NEW RPSGT EXAM- 2022 Study Guide and Practice Test with complete solutions

The purpose of an intentional mask leak is to... - ANSWER Wash out CO2 and prevent rebreathing Recommended guidelines state that HSV can be considered when.... - ANSWER Cheyne Stokes and central Apneas have not been eliminated. What is aerophagia? - ANSWER The swallowing of air What is maxillomandibular advancement? - ANSWER Treatment that involves cutting and advancing the upper and lower jaw bones; enlarging and stabilizing the posterior airway. What is the PRIMARY function of the EPAP setting? - ANSWER To eliminate desaturations and arousals. According to guidelines, how many Hypopneas need to occur in peds pts prior to increasing pressure? - ANSWER 1 What are the AASM guidelines for supplemental O2 during PAP studies? - ANSWER 1lmp during PAP titration when SPO2 is less than or equal to 88% for 5 or more minutes and in the absence of obstructive events. If a pts Apneas are fixed at 10cm, but Hypopneas and snoring still occur at 16cm, what levels of BiLevel should be used? - ANSWER IPAP: 14 EPAP: 10 Which of the following can reduce the effectiveness of CPAP and why: Nasal spray, Alcohol, Anti depressants. - ANSWER Alcohol: impairs arousal response which can lead to longer than normal events and severe desats. Inhibits upper airway activity What syndrome would a pt with COPD and OSA have? - ANSWER Overlap syndrome What are hypoxemia and hypercapnia? - ANSWER Hypoxemia: very low 02 in the blood Hypercapnia: very high CO2 in the blood. What would a patient with both hypoxemia and hypercapnia most likely be diagnosed with? - ANSWER Hypoventilation What is an MWT's MOST important use? - ANSWER Measure patients ability to resist the urge to fall asleep Tricyclic antidepressants, large amounts of caffeine and large amounts of chocolate have been known to trigger what? - ANSWER REM sleep behavior disorder Recommended impedance for eeg and eog - ANSWER 5k ohms The amount of space needed to archive digitized data is MOST impacted by? - ANSWER Sampling rate Cortical activity is best described as - ANSWER Spontaneous arousal Calculate the AHI based on the following data 25 obstructive apneas 5 central apneas 23 mixed apneas 15 hypopneas 48 RERAS 65 arousals 360 min of sleep - ANSWER 11 According to RECOMMENDED guidelines, the minimum duration of a significant leg movement is - ANSWER .5 According to RECOMMENDED guidelines, an optional parameter to include in the report for an adult polysomnogram is - ANSWER Occurrence of hypoventilation during the diagnostic study in adult The respiratory event that requires oxygen desaturation and/ or an arousal as part of the scoring criteria is - ANSWER Obstructive hypopnea An ECG arrhythmia commonly seen when recording PSG's, particularly in patients that have obstructive sleep apnea and cardiac disease. It can be identified by the morphology of an irregularly irregular ventricular rhythm associated with replacement of consistent P waves by rapid oscillations that vary in size, shape, and timing - ANSWER Atrial fibrillation The stage that is the greatest portion of the epoch - ANSWER The stage that is the greatest portion of the epoch What is the best response when a patient asks the technologist if they have sleep apnea and will need to wear a CPAP mask? - ANSWER Provide the patient with educational material about sleep apnea Which of the following is the MOST LIKELY cause of a 35 minute REM latency - ANSWER Untreated depression A breathing pattern characterized by at least three cycles of crescendo breathing with duration of at least 10 minutes is - ANSWER Cheyne Stokes respiration An important responsibility of the scoring tech is to - ANSWER Confirm accuracy of report components Which type of calibration is based on a series of patient instructions intended to verify the signal response and quality - ANSWER Physiological The most important reason for performing a MWT is to - ANSWER Measure the patient's ability to resist the urge to fall asleep The importance of selecting sampling rates according to RECOMMENDED guidelines is to - ANSWER Minimize aliasing effect The syndrome characterized by prolonged episodes of severe hypoxemia and associated PaCO2 elevation that worsens during sleep is - ANSWER Obesity hypoventilation The patient's medical history indicates the patient has been taking tricyclic antidepressants for the past 5 years. The technologist should anticipate that the patient may have an increased likelihood of - ANSWER REM Sleep Behavior Disorder According to RECOMMENDED guidelines, the sampling rate to provide the optimal resolution for recording EEG in a patient with suspected nocturnal seizure is - ANSWER 500Hz The electrode located 30% above the left pre-a crease is - ANSWER C3 According to RECOMMENDED guidelines, four nap opportunities on a MSLT would be acceptable when the patient - ANSWER Had REM on at least two nap opportunities A patient's history indicates a diagnosis of overlap syndrome. The tech can anticipate that the patient has - ANSWER COPD AND OSA ACCORDING TO RECOMMENDED GUIDELINES, WHICH OF THE FOLLOWING SHOULD BE INCLUDED WHEN RECORDING PEDIATRIC PATIENTS - ANSWER END-TIDAL CO2 THE ABILITY TO REMONTAGE WHILE RECORDING ON DIGITAL EQUIPMENT IS THE RESULT OF - ANSWER SYSTEM REFERENCING WHEN REVIEWING A PATIENT'S HISTORY IN PREPARATION FOR A POLYSOMNOGRAM, PHYSIOLOGIC FINDINGS SUGGESTIVE OF HYPOVENTILATION INCLUDE - ANSWER HYPOXEMIA AND HYPERCAPNIA WHEN THE AMPLITUDE OF A SIGNAL EXCEEDS THE PHYSICAL LIMITATIONS OF A CHANNEL THE MOST IMPORTANT ADJUSTMENT THE TECH CAN MAKE TO OPTIMIZE WAVEFORM DISPLAY IS TO - ANSWER DECREASE SENSITIVITY WHEN INTERMITTENT 60 HZ ACTIVITY OCCURS IN THE F4-M1 ELECTRODES DURING REM SLEEP THE BEST IMMEDIATE ACTION WOULD BE TO - ANSWER RELY ON F3-M2 A PATIENT WITH MILD DEMENTIA BECOMES MORE CONFUSED AND/OR AGITATED IN THE EARLY EVENING. THE PATIENT IS MOST LIKELY EXPERIENCING - ANSWER SUNDOWNING THE MOST COMMON METHOD TO MONITOR BLOOD OXYGEN SATURATION DURING POLYSOMNOGRAPHY IS - ANSWER PULSE OXIMETRY THE MOST APPROPRIATE ACTION A TECHNOLOGIST WOULD TAKE WHEN THERE IS CONFIRMED VENTRICULAR TACHYCARDIA GREATER THAN 30 SECONDS IS - ANSWER INITIATE EMERGENCY RESPONSE SYSTEM A PATIENT'S CHART INDICATES THAT THEY USE 30 L/MIN OF OXYGEN AT HOME. THE TECH NOTES THAT THE PHYSICIAN'S ORDERS FOR THE PSG SPECIFIES THE STUDY WITHOUT SUPPLEMENTAL OXYGEN AND TO ADD 1.0 L/MIN OXYGEN IF THE SATURATION IS LESS THAN 89%. THE BEST ACTION FOR THE TECH IS TO - ANSWER CALL THE PHYSICIAN FOR CONFIRMATION WHICH OF THE FOLLOWING IS THE MOST LIKELY EFFECT OF ZOLPIDEM AND ZALEPLON ON SLEEP ARCHITECTURE - ANSWER INCREASED SLEEP LATENCY WHICH OF THE FOLLOWING BEST DESCRIBES A REFERENTIAL MONTAGE - ANSWER THERE IS POTENTIAL FOR ELECTRODE CONTAMINATION ACCORDING TO RECOMMENDED GUIDELINES, THE DEVICE THAT SHOULD BE USED TO MONITOR AIRFLOW AND DETECT APNEA DURING A DIAGNOSTIC STUDY IS - ANSWER ORONASAL THERMAL SENSOR WHICH PROCESS WOULD BE AN ADEQUATE ROUTINE FOR DISINFECTING CUP ELECTRODES AFTER REMOVING ADHESIVE RESIDUE, GEL AND ORGANIC MATERIAL, AND WASHING IN WARM WATER AND MILD DETERGENT - ANSWER SOAKING IN 1: 10 BLEACH AND WATER FOR 10 MIN. WHICH OF THE FOLLOWING WOULD BE MOST IMPORTANT TO DOCUMENT DURING A POLYSOMNOGRAM - ANSWER POSITION CHANGES THE ELECTRODE ARRAY USED FOR RECORDING PHYSIOLOGIC ACTIVITY IS REFERRED TO AS - ANSWER MONTAGE ACCORDING TO RECOMMENDED GUIDELINES, THE MAXIMUM ELECTRODE IMPEDANCE FOR EEG AND EOG RECORDING IS - ANSWER 5000 OHMS ACCORDING TO RECOMMENDED GUIDELINES, UNATTENDED PORTABLE MONITORING CAN BE USED AS AN ALTERNATIVE TO IN LAB TESTING WHEN - ANSWER THERE IS A HIGH PROBABILITY OF MODERATE TO SEVERE OSA WITHOUT COMORBID CONDITIONS A SELF REPORTING TOOL USED TO EVALUATE SUBJECTIVE SLEEP QUALITY AND DISTURBANCE OVER THE PREVIOUS MONTH IS - ANSWER PITTSBURGH SLEEP QUALITY INDEX THE MOST APPROPRIATE SETTING A TECHNOLOGIST WOULD USE TO CONTROL THE