Polysomnography and Respiratory Therapy: A Comprehensive Guide, Exams of Nursing

Download Polysomnography and Respiratory Therapy: A Comprehensive Guide and more Exams Nursing in PDF only on Docsity! NEW RPSGT EXAM STUDY GUIDE AND PRACTICE TEST The purpose of an intentional mask leak is to... - Correct answer-Wash out CO2 and prevent rebreathing Recommended guidelines state that HSV can be considered when.... - Correct answer- Cheyne Stokes and central Apneas have not been eliminated. What is aerophagia? - Correct answer-The swallowing of air What is maxillomandibular advancement? - Correct 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? - Correct answer-To eliminate desaturations and arousals. According to guidelines, how many Hypopneas need to occur in peds pts prior to increasing pressure? - Correct answer-1 What are the AASM guidelines for supplemental O2 during PAP studies? - Correct 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? - Correct answer-IPAP: 14 EPAP: 10 Which of the following can reduce the effectiveness of CPAP and why: Nasal spray, Alcohol, Anti depressants. - Correct 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? - Correct answer-Overlap syndrome What are hypoxemia and hypercapnia? - Correct 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? - Correct answer-Hypoventilation What is an MWT's MOST important use? - Correct 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? - Correct answer-REM sleep behavior disorder Recommended impedance for eeg and eog - Correct answer-5k ohms The amount of space needed to archive digitized data is MOST impacted by? - Correct answer-Sampling rate Cortical activity is best described as - Correct 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 - Correct answer-11 According to RECOMMENDED guidelines, the minimum duration of a significant leg movement is - Correct answer-.5 According to RECOMMENDED guidelines, an optional parameter to include in the report for an adult polysomnogram is - Correct 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 - Correct 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 - Correct answer-Atrial fibrillation The stage that is the greatest portion of the epoch - Correct 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? - Correct answer- Provide the patient with educational material about sleep apnea DETERGENT - Correct answer-SOAKING IN 1: 10 BLEACH AND WATER FOR 10 MIN. WHICH OF THE FOLLOWING WOULD BE MOST IMPORTANT TO DOCUMENT DURING A POLYSOMNOGRAM - Correct answer-POSITION CHANGES THE ELECTRODE ARRAY USED FOR RECORDING PHYSIOLOGIC ACTIVITY IS REFERRED TO AS - Correct answer-MONTAGE ACCORDING TO RECOMMENDED GUIDELINES, THE MAXIMUM ELECTRODE IMPEDANCE FOR EEG AND EOG RECORDING IS - Correct answer-5000 OHMS ACCORDING TO RECOMMENDED GUIDELINES, UNATTENDED PORTABLE MONITORING CAN BE USED AS AN ALTERNATIVE TO IN LAB TESTING WHEN - Correct 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 - Correct 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 - Correct answer-(LOW FILTER (HIGH PASS FILTER) WHICH OF THE FOLLOWING CAN NEGATIVELY IMPACT ALL BIOELECTRIC CHANNELS - Correct answer-CONTAMINATED M1 WHICH OF THE FOLLOWING SUBSTANCES CAN REDUCE THE EFFECTIVENESS OF PAP THERAPY - Correct answer-ALCOHOLIC BEVERAGES A PATIENT THAT INTENTIONALLY ENGAGES IN BEHAVIORAL PATTERNS THAT ARE INCONSISTENT WITH SLEEPING WELL IS DEMONSTRATING - Correct 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 - Correct answer-HISTOGRAM REAL TIME ACCESS TO PAP COMPLIANCE DATA IS AN EXAMPLE OF - Correct answer-EFFICACY MONITORING A PROCESS TO DECREASE FEAR OF ARTIFICIAL CIRCUMSTANCES BY REPEATED AND CONTROLLED EXPOSURE TO A FEARED SITUATION IS - Correct answer-DESENSITIZATION WHAT HAS THE LARGEST IMPACT ON ADHERENCE TO PAP THERAPY - Correct answer-PATIENT EDUCATION WHICH STATEMENT IS TRUE REGARDING CPAP - Correct answer-THERE IS ONE LEVEL OF PRESSURE FOR INSPIRATION AND EXPIRATION SLEEP DEBT CAN BEST BE DESCRIBED AS THE - Correct answer- CUMULATIVE EFFECT OF INSUFFICIENT SLEEP ACCORDING TO RECOMMENDED GUIDELINES FOR PEDIATRIC CPAP TITRATION, HOW MANY HYPOPNEAS MUST OCCUR PRIOR TO INCREASING PRESSURE - Correct answer-ONE EXCESSIVE WARMING AND HUMIDIFICATION WILL CAUSE - Correct answer- WATER TO POOL IN THE CPAP TUBING MAXILLOMANDIBULAR ADVANCEMENT TREATS OSA BY - Correct 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 - Correct answer-REM AND SLOW WAVE REBOUND WHICH OF THE FOLLOWING IS MOST LIKELY TO OCCUR DUE TO AN IMPROPERLY FITTING PAP INTERFACE? - Correct 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 - Correct answer-SCHEDULE DESENSITIZATION A PATIENT REPORTS A COMPLETE NASAL OBSTRUCTION PRIOR TO PAP TITRATION. THE TECH SHOULD - Correct answer-USE A ORO-NASAL INTERFACE THE BEST CANDIDATE FOR ORAL APPLIANCE WOULD HAVE - Correct