2) - ANSWER Measurement of carbon dioxide at the
end of exhalation.
8. EOG (electrooculogram) - ANSWER Movement of the eyes
9. Epochs - ANSWER A set period of time. The epoch for scoring sleep stages
is 30 seconds
10.Fibrillation - ANSWER Rapid, irregular contraction of muscles, especially
the muscles of the heart.
11.Frequency - ANSWER The number of cycles of signal in a fixed period of
time (usually 1 second) the number of cycles per second is the frequency in
Hz (in honor of heinrich hertz)
12.Esophageal Manometer - ANSWER A device used to measure the pressure
in the esophagus.
13.High Frequency Filter - ANSWER A filter to reduce the amount of fast
frequency noise in order to see slower frequency activity more clearly.
14.Excessive Fragmentary Myoclonus - ANSWER Limb electromyography
(EMG) activity characterized by small movements of the corners of the
mouth, fingers or toes, or by no visible movement at all. The incidental
polysomnographic finding is associated with no known clinical
consequence.
15.Excessive Sustained Muscle Activity (tonic activity) in REM - ANSWER
An epoch of stage R sleep with at least 50% of the duration of the epoch
having a chin electromyography (EMG) amplitude at least two times greater
, than the stage R sleep atonia level (or lowest amplitude in NREM sleep: if
no stage R sleep atonia is present.) Multiple segments may contribute to the
total duration, but each segment must be greater than 5 seconds.
16.Excessive Transient Muscle Activity (phasic activity) in REM - ANSWER
In a 30 second epoch of stage R sleep divided into sequential 3-second min-
epochs, at least 5 (50%) of the mini-epochs contain bursts of transient
muscle activity in the chin or limb electromyography (EMG). In REM sleep
with our atonia, excessive transient muscle activity bursts are 0.1-5.0
seconds in duration and at least two times as high in amplitude as the stage R
sleep atonia level
17.Eye Blinks - ANSWER Conjugate vertical eye movements at a frequency of
0.5-2 Hz present in wakefulness with eyes open or closed
18.Any Chin Electromyography (EMG) Activity - ANSWER Activity with a
minimum amplitude two times greater than the stage R sleep atonia level (or
lowest amplitude in NREM sleep, if no stage R sleep atonia is present)
without regard to the duration of the activity (including bursts of 5 to 15
seconds).
19.Apnea - ANSWER Classified as obstructive, mixed, or central based on the
pattern of respiratory effort
20.Apnea Hypopnea Index (AHI) - ANSWER Total number of apneas and
hypopneas scored x 60 divided by total sleep time (TST).
21.Asystole - ANSWER An interruption of cardiac rhythm lasting more than 3
seconds for ages 6 years through adulthood
, 22.Atrial Fibrillation - ANSWER Irregularly irregular QRS complexes
associated with replacement of consistent P waves by rapid oscillations that
vary in size, shape and timing.
23.Beta Waves - ANSWER an electroencephalography (EEG) rhythm
consisting of >13Hz activity
24.Bradycardia or Sinus Bradycadia (during sleep) - ANSWER A sustained
(>30seconds) sinus heart rate ages 6 years through adulthood
25.Bruxism - ANSWER teeth grinding
26.Cardiac Pacemaker Rhythm - ANSWER Sharp vertical spikes either
immediately preceding the onset of P wave (atrial pacing) or QRS complex
(ventricular pacing) or both on the electrocardiography (ECG).
27.Central Apnea - ANSWER a type of apnea with no airflow and no effort to
breathe.
28.Central Hypopnea - ANSWER A respiratory event meeting all criteria for a
hypopnea and during which there is no evidence of snoring, increased
inspiratory flattening of the nasal pressure or PAP device flow signal
compared to baseline breathing.
29.Cheyne-Stokes Breathing - ANSWER A breathing rhythm with a specified
crescendo and decrescendo change in breathing amplitude separating central
apneas or hypopneas
30.Chronological Age - ANSWER time elapsed since birth