FREQUENCY BAND OF WAVEFORMS ON A RECORDING IS THE - ANSWER (LOW FILTER (HIGH PASS FILTER) WHICH OF THE FOLLOWING CAN NEGATIVELY IMPACT ALL BIOELECTRIC CHANNELS - ANSWER CONTAMINATED M1 WHICH OF THE FOLLOWING SUBSTANCES CAN REDUCE THE EFFECTIVENESS OF PAP THERAPY - ANSWER ALCOHOLIC BEVERAGES A PATIENT THAT INTENTIONALLY ENGAGES IN BEHAVIORAL PATTERNS THAT ARE INCONSISTENT WITH SLEEPING WELL IS DEMONSTRATING - ANSWER INADEQUATE SLEEP HYGIENE WHAT IS THE BEST TOOL THAT A PHYSICIAN COULD USE TO MORE CLEARLY EXPLAIN THE RESULTS OF THE SLEEP STUDY AND THE IMPORTANCE OF THERAPY TO A PATIENT - ANSWER HISTOGRAM REAL TIME ACCESS TO PAP COMPLIANCE DATA IS AN EXAMPLE OF - ANSWER EFFICACY MONITORING A PROCESS TO DECREASE FEAR OF ARTIFICIAL CIRCUMSTANCES BY REPEATED AND CONTROLLED EXPOSURE TO A FEARED SITUATION IS - ANSWER DESENSITIZATION WHAT HAS THE LARGEST IMPACT ON ADHERENCE TO PAP THERAPY - ANSWER PATIENT EDUCATION WHICH STATEMENT IS TRUE REGARDING CPAP - ANSWER THERE IS ONE LEVEL OF PRESSURE FOR INSPIRATION AND EXPIRATION SLEEP DEBT CAN BEST BE DESCRIBED AS THE - ANSWER CUMULATIVE EFFECT OF INSUFFICIENT SLEEP ACCORDING TO RECOMMENDED GUIDELINES FOR PEDIATRIC CPAP TITRATION, HOW MANY HYPOPNEAS MUST OCCUR PRIOR TO INCREASING PRESSURE - ANSWER ONE EXCESSIVE WARMING AND HUMIDIFICATION WILL CAUSE - ANSWER WATER TO POOL IN THE CPAP TUBING MAXILLOMANDIBULAR ADVANCEMENT TREATS OSA BY - ANSWER ENLARGING AND STABILIZING THE UPPER AIRWAY IN PATIENTS WITH SEVERE SLEEP-DISORDERED BREATHING THE MOST COMMONLY SEEN RESPONSE RESULTING FROM SUCCESSFUL PAP TITRATION IS - ANSWER REM AND SLOW WAVE REBOUND WHICH OF THE FOLLOWING IS MOST LIKELY TO OCCUR DUE TO AN IMPROPERLY FITTING PAP INTERFACE? - ANSWER CONJUNCTIVITIS WHEN A PATIENT COMPLAINS OF CLAUSTROPHOBIA, IS UNABLE TO TOLERATE PAP AND REQUESTS TO END THE PSG, THE NEXT BEST STEP IS TO - ANSWER SCHEDULE DESENSITIZATION A PATIENT REPORTS A COMPLETE NASAL OBSTRUCTION PRIOR TO PAP TITRATION. THE TECH SHOULD - ANSWER USE A ORO-NASAL INTERFACE THE BEST CANDIDATE FOR ORAL APPLIANCE WOULD HAVE - ANSWER MILD OSA DURING STAGE N2 SLEEP, THE PATIENT CHANGES POSITION AND THE TECH NOTES INCREASED SNORING AND AN INCREASING LEAK. THE TECH SHOULD - ANSWER REPOSITION AND ADJUST PAP INTERFACE ACCORDING TO RECOMMENDED GUIDELINES, CPAP SHOULD BE INCREASED AT AN INTERVAL NO LESS THAN - ANSWER 5 MINUTES THE PRIMARY FUNCTION OF EPAP IS TO - ANSWER MAINTAIN UPPER AIRWAY PATENCY THROUGH INSPIRATION BASED ON THE PSG RESULTS BELOW, WHAT WOULD BE THE BEST RECOMMENDATION FOR A PATIENT THAT IS NON-COMPLIANT AND REFUSES TO CONTINUE WITH CPAP THERAPY OVERALL AHI 8 OVERALL REM AHI 38 SUPINE REM AHI 28 SUPINE NREM AHI 21 LATERAL NREM AHI 1 LATERAL REM 3 - ANSWER POSITION THERAPY THE BEST METHOD FOR DETECTING APNEAS AND HYPOPNEAS DURING PAP TITRATION IS TO USE A/AN - ANSWER AIRFLOW SIGNAL GENERATED BY THE PAP DELIVERY DEVICE THE PRIMARY BENEFIT OF HEATED HUMIDIFICATION IS TO - ANSWER HELP REDUCE NASAL CONGESTION A SIDE EFFECT OF CPAP IS - ANSWER AEROPHAGIA THE MOST COMMON REASON FOR CHANGING THE PAP INTERFACE DURING A TITRATION IS - ANSWER UNACCEPTABLE LEAK VALUE WHAT IS THE RECOMMENDED STARTING PRESSURE FOR PEDIATRIC AND ADULT CPAP TITRATION - ANSWER 4 CMH2O THE PURPOSE OF INTENTIONAL LEAK IS TO - ANSWER WASH OUT CO2 AND PREVENT REBREATHING DURING CPAP TITRATION AT 10 CM H2O, SPO2, VALUES RANGE BETWEEN 80 AND 85% FOR 10 MIN DESPITE ABSENCE OF RESPIRATORY EVENTS. WHAT IS THE BEST ACTION FOR THE TECH TO TAKE - ANSWER FOLLOW PROTOCOL FOR SUPPLEMENTAL OXYGEN ACCORDING TO RECOMMENDED GUIDELINES, ADAPTIVE SERVO VENTILATION CAN BE CONSIDERED DURING A TITRATION STUDY WHEN A DOWN TITRATION - ANSWER HAS NOT ELIMINATED CHEYNE STOKES RESPIRATION OR CENTRAL EMERGENT APNEAS DURING A TITRATION STUDY THE PATIENTS APNEAS ARE ELIMINATED AT 10 CM H2O BUT HYPOPNEAS AND SNORING CONTINUE AT 16 CM H20. ACCORDING TO RECOMMENDED GUIDELINES, THE APPROPRIATE PRESSURES TO BEGIN A BILEVEL TITRATION ARE - ANSWER IPAP 10 EPAP 14 DURING A CPAP TITRATION AT 15 CM H20, THE PATIENT IS RESTLESS AND CONTINUES TO HAVE FREQUENT OBSTRUCTIVE RESPIRATORY EVENTS. THE BEST ACTION IS TO - ANSWER CHANGE TO BI LEVEL DC Channel - ANSWER PSG channel derived from an external piece of equipment such as a PAP device or oximeter. Stray Capacitance - ANSWER When electrical signals from external sources interfere w/ signals derived from the pt. Amperes are measured in what units? - ANSWER Coulombs/second Time Axis - ANSWER Horizontal positioning of the pen. Common Mode Rejection - ANSWER The process by which a differential amplifier rejects identical inputs (unwanted signals). Mechanical Baseline - ANSWER Pen's vertical position when the power to the PSG is turned off. Electrical Baseline - ANSWER The vertical positioning of the pen w/ power of PSG turned ON. Capnometer - ANSWER A device used to measure the level of CO2 in a sample of air. Frequency - ANSWER Measured in hertz(Hz) or cycles/second. Paper Speed for PSG - ANSWER 10 mm/sec When a pt. looks towards an EOG electrode it causes what? - ANSWER A positive charge, or downward deflection. Rise Time - ANSWER Amount of time it takes for a wave to reach 63% of its peak. Sensitivity Setting for EEG Channel - ANSWER 7uV/mm or 70uV/cm *In pt.'s w/ low amplitude EEGs, the sensitivity can be adjusted to 5uV/mm or 50uV/cm Filter Settings for Respiratory Effort & Airflow - ANSWER LFF= 0.1Hz HFF= 15Hz Filter Settings for EOG - ANSWER LFF= 0.3Hz HFF= 35Hz High Level Disinfection - ANSWER Used for items that come into contact w/ non-intact skin, blood, and mucous membranes. DO THE NAPS OCCUR EVERY 2 HOURS FROM THE TIME THE PREVIOUS NAP ENDED OR EVERY 2 HOURS ON THE HOU R OR HALF-HOUR? - ANSWER Every 2 hours on the hour or half hour. HOW LONG BEFORE A NAP BEGINS SHOULD THE SUBJECT CEASE SMOKING? - ANSWER 30 minutes WHAT EPOCH SIZE IS BEST FOR RECORDING THE "MSLT"? - ANSWER 30 seconds. A MEAN SLEEP LATENCY OF INDICATES WHAT? - ANSWER Pathological sleepiness. A normal mean sleep latency is how many minutes? - ANSWER 10 - 20 minutes How many naps must have unequivocal periods of REM to arrive at a Diagnosis of Narcolepsy? - ANSWER 2 naps. What is the Narcoleptic Tetrad? - ANSWER Excessive daytime sleepiness, hypnagogic hallucinations, sleep paralysis, cataplexy. How is the mean sleep latency calculated? - ANSWER Sum of all latencies, divided by total# of naps. During REM, inhibition of thermoregulatory mechanisms lead to what state? - ANSWER Poikilothermia. What equation best expresses time constant? - ANSWER TC= C x R TC=Time Constant C= Capacitance R= Resistance What sleep stage requires at least 20% but no more than 50% of the epoch to consist of wave of 2 cps or slower w/amplitudes greater than 75 uV. - ANSWER Stage 3. AN EPOCH THAT DOES NOT MEET THE CRITERIA FOR ACTIVE SLEEP OR QUITE SLEEP IS CALLED WHAT? - ANSWER Intermediate Sleep TRACE ALTERNANT PATTERN IS ASSOCIATED WITH WHAT STAGE OF SLEEP IN THE INFANT? - ANSWER Quiet Sleep (NREM Sleep) INFANT BREATHING PATTERNS THAT ALTERNATES REGULAR BREATHING WITH 5-10 SECONDS OF APNEA? - ANSWER Periodic Breathing. REM OCCUPIES WHAT PERCENTAGE OF SLEEP IN THE NEONATE AT TERM? - ANSWER 50%. A FUNCTION THAT EXPRESSES THE FREQUENCY OF EYE MOVEMENTS PER UNIT TIME DURING SLEEP STAGE REM? - ANSWER REM Density. KNOW AS THE PACEMAKER FOR MAMMALIAN CIRCADIAN RHYTHMS? - ANSWER Suprachiasmatic Nucleus (SCN). A COMPLAINT OF MORNING HEADACHES ASSOCIATED WITH SEVERE SLEEP APNEA IS A RESULT OF WHAT? - ANSWER Severe oxygen desaturation and hypercapnia (Elevated levels of carbon dioxide in the blood). Pre-Sleep Interviews - ANSWER conducted by sleep technicians who ask questions to clarify information and make careful observations of the patient such as, willingness to learn, mental age, physical limitations, etc. Sleep Diary - ANSWER Patient keeps a record of sleep habits for 2 weeks preceding the test. The sleep diary generally has two components: Before Sleep and After Sleep. Pre-sleep Questionnaire - ANSWER standardized form that reviews issues related to sleep, but tech asks additional questions for clarification, as needed. The questionnaire determines if the patient's preceding 24 hrs was normal for that individual. Bed-Partner Questionnaires - ANSWER Filled out by the patient's bed partner (or roommate or parent in some cases) with the patient's permission. The partner typically is aware of snoring or periods of apnea even though the patient may not be aware. Morning Questionnaire - ANSWER Takes place in the morning after PSG; May come in the form of a checklist, or the tech may ask specific questions regarding sleep quality,onset to sleep time,number of arousals,TST,Differences between sleeping at home and in lab, and Sleepiness upon awakening.