answer- MILD OSA DURING STAGE N2 SLEEP, THE PATIENT CHANGES POSITION AND THE TECH NOTES INCREASED SNORING AND AN INCREASING LEAK. THE TECH SHOULD - Correct answer-REPOSITION AND ADJUST PAP INTERFACE ACCORDING TO RECOMMENDED GUIDELINES, CPAP SHOULD BE INCREASED AT AN INTERVAL NO LESS THAN - Correct answer-5 MINUTES THE PRIMARY FUNCTION OF EPAP IS TO - Correct 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 HOW LONG BEFORE A NAP BEGINS SHOULD THE SUBJECT CEASE SMOKING? - Correct answer-30 minutes WHAT EPOCH SIZE IS BEST FOR RECORDING THE "MSLT"? - Correct answer-30 seconds. A MEAN SLEEP LATENCY OF INDICATES WHAT? - Correct answer- Pathological sleepiness. A normal mean sleep latency is how many minutes? - Correct answer-10 - 20 minutes How many naps must have unequivocal periods of REM to arrive at a Diagnosis of Narcolepsy? - Correct answer-2 naps. What is the Narcoleptic Tetrad? - Correct answer-Excessive daytime sleepiness, hypnagogic hallucinations, sleep paralysis, cataplexy. How is the mean sleep latency calculated? - Correct answer-Sum of all latencies, divided by total# of naps. During REM, inhibition of thermoregulatory mechanisms lead to what state? - Correct answer-Poikilothermia. What equation best expresses time constant? - Correct 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. - Correct answer-Stage 3. AN EPOCH THAT DOES NOT MEET THE CRITERIA FOR ACTIVE SLEEP OR QUITE SLEEP IS CALLED WHAT? - Correct answer-Intermediate Sleep TRACE ALTERNANT PATTERN IS ASSOCIATED WITH WHAT STAGE OF SLEEP IN THE INFANT? - Correct answer-Quiet Sleep (NREM Sleep) INFANT BREATHING PATTERNS THAT ALTERNATES REGULAR BREATHING WITH 5-10 SECONDS OF APNEA? - Correct answer-Periodic Breathing. REM OCCUPIES WHAT PERCENTAGE OF SLEEP IN THE NEONATE AT TERM? - Correct answer-50%. A FUNCTION THAT EXPRESSES THE FREQUENCY OF EYE MOVEMENTS PER UNIT TIME DURING SLEEP STAGE REM? - Correct answer-REM Density. KNOW AS THE PACEMAKER FOR MAMMALIAN CIRCADIAN RHYTHMS? - Correct answer-Suprachiasmatic Nucleus (SCN). A COMPLAINT OF MORNING HEADACHES ASSOCIATED WITH SEVERE SLEEP APNEA IS A RESULT OF WHAT? - Correct answer-Severe oxygen desaturation and hypercapnia (Elevated levels of carbon dioxide in the blood). Pre-Sleep Interviews - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct answer-asks 19 questionnaires about time preferences to determine if patient is a morning,evening, or neutral person. Excessive Daytime Sleepiness - Correct 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 - Correct 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? - Correct 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? - Correct answer-Fatigue Stages of sleep should be reported in minutes, minutes of latencies, and percentage of - Correct answer-TST should be reported as a total number, index number, numbers occurring inREM sleep and in non-REM sleep for all different types and associations. - Correct answer-Arousals Sinus Bradycardia - Correct 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. - Correct answer-40 Alternating Leg Muscle Activation (ALMA) - Correct 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. - Correct answer-4 Hypnagogic Foot Tremors - Correct 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. - Correct answer-4 Hypnagogic Foot Tremors have a frequency of _._-_._ Hz. - Correct answer-0.3- 4.0 Cheyne-Stokes Respirations - Correct 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. - Correct 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. - Correct answer-3 Rhythmic Movement Disorder - Correct 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: term 'alpha rhythm.' - Correct answer-Dominant Posterior Rhythm (DPR) If there is no reactive alpha waves or age-appropriate DPR, score wake with . - Correct answer-Eye Movements What is the recommended square feet for patient rooms? - Correct answer- 140 Electroencephalogram (EEG) - Correct 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 - Correct answer-8-13 Hz Beta wave frequency - Correct answer-13-30 Hz Delta wave frequency - Correct answer-< 0.5-4Hz Theta wave frequency - Correct 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 - Correct answer-6 Electrocardiogram (ECG) - Correct answer-Record and display electrical activity of the heart through a number of different wave-forms, complexes, and intervals. P wave - Correct answer-wave in ECG that represents the beginning of electrical impulses in the Sinus Node, which spread through the atria (muscle depolarization). QRS Complex - Correct answer-wave in ECG that represents ventricular muscle depolarization and atrial repolarization. T wave - Correct answer-wave in ECG that represents ventricular muscle repolarization (resting state) as cells regain negative charge. U wave - Correct answer-wave that represents repolarization of the Purkinje Fibers Anterior Tibialis Electromyogram (atEMGs) - Correct 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 - Correct answer-non-invasive method of monitoring human rest/activity cycles.