-If pt reports sleep was very different from home, repeat PSG may be warranted. Morning/Evening Questionnaires - ANSWER asks 19 questionnaires about time preferences to determine if patient is a morning,evening, or neutral person. Excessive Daytime Sleepiness - ANSWER increasing societal problem related to lack of adequate sleep, causing the patient to feel sleepy during the waking hours to the point that the patient may fall asleep or feel the need to nap. Fatigue - ANSWER General feeling of tiredness, weakness, or lack of energy and may be related to physical or emotional problems. "Do you feel the need to sleep during the daytime?" "Do you feel drowsy?"---are questions a tech should ask to determine if they are experiencing EDS or Fatigue? - ANSWER EDS "Do you feel as though you have no energy?" "Do you feel weary or weak?"---are questions a tech should ask to determine if they are experiencing EDS or Fatigue? - ANSWER Fatigue Stanford Sleepiness Scale - ANSWER brief assessment used a number of different times a day to determine if people have excessive daytime sleepiness (EDS). Epworth Sleepiness Scale - ANSWER evaluates how likely a person is to fall asleep during a number of different activities. The person rates each situation on a scale of 0-3 corresponding to the chance of falling asleep (none, slight, moderate, or high). Sleep-Wake Activity Inventory (SWAI) - ANSWER Measures a number of different aspects of sleep disorders:excessive daytime sleepiness, nocturnal sleep,relaxing ability,energy, etc.-asks patient to score 9 different statements about sleepiness on a 1-9 scale. (A score of 50 or more is normal, 40-50 suggests EDS, 40 or less indicated EDS. Fatigue Severity Scale - ANSWER list of nine descriptions related to fatigue; patient scores each statement on a 1-7 scale (strongly disagree to strongly agree). Scores of 9-35=normal; scores above 35 suggest high degree of fatigue. Multiple Sleep Latency Tests (MSLT's) - ANSWER measure sleepiness during waking hours and the tendency of a person to fall asleep.-may diagnose narcolepsy and idiopathic hypersomnia. MSLT includes how many nap periods with first within 3 hours of nocturnal PSG, and then spaced at 2 hours after preceding nap. - ANSWER 5 No smoking is allowed within _____ minutes of starting MSLT nap and no strenuous activity within ____ minutes of a nap. - ANSWER 30;15 Maintenance of Wakefulness Test - ANSWER determines patient's ability to stay awake in the daytime. During MWT, patient is placed at rest, sitting in bed with low lights for ___ 40 minute periods spaced at 2 hours. - ANSWER 4 Tracheostomy - ANSWER An opening directly into the trachea bypasses the obstruction and opens the airway, but it is invasive and can result in many complications, so it is rarely done.-can be blocked during waking hours and opened during sleep.-usued as last resort usually in elderly or morbidly obese, facial abnormalities etc Higher Sampling Rates are needed to detect seizure activity in infant and child PSG'S. What sampling Rates for EOG AND EMG recordings during psg for seizure acivity? - ANSWER greater than or equal to 500 Hz for EOG and greater than or equal to 200 Hz for EMG recording. Initiate Low-Flow Supplemental Oxygen at how many liters per minute when SpO2 falls below 85% on ambient room air. - ANSWER 1 liter per minute Monitor SpO2 carefully to ensure it increases to at least __% - ANSWER 90% Titrate oxygen by slowly increasing the flow rate by _._ liters per minute at a time until the SpO2 is 90% or more, but do not exceed 4 liters/min. without a physicians order. - ANSWER 0.5 l/min. Obesity Hypoventilation Syndrome occurs when the body mass index is __kg/m2 or more, resulting in impaired respirations,hypoxia, and hypercapnia during sleep. The obesity results in impairment of muscles of muscles of inspiration, restricting the thorax and causing hypoventilation, leading to hypercapnia. - ANSWER 30 You should begin CPAP when the patient is ready for sleep and start it at the lowest setting, usually _ cm H20 and maintain the low pressure until the patient falls asleep. - ANSWER 5 Increase Positive Airway Pressure during CPAP titration by _ cm h20 at a time, usually at 15 minute intervals, and observe effects, including changes in oxygen saturation, EEG,EMG, and ECG. - ANSWER 1 Ensure that the patient is in what body position during titration for part of the titration period? - ANSWER supine Respiratory Effort Related Arousal (RERA) - ANSWER Occurs when the airway narrows during sleep, usually indicated by snoring. Although the constricted airway does not result in apnea or hypopnea, it does cause a brief arousal. For scoring of a RERA, there should be a sequence of respirations indicating increased respiratory effort or flattening of nasal pressure waveforms with a duration of ___ seconds or more. - ANSWER 10 Hypoventilation - ANSWER based on PaCO2 scores on awakening and not on persistent desaturation.-the use of other sensors is not considered adequate to determine this. To score Hypoventilation, the PaCO2 level (immediately upon awakening) increases __mm Hg or more as compared to the baseline awake/supine value. - ANSWER 10 Bruxism - ANSWER teeth grinding Stages of sleep should be reported in minutes, minutes of latencies, and percentage of - ANSWER TST ________ should be reported as a total number, index number, numbers occurring in REM sleep and in non-REM sleep for all different types and associations. - ANSWER Arousals Sinus Bradycardia - ANSWER is caused by a decreased rate of impulses from the sinus node. The pulse and ECG usually appear normal except for at a slower rate. (Less than 50-60 beats per minute). Sinus Bradycardia is scored during sleep with a sustained heart rate of less than __ beats/min for patients 6 years of age or more. - ANSWER 40 Alternating Leg Muscle Activation (ALMA) - ANSWER Occurs with a rapid alternating activation of EMG's in the lower extremities. - may be associated with PLM'S. Usually considered benign, do not require treatment, and are unrelated to sleep disorders. An ALMA Series requires at least _ Alma's at a minimum frequency of 0.5 Hz and a maximum frequency of 3.0 Hz. - ANSWER 4 Hypnagogic Foot Tremors - ANSWER tremors that occur during sleep onset in one or both feet that are most common in stage wake but may continue into stages 1 and 2. Hypnagogic Foot Tremors are scored with a minimum of _ EMG bursts in the frequency range of 0.3-4.0 Hz. - ANSWER 4 Hypnagogic Foot Tremors have a frequency of _._-_._ Hz. - ANSWER 0.3-4.0 Cheyne-Stokes Respirations - ANSWER periodic breathing characterized by periods of apnea, alternating with rapid respirations that increase in intensity and then decrease in a crescendo-decrescendo pattern. What respirations are common before death or can occur with central nervous system damage (ex: brain tumor), hyperventilation, and heart failure. - ANSWER Cheyne-Stokes Criteria for scoring Cheyne-Stokes respirations includes _ or more consecutive cycles of crescendo-decrescendo pattern and one of the following: 1. Cycles that persist for 10 or more consecutive minutes 2. Five central apneas or central hypopneas PER HOUR of sleep. - ANSWER 3 Rhythmic Movement Disorder - ANSWER very common in infants; beginning at about 6 months of age continuing until 2-3 years of age. -incidence after age 5 is rare unless pt has injury to the central nervous system. often includes: 1. Rocking 2.Head Banging 3.Head Rolling 4.Leg Banging 5.Body Rolling -These Movements may be accompanied by humming. Rhythmic Movement Disorder-scoring - ANSWER -often occurs in stage wake when the pt is very drowsy or during stage 1. -clusters of 4 or more rhythmic movements. -amplitude of each burst is double background EMG activity. -minimum frequency of 0.5 Hz and maximum frequency of 2.0 Hz. (Video Synchronized with PSG required for diagnosis). Stage 3 non-REM Sleep - ANSWER -also referred to as Slow Wave Sleep (SWS) or Delta Sleep. -Adolescents have higher percentage of this stage as it is the stage the growth hormone is produced. -pt is easily aroused by external stimuli Stage 3 - ANSWER 20% of TST; Delta activity of 0.5-2 Hz; stage where parasomnias such as, sleep walking, enuresis, and night terrors occur. This is an example of Cheyne-Stokes Respiration - ANSWER Example of Central Apnea - ANSWER Example of Hypopnea - ANSWER Example of Obstructive Apnea - ANSWER Pediatric RERAs must be scored with adequate ______ or nasal pressure signals. - ANSWER esophageal REM Sleep Behavior Disorder (RBD) - ANSWER Requires a PSG and a video, audio, or clinical history of REM occuring without atonia or with excessive muscle activity. -chin and leg EMG may have slightly higher frequency than usual for REM. Score RBD if REM Epoch has __% or more increased cEMG activity and __% or more of excessive transient movement for 10 mini-epochs. -bursts of activity are usually 0.1-5.0 seconds in duration - ANSWER 50 To score an apnea, it must last __ seconds or more and the thermal sensor must drop at least 90% or more below baseline. - ANSWER 10 Obstructive - ANSWER Inspiratory effort continues or increases throughout the apneic period. Central - ANSWER Inspiratory effort is absent during apneic period. Mixed - ANSWER Inspiratory effort is absent for the initial apneic period but resumes during the second half of the apneic period. Example of Mixed Apnea - ANSWER How many stages does the normal conduction of the heart have? - ANSWER 4 SA Node - ANSWER primary pacemaker Purkinje Fibers - ANSWER stimulate the myocardial cells to contract the ventricles Pediatric Sleep scoring rules apply to children _ months post term or older. - ANSWER 2 Sleep Spindles occur at _-_ months or older - ANSWER 2-3 K complexes and slow-wave activity occur at _-_ months or older - ANSWER 4-6 Stages 1, 2, and 3 can be scored in most infants at _-_ months or older. - ANSWER 5-6 REM Sleep - ANSWER occupies about 25% of TST for adults. Dreaming as well as sexual arousal (penile/clitoral erection) most often occurs in what stage of sleep? - ANSWER REM Non-REM and REM cycles occur about every _._-_hours. - ANSWER 1.5-2 What sleep stage are sawtooth theta waves most likely to be present? - ANSWER REM How many seconds of chin activity in REM for it to be scored as an arousal? - ANSWER 1 Excessive Fragmentary Myoclonus (EFM) - ANSWER Twitching movements of the fingers, toes, and mouth that may occur in any stage, including wake. To score EFM, activity needs to continue for at least __ minutes of Non-REM sleep with at least 5 EMG potentials per minute. - ANSWER 20 Pediatric Scoring of Wake uses the __________ _________ _________ rather than the term 'alpha rhythm.' - ANSWER Dominant Posterior Rhythm (DPR) If there is no reactive alpha waves or age-appropriate DPR, score wake with _________ _____________. - ANSWER Eye Movements What is the recommended square feet for patient rooms? - ANSWER 140 Electroencephalogram (EEG) - ANSWER Measure the electrical activity within the brain through the scalp electrodes to rule out seizure disorders and to determine characteristics of the sleep-wake state. Alpha wave frequency - ANSWER 8-13 Hz Beta wave frequency - ANSWER 13-30 Hz Delta wave frequency - ANSWER < 0.5-4Hz Theta wave frequency - ANSWER > 4-7 Hz How many leads are typically used for the EEG channels during a nocturnal PSG?-although more may be applied to diagnose seizure disorders - ANSWER 6 Electrocardiogram (ECG) - ANSWER Record and display electrical activity of the heart through a number of different wave-forms, complexes, and intervals. P wave - ANSWER wave in ECG that represents the beginning of electrical impulses in the Sinus Node, which spread through the atria (muscle depolarization). QRS Complex - ANSWER wave in ECG that represents ventricular muscle depolarization and atrial repolarization. T wave - ANSWER wave in ECG that represents ventricular muscle repolarization (resting state) as cells regain negative charge. U wave - ANSWER wave that represents repolarization of the Purkinje Fibers Anterior Tibialis Electromyogram (atEMGs) - ANSWER monitor the electrical activity in the leg muscles allowing for monitoring of periodic leg movement during the PSG because electrical activity is absent when the muscle is relaxed and increases with movement. Actigraphy - ANSWER non-invasive method of monitoring human rest/activity cycles.-monitors gross motor activity (like a fitbit). True or False? Duration of sleep is not important for the MWT - ANSWER True The physician's orders should be checked before PSG to ensure that the correct _______ is selected. - ANSWER Montage Face Electrodes - ANSWER used to ground and record eye and chin activity and include EOG, cEMG, and Ground Electrode. Ground Electrode - ANSWER This electrode does not impact measurements with modern computerized equipment. It is usually placed in the middle of the forehead, but can be placed anywhere on the body. EOG - ANSWER records vertical and horizontal eye movements and helps to identify periods of REM sleep. cEMG - ANSWER records muscle tone of the chin muscles and helps to identify REM sleep, during which muscle tone decreases.-can also provide information on teeth grinding and snoring which causes artifacts. Pulse Oximetry - ANSWER continuous or intermittent, uses an external oximeter that attaches to the patient's finger (or earlobe) to measure arterial oxygen saturation (SpO2), the percentage of hemoglobin that is saturated with oxygen.-also indicates the current heart rate. Normal SpO2 should be over what percent? - ANSWER 95% ___________ _________ is a common cause of inaccurate SpO2 readings. - ANSWER Incorrect Position Patient's with ____ may have lower SpO2 values. - ANSWER COPD Nocturnal PSG - ANSWER used to diagnose obstructive sleep apnea syndrome and may be done before MSLT. MSLT - ANSWER used to diagnose excessive sleepiness (hypersomnia) and narcolepsy during waking hours; done AFTER nocturanl PSG to ensure 6 hours of sleep preceding test. MWT - ANSWER used to evaluate success of treatment or ability to stay awake during the daytime; does not usually require a nocturnal PSG although it may be indicated for shift workers. (ex: Truck Drivers) EEG electrodes are placed using what measuring system? - ANSWER 10/20 example of the nasion - ANSWER example of the inion - ANSWER example of the preauricular points - ANSWER odd numbers equal what side of the head? (ex: C3) - ANSWER left even numbers equal what side of the head? (ex: C4) - ANSWER right Impedance Levels should remain low. How many kilohms is preferrered?