-monitors gross motor activity (like a fitbit). Pediatric Scoring of Wake uses the rather than True or False? Duration of sleep is not important for the MWT - Correct answer-True The physician's orders should be checked before PSG to ensure that the correct is selected. - Correct answer-Montage Face Electrodes - Correct answer-used to ground and record eye and chin activity and include EOG, cEMG, and Ground Electrode. Ground Electrode - Correct 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 - Correct answer-records vertical and horizontal eye movements and helps to identify periods of REM sleep. cEMG - Correct 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 - Correct 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? - Correct answer-95% is a common cause of inaccurate SpO2 readings. - Correct answer-Incorrect Position Patient's with may have lower SpO2 values. - Correct answer-COPD Nocturnal PSG - Correct answer-used to diagnose obstructive sleep apnea syndrome and may be done before MSLT. MSLT - Correct 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 - Correct 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? - Correct answer- 10/20 example of the nasion - Correct answer- example of the inion - Correct answer- Hypoxemia - Correct answer-Abnormally low blood cO2 saturation level Sundowning - Correct answer-Term linked with pts experiencing evening and nocturnal hallucinations associated with dementia Anterior Tibialis - Correct answer-Leg muscle used to monitor/record myoclonic events Voltage calculation - Correct answer-V= A x S Suggested Solution to soak contaminated electrodes - Correct answer-5% Hypochlorite Solution (Household Bleach) Complaints of Severe Sleep Apnea and morning headaches is a result of??? - Correct answer-Severe O2 Desat and Hypercapnia Beta Activity - Correct answer-EEG Activity with a frequency greater than 13 Hz In 1953, Aserinsky and Kleitman associated what with dreaming during sleep? - Correct answer-Rapid Eye Movements Alpha Activity in REM is _-_ Hz slower than during wakefulness - Correct answer-1-2 Periodic Breathing - Correct answer-infant breathing pattern that alternates regular breathing with 5-10 secs of apnea Current - Correct answer-flow of electrical force along a conductor Normal Arterial pCO2 value - Correct answer-35-45 mmHg Sleep Architecture - Correct answer-Progression and Distribution of the various sleep stages and their quantitative relationship to each other. 3 potential sources of stray electrical current - Correct answer-*short circuit *leakage current *ground loop What is the minimum paper speed recommended to allow clear visual representation of alpha and sleep spindles? - Correct answer-10 mm/sec 3 Grounds found in electrical equipment - Correct answer-*Earth (building and power outlets) *Chassis Ground (metal) *Common Connection Ground Ground Loop - Correct 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. - Correct answer-Epoch Reflux is identified in the distal esophagus by a drop in the pH below what? - Correct answer-4.0 Normal Arterial pO2 value - Correct answer-80-100 mmHg Which class of drugs is known to aggravate Periodic Limb Movements of sleep? - Correct answer-Tricyclic Antidepressants What considerations should be considered when given to the choice of of electrodes used for recording EEG? - Correct 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 - Correct answer-Capacitor NREM in infants is known as - Correct answer-Quiet Sleep Normal mean sleep latency - Correct answer-10-20 mins Paradoxical Breathing is noted in neonates or infants? - Correct answer- neonates Known as the circadian rhythm pacemaker - Correct answer- suprachiasmatic nuclei (SCN) If no sleep is noted during MSLT , when is the nap terminated? - Correct answer-20 mins. after 'lights out.' Referential Derivation - Correct answer-signal obtained by comparing voltages from an exploring electrode to a relatively inactive location Functional Residual Capacity (FRC) - Correct 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? - Correct answer-Observed Behavior and Movement Patterns Baseline Sway - Correct answer-undesirable variations in baseline during a recording, usually caused by sweat or movement Arousal - Correct answer-interruption of sleep continuity, identified by an abrupt shift in EEG frequency effect of chronic alcoholism - Correct answer-decreased REM and reduced NREM Delta Sleep Gain - Correct answer-Ratio of output voltage to input voltage, amplifier sensitivity Periodic Breathing most commonly occurs in quiet sleep or active sleep? - Correct answer-Active Device used to convert