----but how many is accepted? - ANSWER 5;10 If the impedance level of an electrode is high, the electrode may need to be _______________. - ANSWER repositioned Bioeletrical Signals - ANSWER generated by the patient's tissue and motion recorded by surface electrodes Transduced Signals - ANSWER These derive from sensors that convert action, such as chest wall movement, into electrical signal generated by the sensor instead of the body. Equipment Signals - ANSWER Sometimes ancillary equipment, such as a carbon dioxide analyzer is used during the PSG. - This equipment, which has seperate signal displays, outputs, and processing units, may be stand-alone or interfaced with the digital PSG equipment. Physiological bio-calibrations - ANSWER calibrations performed by the technologist to evaluate signals generated by the patient. - should be repeated at the end of the study to ensure that leads and and sensors remain in the correct position and that the recordings were accurate. macroshock - ANSWER shock that involves large and quite perceptible currents passing from one external surface area to another rise time constant - ANSWER time required for pen to reach 63% of signal amplitude fall time constant - ANSWER time required for a pen to descend to 37% of signal amplitude when a DC calibration signal is applied to an amplifier sleep spindle is how many Hz - ANSWER 12-14 Hz Active Sleep - ANSWER REM in the infant How many sleep-onset REM episodes in a series of 5 naps are diagnostic for narcolepsy? - ANSWER 2 naps lower portion of temporal bone behind ear - ANSWER mastoid alpha intrusion - ANSWER term used for a brief superimposition of EEG alpha activity on sleep activities during a stage of sleep An electrode closest to the cornea will register as negative or positive deflection? - ANSWER positive An electrode closest to the retina will register as a negative or postitive deflection? - ANSWER negative Resistor - ANSWER Device used to limit the passage of electrical current Respiratory Disturbance Index (RDI) - ANSWER measures apneas, hypopneas, and RERA's per hour of TST normal sinus rhythm - ANSWER Regular Rhythm; Rate of 60-100 bpm; P-waves present/up-right before each QRS complex; Time interval same for all beats. REM occupies what percent of sleep in the neonate term - ANSWER 50% After sleep onset occurs in MSLT, when is the nap terminated? - ANSWER 15 mins from 1st epoch of sleep Trace Alternant Pattern is associated with what stage of sleep in the infant? - ANSWER Quiet Sleep Trace Alternant - ANSWER Bursts of slow waves, at times intermixed with sharp waves and intervening periods of relative quiescence (quiet and inactive) with extreme low-amplitude activity A mean sleep latency of <5 mins during MSLT indicated what? - ANSWER Pathological Sleepiness Bio-electrical potentials - ANSWER voltages originating from living tissues What sleep stage? *low voltage *mixed frequency EEG 2-7 Hz *slow eye movements *tends to be relatively short, ranging from 1-7 mins. - ANSWER Stage 1 Ohm's law equation - ANSWER E= I x R Ohm's law - ANSWER states that the current through a conductor between 2 points is directly proportional to the voltage across the 2 points. Hypoxemia - ANSWER Abnormally low blood cO2 saturation level Sundowning - ANSWER Term linked with pts experiencing evening and nocturnal hallucinations associated with dementia Anterior Tibialis - ANSWER Leg muscle used to monitor/record myoclonic events Voltage calculation - ANSWER V= A x S Suggested Solution to soak contaminated electrodes - ANSWER 5% Hypochlorite Solution (Household Bleach) Complaints of Severe Sleep Apnea and morning headaches is a result of??? - ANSWER Severe O2 Desat and Hypercapnia Beta Activity - ANSWER EEG Activity with a frequency greater than 13 Hz In 1953, Aserinsky and Kleitman associated what with dreaming during sleep? - ANSWER Rapid Eye Movements Alpha Activity in REM is _-_ Hz slower than during wakefulness - ANSWER 1-2 Periodic Breathing - ANSWER infant breathing pattern that alternates regular breathing with 5-10 secs of apnea Current - ANSWER flow of electrical force along a conductor Normal Arterial pCO2 value - ANSWER 35-45 mmHg Sleep Architecture - ANSWER Progression and Distribution of the various sleep stages and their quantitative relationship to each other. 3 potential sources of stray electrical current - ANSWER *short circuit *leakage current *ground loop What is the minimum paper speed recommended to allow clear visual representation of alpha and sleep spindles? - ANSWER 10 mm/sec 3 Grounds found in electrical equipment - ANSWER *Earth (building and power outlets) *Chassis Ground (metal) *Common Connection Ground Ground Loop - ANSWER undesirable electrical pathway between 2 separate ground connections, resulting in a possible hazard to the patient. A single page of a PSG, typically representing 30 secs of data. - ANSWER Epoch Reflux is identified in the distal esophagus by a drop in the pH below what? - ANSWER 4.0 Normal Arterial pO2 value - ANSWER 80-100 mmHg Which class of drugs is known to aggravate Periodic Limb Movements of sleep? - ANSWER Tricyclic Antidepressants What considerations should be considered when given to the choice of of electrodes used for recording EEG? - ANSWER Choose a material that has minimum drift of electrode potential and a very long time constant. An amplifier component used for storing an electrical charge - ANSWER Capacitor NREM in infants is known as - ANSWER Quiet Sleep Normal mean sleep latency - ANSWER 10-20 mins Paradoxical Breathing is noted in neonates or infants? - ANSWER neonates Known as the circadian rhythm pacemaker - ANSWER suprachiasmatic nuclei (SCN) If no sleep is noted during MSLT , when is the nap terminated? - ANSWER 20 mins. after 'lights out.' Referential Derivation - ANSWER signal obtained by comparing voltages from an exploring electrode to a relatively inactive location Functional Residual Capacity (FRC) - ANSWER Content of air remaining in the lungs at the end of normal expiration Other than the EEG, what else is used to differentiate the sleep stages in an infant? - ANSWER Observed Behavior and Movement Patterns Baseline Sway - ANSWER undesirable variations in baseline during a recording, usually caused by sweat or movement Arousal - ANSWER interruption of sleep continuity, identified by an abrupt shift in EEG frequency effect of chronic alcoholism - ANSWER decreased REM and reduced NREM Delta Sleep Gain - ANSWER Ratio of output voltage to input voltage, amplifier sensitivity Periodic Breathing most commonly occurs in quiet sleep or active sleep? - ANSWER Active Device used to convert non-electrical physiologicak activity into electrical signals - ANSWER Transducer In order to assess the occurrence of REM during the MSLT, the test should continue for how long after the 1st epoch of sleep? - ANSWER 15 mins The number of waves, or pen deflections, recorded in 1 second - ANSWER signal frequency Jaw Muscle - ANSWER Masseter A patient can become the pathway of least resistance and therefore susceptible to shock when what occurs? - ANSWER when not all equipment attached to patient is connected to a common ground Ultradian Rhythm refers to what period of time - ANSWER less than 24 hrs Ultradian Rhythm of alternating sleep cycles has a period of how many minutes during infancy? - ANSWER 30-70 mins Which type of montage is recommended in order to maximize the the voltages recorded during PSG? - ANSWER Referential montage using contralateral ear references Time Constant - ANSWER Response time of the polygraph pens in relation to high and low frequency filter settings during a calibration procedure What initial effect does administering supplemental O2 have on the OSA patient? - ANSWER a significant increase in apnea duration with associated hypercapnia and respiratory acidosis Conductor - ANSWER Any Material capable of transmitting electrical current How many naps are usually performed during an MSLT? - ANSWER 4-5 An epoch that does not meet criteria for Active Sleep or Quiet Sleep is called - ANSWER indeterminate sleep Sleep Efficiency - ANSWER Ratio of TST to total time in bed Bipolar Derivation - ANSWER Signals obtained by comparing voltages from 2 exploring electrodes. K-complex - ANSWER should exceed 0.5 secs with well-delinated negative sharp wave followed by a positive component REM sleep is associated with what changes in the autonomic nervous system? - ANSWER *Variable