non-electrical physiologicak activity into electrical signals - Correct 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? - Correct answer-15 mins The number of waves, or pen deflections, recorded in 1 second - Correct answer-signal frequency Jaw Muscle - Correct answer-Masseter A patient can become the pathway of least resistance and therefore susceptible to shock when what occurs? - Correct answer-when not all equipment attached to patient is connected to a common ground Ultradian Rhythm refers to what period of time - Correct answer-less than 24 hrs Ultradian Rhythm of alternating sleep cycles has a period of how many minutes during infancy? - Correct answer-30-70 mins Which type of montage is recommended in order to maximize the the voltages recorded during PSG? - Correct answer-Referential montage using contralateral ear references Time Constant - Correct 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? - Correct answer-a significant increase in apnea duration with associated hypercapnia and respiratory acidosis Conductor - Correct answer-Any Material capable of transmitting electrical current How many naps are usually performed during an MSLT? - Correct answer-4-5 An epoch that does not meet criteria for Active Sleep or Quiet Sleep is called - Correct answer-indeterminate sleep Central Aveolar Hypoventilation Syndrome - Correct answer-Respiratory Arrest during Sleep Jactatio Capitis Noctuna - Correct answer-Head Banging Thermocouple - Correct 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. - Correct answer-False; Sweating and Panting are seen in NREM, but are absent in REM REM Density - Correct answer-A function that expressed eye movements per unit time during REM Sinus Tachycardia example - Correct answer- Sinus Bradycardia example - Correct answer- Supraventricular Tachycardia example - Correct answer- Premature Atrial Contractions (PAC's) example - Correct answer- Sinus Arrhythmia example - Correct answer- Atrial Flutter example - Correct answer- Atrial Fibrillation example - Correct answer- Sinus Pause example - Correct answer- Premature Junctional Contractions example - Correct answer- Junctional Rhythms example - Correct answer- Premature Ventricular Contractions (PVC's) example - Correct answer- Ventricular Tachycardia example - Correct answer- Narrow-complex tachycardia example - Correct answer- Ventricular Fibrillation example - Correct answer- Idioventricular Rhythm example - Correct answer- Ventricular Asystole example - Correct answer- The appearance of the waveform is-------------------------Correct answer- First-Degree Atrioventricular Block example - Correct answer- Second Degree Atrioventricular Block Type 1 example - Correct answer- Second-degree atrioventricular block type 2 example - Correct answer- Third Degree Atrioventricular Block example - Correct answer- Wide Complex Trachycardia example - Correct answer- Right Bundle Branch Block example - Correct answer- Left Bundle Branch Block example - Correct answer- Frequency - Correct answer-number of waves/cycles generated per second Amplitude - Correct answer-vertical height of wave determined by electrical voltage Setting of microvolts/cm used for EEG,EOG, and EMG.-1 cm high - Correct answer- 50 filters - Correct 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) - Correct answer-rarely used filter because it can interfere with recordings-used mainly on anterior tibialis EMG's Band-Pass filter - Correct answer-record frequencies only within a particular range Sampling Rate - Correct 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 filters Interictal Epileptiform Activity - Correct answer-electrical discharges that occur between epileptic seizures Frontal Lobe Epilepsy seizures occurs primarily during what? - Correct answer- sleep Seizure Activity is most common in what stage? - Correct answer-Stage 2 can result in similar symptoms of choking and EDS. -Some cases may have both present. - Correct answer-Frontal Lobe Frontal Lobe Epilepsy is more easily identified with _-channel EEG recordings. - Correct answer-4 Temporal Lobe epilepsy is more accurately identified with -channel EEG recording. - Correct answer-18 can help to identify Seizure Activity, which usually involves some degree of arousal. - Correct answer-Video Monitoring Blinks produce waves - Correct answer-slow ECG artifacts are usually are more ponounced inpatients. -so reference electrodes should not be placed over fatty tissue - Correct answer-obese ECG artifacts in the EMG channels usually indicate poor placement or unequal . - Correct answer-impedances Slow-frequency artifacts can be related to , pressure on an electrode, or body movement - Correct answer-perspiration Perspiration= - Correct answer-sweating may interfere with pulse oximetry readings. oximetry artifacts must be tagged or removed from the recording. - Correct answer-obesity microsleep - Correct answer-brief, unintended episodes of loss of attention associated with blank stare, etc... Enuresis - Correct answer-typically normal EEG, inability to control urination Confusional Arousals - Correct answer-Shows Alpha Waves, repetitive periods of microsleep, or stage N1 sleep during arousal period. Exploding Head Syndrome - Correct answer-Shows sudden arousal during transition period between sleep and awakening, and electroencephalogram shows alpha and theta waves Alpha waves example - Correct answer- Beta Waves example - Correct answer- Theta Waves example - Correct answer- A Psg may help to differentiate between OSA and Epilepsy, Periodic Breathing is common with When relating to only, snoring is not a threat to health The slows down during sleep as a protective The Respiratory System during wake is under primary control of the Nervous System - Correct answer-Autonomic Acute Respiratory Distress Syndrome - Correct answer-Condition in which fluid collects in the lungs' air sacs depriving organs of oxygen. answer-Congestive Heart Failure Hypotonia (Floppy Baby Syndrome) - Correct answer-low muscle tone and strength Minute Ventilation - Correct 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? - Correct answer-REM Snoring - Correct answer-results from vibration within the respiratory system, often within the throat or nasal passage.-the sound arises from tissues vibrating against each other. it is annoying. - Correct answer-Nasal Obstruction prevent aspiration - Correct answer-Gastrointestinal Tract It is likely that will increase if the patient lies in the right lateral decubitus positon - Correct answer-GERD Uvulopalato-Pharyngoplasty (UPPP) - Correct 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) - Correct answer-Removes minimal tissue from the soft palate, lifting it and removing the tonsils to increase the size of the airway, Genioglossus Advancement (GA) - Correct answer-Enlarges the hypopharyngeal area and is recommended for individuals whose tongues fall back and obstruct the airway. Hyoid Myotomy (HM) - Correct 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) - Correct answer-Recommended for patients with severe OSA that does not respond to other surgical treatments or continuous Patients with SAD who take mood stabilizers shuld be monitored carefully befpre light therapy because it may trigger manic positive airway pressure, especially related to anatomic abnormalities (micrognathia) that narrow the airway. Maxillomandibular Expansion (MME) - Correct 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 - Correct 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 - Correct 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) - Correct 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) - Correct 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 Ataxia - Correct answer-the loss of full control of bodily movements. Hypnotic - Correct answer-"sleep inducing" EPAP is usally set at 4 cm H20 and IPAP IS usally sat at _ cm H20 - Correct answer-8 Excellent, Good, Adequate, or Inadequate? At least 5 AHI/Hr or more and some periods of REM uninterrupted by arousals - Correct 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 - Correct 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) - Correct answer-Adequate Excellent, Good, Adequate, or Inadequate? AHI more than 75% of baseline and 10-20 AHI/Hr or more - Correct answer- Inadequate Transcutaneous - Correct answer-across the depth of the skin Room Air = % Oxygen - Correct answer-21 Patients with COPD who are receiving high fractions of inspired oxygen may actually have increased levels. - Correct answer-Carbon Dioxide Nasal Cannulae (prongs) - Correct answer-Most common delivery system for oxygen because of ease of use. is needed for oxygen flow rates of 4 L/min or more. - Correct answer- Humidification Venturi Mask - Correct 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. - Correct answer-CSA High-Flow Oxygen Delivery Devices - Correct 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 - Correct 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 - Correct 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. - Correct answer-85 Monitor SpO2 when on oxygen to ensure it increases to at least %. - Correct answer- 90 Do not exceed 4 L/min of supplemental O2 without what? - Correct answer-specific physician's order Infants younger than _ months may be started on CPAP immediately without prior practice or behavioral training. - Correct answer-9 what is the AASM alternative placement for eye monitors? - Correct answer- below each eye and referenced to FZ What are the AASM recommended EEG scalp electrode placements? - Correct answer- FPZ, CZ, F3, F4, C3, C4, O1, O2 M1, M2 AASM filter settings