Heart Rate *Irregular Respirations *Decrease in Tonic Muscle Activity How long before a nap begins in MSLT should the subject cease smoking - ANSWER 30 mins Electronic Device designed to reduce or eliminate unwanted frequencies from passing through the amplifier - ANSWER Filter Mu Rhythm - ANSWER Morphologically and Topographically distinct EEG activity seen in the central areas; frequency is about 9 Hz Amplitude of this wave is sometimes as high as 200 uv - ANSWER Vertex Sharp Wave Resistance - ANSWER Opposition to an electrical current Attenuation - ANSWER Reduction in size on amplitude of signal Monomorphic - ANSWER distinct EEG activity appearing to be composed of one dominant frequency Hyperventilation - ANSWER Rapid,depp, breathing resulting in reduced levels of CO2 in the blood An instrument used to measure electrical resistance - ANSWER Ohmmeter The degree to which an amplifier will reject a common mode signal is expressed as what? - ANSWER Common Mode Rejection Ratio Vital Capacity - ANSWER A person's maximum breathing ability Signal obtained from a pair of electrode sensors - ANSWER Derivation A person with Ondine's Curse would be expected to have what type of respiratory impairment - ANSWER Central Aveolar Hypoventilation Central Aveolar Hypoventilation Syndrome - ANSWER Respiratory Arrest during Sleep Jactatio Capitis Noctuna - ANSWER Head Banging Thermocouple - ANSWER Device containing two dissimilar metals, which generate an electrical signal in response to temperature variations. True or False? Thermoregulatory responses such as, swetain and panting, are noted in REM, but are absent in NREM. - ANSWER False; Sweating and Panting are seen in NREM, but are absent in REM REM Density - ANSWER A function that expressed eye movements per unit time during REM Sinus Tachycardia example - ANSWER Sinus Bradycardia example - ANSWER Supraventricular Tachycardia example - ANSWER Premature Atrial Contractions (PAC's) example - ANSWER Sinus Arrhythmia example - ANSWER Atrial Flutter example - ANSWER Atrial Fibrillation example - ANSWER Sinus Pause example - ANSWER Premature Junctional Contractions example - ANSWER Junctional Rhythms example - ANSWER Premature Ventricular Contractions (PVC's) example - ANSWER Ventricular Tachycardia example - ANSWER Narrow-complex tachycardia example - ANSWER Ventricular Fibrillation example - ANSWER Idioventricular Rhythm example - ANSWER Ventricular Asystole example - ANSWER First-Degree Atrioventricular Block example - ANSWER Second Degree Atrioventricular Block Type 1 example - ANSWER Second-degree atrioventricular block type 2 example - ANSWER Third Degree Atrioventricular Block example - ANSWER Wide Complex Trachycardia example - ANSWER Right Bundle Branch Block example - ANSWER Left Bundle Branch Block example - ANSWER Frequency - ANSWER number of waves/cycles generated per second Amplitude - ANSWER vertical height of wave determined by electrical voltage Setting of __ microvolts/cm used for EEG,EOG, and EMG.-1 cm high - ANSWER 50 filters - ANSWER can later be applied to 'clean up' recording- however, can cause a 'phase shift' that causes wave to appear earlier or later. 60 Hz notch (band reject) - ANSWER rarely used filter because it can interfere with recordings-used mainly on anterior tibialis EMG's Band-Pass filter - ANSWER record frequencies only within a particular range Sampling Rate - ANSWER must be selected before testing when converting analog to digital recordings as they cannot be changed afterward in the way that filters can be changed.-determines the Amplitude (height) of the waveform.-higher sampling rate necessary to achieve adequate waveform The appearance of the waveform is ______ ___ ________ - ANSWER affected by filters Interictal Epileptiform Activity - ANSWER electrical discharges that occur between epileptic seizures Frontal Lobe Epilepsy seizures occurs primarily during what? - ANSWER sleep Seizure Activity is most common in what stage? - ANSWER Stage 2 A Psg may help to differentiate between OSA and _______ ________ Epilepsy, which can result in similar symptoms of choking and EDS. -Some cases may have both present. - ANSWER Frontal Lobe Frontal Lobe Epilepsy is more easily identified with _-channel EEG recordings. - ANSWER 4 Temporal Lobe epilepsy is more accurately identified with __-channel EEG recording. - ANSWER 18 ________ ____________ can help to identify Seizure Activity, which usually involves some degree of arousal. - ANSWER Video Monitoring Blinks produce ____ waves - ANSWER slow ECG artifacts are usually are more ponounced in ____ patients. -so reference electrodes should not be placed over fatty tissue - ANSWER obese ECG artifacts in the EMG channels usually indicate poor placement or unequal __________. - ANSWER impedances Slow-frequency artifacts can be related to __________, pressure on an electrode, or body movement - ANSWER perspiration Perspiration= __________ - ANSWER sweating _______may interfere with pulse oximetry readings. oximetry artifacts must be tagged or removed from the recording. - ANSWER obesity microsleep - ANSWER brief, unintended episodes of loss of attention associated with blank stare, etc... Enuresis - ANSWER typically normal EEG, inability to control urination Confusional Arousals - ANSWER Shows Alpha Waves, repetitive periods of microsleep, or stage N1 sleep during arousal period. Exploding Head Syndrome - ANSWER Shows sudden arousal during transition period between sleep and awakening, and electroencephalogram shows alpha and theta waves Alpha waves example - ANSWER Beta Waves example - ANSWER Theta Waves example - ANSWER Cortisol - ANSWER made by the adrenal glands; helps body manage stress and helps body use sugar and fat for energy (metabolism). People with Alzheimer's show a decrease in what stage of sleep? - ANSWER REM Sleep People who sleep less than _ hours a night or more than 9-10 hours a night are at increased risk of weight gain and risk of metabolic syndrome. - ANSWER 6 Infants usually begin to establish a normal sleeping pattern by _ months of age, at which time the mother's sleeping pattern also returns to normal. - ANSWER 3 patient's with ____ may have to sleep sitting upright in chair - ANSWER COPD Emergency action may be needed if an infant has apneic periods for over __ seconds. - ANSWER 20 A __ ________ may be placed in the esophagus to diagnose gastric acid reflux in infants and children. - infants will have thin wire with sensor at end passed nasally, while older children or adults may be able to swallow sensor with fluids. - ANSWER pH Sensor What is a co-morbid condition? - ANSWER presence of 1 or more diseases co-occurring with primary disease The newborn (0-1 months) sleeps about __._ hours a day, evenly spaced throughout the day. - ANSWER 16.5 The 2-4 month old infant sleeps about __ hours per day - ANSWER 15 The 4-6 month old child sleeps about __-__ hours a night with 2-3 daytime naps with TST of 14.25 hours. - ANSWER 10-11 _____________ _________ occurs when there is an imbalance between the heart's demand for oxygen and the supply. - ANSWER Myocardial Infarction (MI) ____________ may relieve symptoms of an Acute Asthma Attack, as patients may become hypoxic. - ANSWER Bronchodilators With Chronic ______, permanent damage to the airways may cause decreased oxygen saturation during sleep and disordered sleep. - ANSWER Asthma If nocturnal is severe, the patient may require supplemental Oxygen (1-2 l/min.) - ANSWER Hypoxia RACE stands for what? - ANSWER -Rescue -Alarm -Contain -Evacuate Patient Education Materials should not be written higher than __th - __th grade level. - ANSWER 6th-8th It is important that the technologist establishes ______ with the patient. - ANSWER trust Functional Outcomes of Sleep Questionnaire - ANSWER tool to assess whether excessive sleepiness persists- should be assessed with this after PSG and PAP titration to look for improvement Maintain a distance of _ feet or more from coughing person when possible. - ANSWER 3 _________ recordings may be stored in patient charts - ANSWER Paper Continuous Quality Improvement (CQI) - ANSWER Represents the concept that most processes can be improved.