for EEG channel? - Correct answer-0.3 hz- 35hz AASM filter settings for EOG channel? - Correct answer-.3 hz- 35hz AASM filter settings for EMG channel? - Correct answer-10hz - 100 hz AASM filter settings for ECG channel? - Correct answer-.3hz - 70hz Leg electrodes should be placed over? - Correct answer-anterior tibialis muscle Amplitude is the measure of? - Correct answer-Voltage What does SaO2 measure? - Correct answer-the percentage of hemoglobin that is saturated with O2 PcO2 is the measurement of? - Correct answer-the amount of carbon dioxide in the blood what SaO2 level is considered normal? - Correct answer->90% what is the main difference between SpO2 and SaO2? - Correct answer- saturation of O2 versus actual measurement of O2 Einthoven's triangle is? - Correct answer-a common placement for three EKG leads how long is the PT. given to fall asleep during MSLT? - Correct answer-20 min what sleep stage is scored if the predominate EEG activity consist of high voltage .5- 3.5hz waves? - Correct answer-N3 MSLT nap attempts last? - Correct answer-20 min What are the AASM recommended ECG placements? - Correct answer-right shoulder, left hip Activate medical procedures immediately for? - Correct answer-ventricular fibrillation What type of therapy do ALS pts. typically get? - Correct answer-Bi-PAP Complex apnea: - Correct answer-The start or continuation of central apneas while on CPAP. COPD/ overlap syndrome - Correct answer-Pts who have both COPD and OSA the distance between FP1 and O1 is 25cm. what is the distance between F3 and C3? - Correct answer-6.25cm which body position typically reduces the patency of the upper airway during sleep resulting in sleep apnea? - Correct answer-supine Cheyne- stokes points to what condition? - Correct answer-CHF REM behavior disorder usually begins - Correct answer-after age 60 what might be seen in a PT. with lesions in the suprachiasmatic nucleus? - Correct answer-altered circadian rhythm electrode pops can be caused by? - Correct answer-impedance difference between electrodes if the circumference is 58cm what is the difference between T3 and O1? - Correct answer-11.6cm if the circumference is 58cm what is the difference between FP2 and T4? - Correct answer-11.6cm if the circumference is 58cm what is the difference between FP2 and O2? - Correct answer-23.2cm if the circumference is 58cm what is the difference between FP1 and T5? - Correct answer-17.4cm maximum electrode impedance is? - Correct answer-5k the AASM recommended starting pressure for adults and children? - Correct answer- 4cm The AASM recommended IPAP and EPAP starting pressure for both adults and children? - Correct answer-IPAP:8cm EPAP:4cm AASM recommended maximum CPAP pressure for adults? - Correct answer- 20cm AASM recommended maximum IPAP pressure for Bi-PAP in adults? - Correct answer- 30cm AASM recommended maximum CPAP pressure for children <12 years? - Correct answer-15cm AASM recommended maximum IPAP pressure for child <12 years on Bi-PAP? - Correct answer-20cm AASM recommended minimum IPAP-EPAP differential? - Correct answer-4cm AASM recommended maximum IPAP-EPAP differential? - Correct answer-10cm The AASM recommends CPAP pressure increase for how many obstructive events in children <12? - Correct answer-1 event The AASM recommends CPAP increase for how many obstructive events in adults? - Correct answer-2 events The AASM recommends IPAP and EPAP pressure increase for how many obstructive events in children <12? - Correct answer-1 event The AASM recommends IPAP and EPAP pressure increase for how many obstructive events in adults? - Correct answer-2 events The AASM recommends CPAP pressure increase for how many hypopneas in children <12? - Correct answer-1 hypopnea The AASM recommends CPAP pressure increase for how many hypopneas in adults? - Correct answer-3 hypopneas The AASM recommends IPAP pressure increase for how many hypopneas in children <12? - Correct answer-1 hypopnea The AASM recommends IPAP pressure increase for how many hypopneas in adults? - Correct answer-3 hypopneas The AASM recommends CPAP or IPAP pressure increase for how many RERAS in children <12? - Correct answer-3 RERAS The AASM recommends CPAP or IPAP pressure increase for how many RERAS in adults? - Correct answer-5 RERAS The AASM recommends CPAP or IPAP pressure increase for how many min. of loud snoring in children <12? - Correct answer-1 min The AASM recommends CPAP or IPAP pressure increase for how many min. of loud snoring in adults? - Correct answer-3 min What is the criteria for scoring a RERA for pediatrics with esophageal pressure? - Correct answer-•Inspiratory effort increases during event. • there is evidence of snoring, nose breathing, increased PCO2, or observable increases respiratory effort. • duration is two or more respirations What is the criteria for a limb movement? - Correct answer-Lasts 0.5- 10 sec. with an increased EMG amplitude of at least 8 microvolts. What is the criteria for a PLM series? - Correct answer-4 or more consecutive movements with a time ranging from 5 sec. to 90sec. Limb movements involving both legs are counted as one if they occur within 5 sec. of each other What is two day testing? - Correct answer-The first day is a PSG the second is a titration if needed. What are some solutions to chronic fatigue on patient using CPAP? - Correct answer-• give the pt. Time to adjust some pts. Do not see results immediately. • evaluate TST to ensure pt. Is getting at least 7 hours a day. Also include daytime naps in TST. • check mask for leaks since inadequate pressure may cause apnea and poor sleep quality. • review symptoms associated with poorly fitted mask or mouth breathing such as: dry mouth, sore nasal passages, and dry eyes. • review sleep hygiene with pt. • discuss alcohol, caffeine, and cigarette use before bed since these can impair sleep. • evaluate environmental factors such as: temp., noise, bed patterns, or interruptions. • ask about RLS or bruxism • observe pt. During sleep to determine if PAP setting is still in place • reassess type of mask used. What is Genioglossus advancement? - Correct answer-GA enlarges the hypo- pharyngeal area and is recommended for those who's youngest fall back and obstruct airways. The genioglossus muscle attaches the tongue to the lower jaw at a bony prominence. GA moves this prominence forward and reattaches the tongue in a more anterior position preventing the tongue from blocking the airway. This procedure may be done along with uvulopalatal flap and radiosurgical tongue reduction. GA is often more successful that a uvulopalatopharyngoplasty. What is a Hyoid Myotomy? - Correct answer-HM enlarges the hypophayngeal area by pulling the hyoid bone forward, opening the airway. It is indicated for those with airway blockage at the epiglottis or base of the tongue. May be done wit GA or alone. What is Uvulopalatopharyngoplasty (UPPP)? - Correct answer-If OSA is related to a narrowed airway then the excess tissue may be removed from the uvula and soft palate, the tonsils and adenoids are also removed. It is painful but is used for pts. Who are unable to use PAP therapy. It may be a better option than a tracheotomy for severe cases. What is Uvulopalatal flap (UPF)? - Correct answer-UPF removes minimal tissue from the soft palate lifting it and removing the tonsils to increase the size of the airway. This is less invasive than UPPP, but is still quite painful. What is a Maxillomandibular advancement (MMA)? - Correct answer-MMA is recommended for pts with severe OSA that does not respond to other surgical treatments or CPAP. Both the mandible and maxilla are fractured on both sides, metal spacers are placed between the bones and the mid face is brought forward up to about 12mm to enlarge posterior airway. May change the appearance of the face. What is maxillomandibular expansion (MME)? - Correct answer-MME is 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 which is later corrected with orthodontics. What is the pillar procedure? - Correct answer-The pillar minimally invasive procedure is used to treat obstruction cause by the soft palate. It involves suturing three small inserts into soft palate to provide support. Effective for mild - moderate OSA. What is a tracheostomy? - Correct answer-An opening directly into the trachea that bypasses the obstruction and opens the airway. What is ALMA? - Correct answer-Occurs with rapid alternating activation of (emg) in the lower extremities How do you score ALMA? - Correct answer-An ALMA series requires at least 4 ALMAS at a minimum frequency of 0.5hz and maximum frequency of 3.0hz. Duration usually ranges from 100-500 milliseconds. Almas are considered benign, do not require treatment, and are unrelated to sleep disorders. what is the Criteria for scoring (RBD)? - Correct answer-1) REM epoch with 50% or more increased cEMG (chin) activity. The # of events that occur within a particular period of time is called? - Correct answer- Frequency When reviewing medical history the tech notes that a pt. takes Xanax for panic attacks. the tech should anticipate?? - Correct answer-decreased N3 What would increase the resolution of EEG spikes and improve definition of the waveforms? - Correct answer-increasing the sampling rate What type of calibration is defined as applying a calibration signal of known voltage to all amplifiers simultaneously, with the sensitivity and filter controls set to values used at the beginning of the study? - Correct answer- Montage The ability of am amplifier to cancel interference that is common to both input signals is called? - Correct answer-common mode rejection Actigraphy is most useful in