-uses scientific method of experimentation. ________________ is based on the principle that fluid flows from areas of higher pressure to areas of lower pressure. - ANSWER Hemodynamics Pulmonary Embolism - ANSWER 1 or more of the arteries in the lungs becomes blocked by a blood clot Oxyhemoglobin Dissociation Curve - ANSWER graph that plots the percentage of hemoglobin saturated with oxygen (y axis) and differential partial pressures of oxygen (PaO2 Levels) (x axis). Cyanosis - ANSWER A bluish discoloration of the skin and mucous membranes due to the tissues near the surface having low oxygen saturation. Barotrauma - ANSWER injury caused by increased air or water pressure. (common of ear)-Ventilator management may require a higher PaCO2 to prevent this Type 1 Sleep Study - ANSWER Nocturnal PSG; at least 12 channels. This type is used to diagnose OSA as well as other sleep disorders Types 2, 3, and 4 Sleep Study - ANSWER Modified Home Sleep Studies, using portable devices.-only appropriate for OSA patients because they provide limited information The Respiratory System during wake is under primary control of the _________ Nervous System - ANSWER Autonomic Acute Respiratory Distress Syndrome - ANSWER Condition in which fluid collects in the lungs' air sacs depriving organs of oxygen. Periodic Breathing is common with ___________ ________ ______________. - ANSWER Congestive Heart Failure Hypotonia (Floppy Baby Syndrome) - ANSWER low muscle tone and strength Minute Ventilation - ANSWER amount of volume of gas inhaled or exhaled from a person's lungs per minute Upper Airway Resistance increases during what stage of sleep? - ANSWER REM Snoring - ANSWER results from vibration within the respiratory system, often within the throat or nasal passage.-the sound arises from tissues vibrating against each other. When relating to ___________ _________ only, snoring is not a threat to health even if it is annoying. - ANSWER Nasal Obstruction The ____________ _________ slows down during sleep as a protective mechanism to prevent aspiration - ANSWER Gastrointestinal Tract It is likely that _________ will increase if the patient lies in the right lateral decubitus positon - ANSWER GERD Uvulopalato-Pharyngoplasty (UPPP) - ANSWER If OSA relates to a narrowed airway, the excess tissue may be removed from the uvula and the soft palate, and the tonsils and adenoids are also removed. Uvulopalatal Flap (UPF) - ANSWER Removes minimal tissue from the soft palate, lifting it and removing the tonsils to increase the size of the airway, Genioglossus Advancement (GA) - ANSWER Enlarges the hypopharyngeal area and is recommended for individuals whose tongues fall back and obstruct the airway. Hyoid Myotomy (HM) - ANSWER Enlarges the hypopharyngeal area by pulling the hyoid bone forward, opening the airway.-indicated for those with airway blockage at the epiglottis or base of the tongue. Maxillomandibular Advancement (MMA) - ANSWER Recommended for patients with severe OSA that does not respond to other surgical treatments or continuous positive airway pressure, especially related to anatomic abnormalities (micrognathia) that narrow the airway. Maxillomandibular Expansion (MME) - ANSWER Recommended for those whose jaws are not wide enough and involves cutting into both sides of the mandible and maxilla and placing distractors, which essentially stretch and expand the jaw, leaving a gap between the teeth, later corrected with orthodontia.-may slightly change the appearance of face. Pillar Procedure - ANSWER minimally invasive procedure used to treat obstruction caused by soft palate.-involves suturing three small inserts into soft palate to provide support, -effective for mild-to-moderate OSA. Radiofrequency Somnoplasty - ANSWER minimally invasive surgical technique that uses low-power radiofrequency to create volumetric lesions in submucosal tissue. In a period lasting up to 8 weeks, the tissue is slowly absorbed, and the volume is decreased. Laser-Assisted Uvuloplasty (LAUP) - ANSWER uses a laser to remove soft tissue of the uvula and soft palate to reduce snoring and open the airway. Seasonal Affective Disorder (SAD) - ANSWER Seasonal Episodes of Depression (usually fall and winter), increased appetite, and hypersomnia, requiring over 2.5 hours of extra sleep each day. -may be chemical or hormonal changes in brain due to reduced exposure to sunlight _________ Patients with SAD who take mood stabilizers shuld be monitored carefully befpre light therapy because it may trigger manic episodes. - ANSWER Bipolar Ataxia - ANSWER the loss of full control of bodily movements. Hypnotic - ANSWER "sleep inducing" EPAP is usally set at 4 cm H20 and IPAP IS usally sat at _ cm H20 - ANSWER 8 Excellent, Good, Adequate, or Inadequate? At least 5 AHI/Hr or more and some periods of REM uninterrupted by arousals - ANSWER Excellent Excellent, Good, Adequate, or Inadequate? At least 10 AHI/Hr or more or by 50% if baseline AHI is 15/Hr or less - ANSWER Good Excellent, Good, Adequate, or Inadequate? AHI decreased to 75% or more of baseline although still 10 AHI/Hr or more (common with severe OSA) - ANSWER Adequate Excellent, Good, Adequate, or Inadequate? AHI more than 75% of baseline and 10-20 AHI/Hr or more - ANSWER Inadequate Transcutaneous - ANSWER across the depth of the skin Room Air = __% Oxygen - ANSWER 21 Patients with COPD who are receiving high fractions of inspired oxygen may actually have increased _____ _________ levels. - ANSWER Carbon Dioxide Nasal Cannulae (prongs) - ANSWER Most common delivery system for oxygen because of ease of use. _________ is needed for oxygen flow rates of 4 L/min or more. - ANSWER Humidification Venturi Mask - ANSWER Oxygen mask that comes with different size color-coded nozzles to control the FIO2 accurately, with different sizes providing different rates.-often used on patients with COPD. An infant with ___ is fitted with apnea alarms, which typically awaken the infant and trigger respirations. - ANSWER CSA High-Flow Oxygen Delivery Devices - ANSWER provide oxygen at flow rates higher than the patient's inspiratory flow rate at a specific medium-to-high fraction of inspired Oxygen (FIO2), UP TO 100%. -Usually not used in sleep center and humidification is usually required because the high flow is drying. Low-Flow Oxygen Delivery Devices - ANSWER provide 100% oxygen at flow rates lower than the patient's inspiratory flow rate, but the oxygen mixes with room air Supplemental Low-Flow Oxygen - ANSWER used with a PSG, the use of which must be explained by technologist Initiate ;ow-Flow Supplemental O2 at 1 L/min when SpO2 falls below __% on ambient room air. - ANSWER 85 Monitor SpO2 when on oxygen to ensure it increases to at least __%. - ANSWER 90 Do not exceed 4 L/min of supplemental O2 without what? - ANSWER specific physician's order Infants younger than _ months may be started on CPAP immediately without prior practice or behavioral training. - ANSWER 9 Pierre Robin Syndrome - ANSWER Present at birth;child has smaller than normal lower jaw, a tongue that falls back into the throat, and difficulty breathing Patient Education increases __________. - ANSWER Compliance Begin CPAP titration at the lowest setting, usally _ cm H2O - ANSWER 5 Increase PAP pressure _ cm H2O at time set intervals, usually about every 15 minutes and observe effects, - ANSWER 1 Titration is done in the second half of the night during a split-night test (at least _ hours). - ANSWER 3 Adaptive Servoventilation devices provide a baseline positive airway pressure abd breathing assist to ensure adequate ventilation (at preset level) with each breath to __% of average for the patient. - ANSWER 90 Upper Airway Resisitance Syndrome (UARS) - ANSWER characterized by AHI of 5 or less but with increased numbers of RERA'S because of airway Resistance to breathing during sleep caused by small, restricted airways. C-Flex (by Respironics) - ANSWER expiratory pressure relief device that is a modified CPAP machine that has some elements of BIPAP-Provides a steady inspiratory pressure but allows patients to select a reduction in pressure during expiration (1-3 cm H2O). EPR (by ResMed) - ANSWER expiratory pressure relief device, provides smiliar relieef of pressure during exhalation but does so by reducing motor speed. Nasal Pillows work best with what nostril shape? -may be impossible to fit otherwise - ANSWER Round Nasal Masks are not effective for....? - ANSWER mouth breathers and those without teeth Orofacial Masks - ANSWER masks that aren't good for those who are claustrophobic Which masks are most appropriate for those with nasal congestion and other nasal obstructions that cause them to breathe primarily through their mouth? - ANSWER Oral Masks Air Hunger - ANSWER when some patients feel short of breathe while using positive airway pressure ________ __________ almost always relates to air leaks and air blowing across the eyes.-can cause conjunctivitis too - ANSWER Eye Irritation _____ _______ are a common complaint with PAP, especially with Nasal Pillows. - ANSWER Nose Bleeds What dies A.W.A.K.E stand for?????? (educates people about sleep apnea). - ANSWER Alert, Well, and Keeping Energetic Patient follow-up - ANSWER almost always necessary to ensurance compliance with PAP therapy. Re-accreditation occurs every _ years for sleep centers. - ANSWER 5 Sleep Center Staff must include a _____ _________with a license to practice and a diplomate of the American Board of Sleep Medicine (ABSM) - ANSWER Medical Director Health Insurance Portability and Accountability Act of 1996 - ANSWER addresses the rights of the individual related to privacy of health information. Confidentiality - ANSWER obligation that is present in a professional-patient relationship. -technologist must make all efforts to safeguard patient records and identification. K- complexes are best seen in? - ANSWER The frontals Vertex sharp waves may be present but are not required for the scoring of N1? - ANSWER True What should be the duration of a k-complex? - ANSWER .5 sec. Sleep efficiency is calculated by? - ANSWER TST/TRT The AASM recommended sampling rate for PSG is? - ANSWER 200-500 AAST? - ANSWER American academy of sleep technology BRPT? - ANSWER Board registered polysomnography technologist AASM? - ANSWER American academy of sleep medicine REM sleep was first discovered in? - ANSWER 1953 Narcolepsy is characterized by what tetrad of symptoms? - ANSWER cataplexy, sleep paralysis, hypnagogic hallucinations, and EDS what is the AASM alternative placement for eye monitors? - ANSWER below each eye and referenced to FZ What are the AASM recommended EEG scalp electrode placements? - ANSWER FPZ, CZ, F3, F4, C3, C4, O1, O2 M1, M2 AASM filter settings for EEG channel? - ANSWER 0.3 hz- 35hz AASM filter settings for EOG channel? - ANSWER .3 hz- 35hz AASM filter settings for EMG channel? - ANSWER 10hz - 100 hz AASM filter settings for ECG channel? - ANSWER .3hz - 70hz Leg electrodes should be placed over? - ANSWER anterior tibialis muscle Amplitude is the measure of? - ANSWER Voltage What does SaO2 measure? - ANSWER the percentage of hemoglobin that is saturated with O2 PcO2 is the measurement of? - ANSWER the amount of carbon dioxide in the blood what SaO2 level is considered normal? - ANSWER >90% what is the main difference between SpO2 and SaO2? - ANSWER saturation of O2 versus actual measurement of O2 Einthoven's triangle is? - ANSWER a common placement for three EKG leads how long is the PT. given to fall asleep during MSLT? - ANSWER 20 min what sleep stage is scored if the predominate EEG activity consist of high voltage .5-3.5hz waves? - ANSWER N3 MSLT nap attempts last? - ANSWER 20 min What are the AASM recommended ECG placements? - ANSWER right shoulder, left hip Activate medical procedures immediately for? - ANSWER ventricular fibrillation What type of therapy do ALS pts. typically get? - ANSWER Bi-PAP Complex apnea: - ANSWER The start or continuation of central apneas while on CPAP. COPD/ overlap syndrome - ANSWER Pts who have both COPD and OSA the distance between FP1 and O1 is 25cm. what is the distance between F3 and C3? - ANSWER 6.25cm which body position typically reduces the patency of the upper airway during sleep resulting in sleep apnea? - ANSWER supine Cheyne- stokes points to what condition? - ANSWER CHF REM behavior disorder usually begins - ANSWER after age 60 what might be seen in a PT. with lesions in the suprachiasmatic nucleus? - ANSWER altered circadian rhythm electrode pops can be caused by? - ANSWER impedance difference between electrodes if the circumference is 58cm what is the difference between T3 and O1? - ANSWER 11.6cm if the circumference is 58cm what is the difference between FP2 and T4? - ANSWER 11.6cm if the circumference is 58cm what is the difference between FP2 and O2? - ANSWER 23.2cm if the circumference is 58cm what is the difference between FP1 and T5? - ANSWER 17.4cm maximum electrode impedance is? - ANSWER 5k the AASM recommended starting pressure for adults and children? - ANSWER 4cm The AASM recommended IPAP and EPAP starting pressure for both adults and children? - ANSWER IPAP:8cm EPAP:4cm AASM recommended maximum CPAP pressure for adults? - ANSWER 20cm AASM recommended maximum IPAP pressure for Bi-PAP in adults? - ANSWER 30cm AASM recommended maximum CPAP pressure for children <12 years? - ANSWER 15cm AASM recommended maximum IPAP pressure for child <12 years on Bi-PAP? - ANSWER 20cm AASM recommended minimum IPAP-EPAP differential? - ANSWER 4cm AASM recommended maximum IPAP-EPAP differential? - ANSWER 10cm The AASM recommends CPAP pressure increase for how many obstructive events in children <12? - ANSWER 1 event The AASM recommends CPAP increase for how many obstructive events in adults? - ANSWER 2 events The AASM recommends IPAP and EPAP pressure increase for how many obstructive events in children <12? - ANSWER 1 event The AASM recommends IPAP and EPAP pressure increase for how many obstructive events in adults? - ANSWER 2 events The AASM recommends CPAP pressure increase for how many hypopneas in children <12? - ANSWER 1 hypopnea The AASM recommends CPAP pressure increase for how many hypopneas in adults? - ANSWER 3 hypopneas The AASM recommends IPAP pressure increase for how many hypopneas in children <12? - ANSWER 1 hypopnea The AASM recommends IPAP pressure increase for how many hypopneas in adults? - ANSWER 3 hypopneas The AASM recommends CPAP or IPAP pressure increase for how many RERAS in children <12? - ANSWER 3 RERAS The AASM recommends CPAP or IPAP pressure increase for how many RERAS in adults? - ANSWER 5 RERAS The AASM recommends CPAP or IPAP pressure increase for how many min. of loud snoring in children <12? - ANSWER 1 min The AASM recommends CPAP or IPAP pressure increase for how many min. of loud snoring in adults? - ANSWER 3 min An optimal pressure should have an RDI of? - ANSWER <5 A good pressure should have an RDI of? - ANSWER <10 An adequate pressure should reduce baseline RDI by what %? - ANSWER 75% The duration of a titration should be > how many hours? - ANSWER > 3 hours which PAP type automatically increases CPAP or BPAP (IPAP/EPAP) as needed to maintain airway patency and then decreases the pressure if no abnormal respiratory events are detected within a set period of time? - ANSWER APAP which PAP device uses a servo-controller that automatically adjusts pressure by breath-by-breath analysis to maintain a steady minute ventilation especially in heart failure patients with central sleep apnea and/or Cheyne-Stokes respiration? - ANSWER ASV What PAP type has been shown to decrease respiratory eve