the evaluation of? - Correct answer-insomnia Cheyne-Stokes respiration - Correct answer-A breathing pattern characterized by at least three cycyles of crescendo and decrescendo breathing with a duration of at least 10 minutes is: Use oronasal interface - Correct answer-A patient reports a complete nasal obstruction prior to PAP titration. The technologist should: Inadequate sleep hygiene - Correct answer-A patient that intentionally engages in behavorial patterns that are inconsistent with sleeping well is demonstrating: Sundowning - Correct answer-A patient with mild dementia becomes more confused and/or agitated in the early evening. The patient is MOST LIKELY expierencing. Call the physician for confirmation - Correct answer-A patient's chart indicates that they use 3.0 L/min of oxygen at home. The technologist notes that the physican's orders for the PSG specifies starting the study without supplemental oxygen and to add 1 L/min oxygen if the SpO2 is less than 89%. The BEST action for the technologist is to: COPD and OSA - Correct answer-A patient's history indicates a diagnosis of overlap syndrome. The technologist can anticipate that the patient has: Desensitization - Correct answer-A process to decrease fear of artificial circumstances by repeated and controlled exposure to a feared situation is: Pittsburgh Sleep Quality Index - Correct answer-A self-reporting tool used to evaluate subjective sleep quality and disturbance over the previous month is: Aerophagia - Correct answer-A side effect of CPAP is: A. Hyperventilation B. CO2 Retention C. Aerophagia D.Intentional Leak .5 seconds - Correct answer-According to RECOMMENDED guidelines, the minimum duration of a significant leg movement is: Occurrence of hypoventilation during the diagnostic study in adults - Correct answer- According to RECOMMENDED guidelines, an optional parameter to include in the report for an adult polysomnogram is: Has not eliminated Cheyne Stokes respiration or central emergent apneas. - Correct answer-According to RECOMMENDED guidelines, adaptive servoventilation can be considered during a titration studey when a down titration: 5 minutes - Correct answer-According to RECOMMENDED guidelines, CPAP should be increased at an interval no less than: Had REM on at least two nap opportunities - Correct answer-According to RECOMMENDED guidelines, four nap opportunities on a MSLT would be acceptable when the patient: Oronasal thermal sensor - Correct answer-According to RECOMMENDED guidelines, the device that should be used to monitor airflow and detect apnea during a diagnostic study is: 500 Hz - Correct answer-According to RECOMMENDED guidelines, the sampling rate to provide the optimal resolution for recording EEG in a patient with suspected nocturnal seizures is: There is a high probability of moderate to severe OSA without comorbid conditions - Correct answer-According to RECOMMENDED guidelines, unattended portable monitoring can be used as an alternative to in-lab testing when: 5000 ohms - Correct answer-According to RECOMMENDED guidelines, the maximum electrode impedance for EEG and EOG recording is: End-tidal CO2 - Correct answer-According to RECOMMENDED guidelines, which of the following should be included when recording pediatric patients? The stage that is the greatest portion of the epoch - Correct answer-According to the RECOMMENDED guidelines, when coexisting sleep stages occur in a signle epoch, the epoch should be scored: Confirm accuracy of report components - Correct answer-An important responsibility of the scoring technologist is to: 11 - Correct answer-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 Change to bi-level - Correct answer-During a CPAP titration at 15 cm H2O, the patient is restless and continues to have frequent obstructive respiratory events. The BEST action is to: IPAP 14 / EPAP 10 - Correct answer-During a titration study the patient's apneas are eliminated at 10 cm H2O but hypopneas and snoring continue at 16 cm H2O. According to RECOMMENDED guidelines, the appropriate pressures to begin a bilevel titration are: Follow protocol for supplemental oxygen - Correct answer-During CPAP titration at 10 cm H2O, SpO2 values range between 80 and 85% for 10 minutes despite absence of respiratory events. What is the BEST action for the technologist to take? Reposition and adjust PAP interface - Correct answer-During stage N2 sleep, the patient changes position and the technologist notes increased snoring and an increasing leak. The technologist should: Water to pool in the CPAP tubing - Correct answer-Excessive warming and humidification will cause: REM and slow wave rebound - Correct answer-In patients with severe sleep- disordered breathing, the most commonly seen response resulting from successful PAP titration is: Modifying the alignment of upper jaw - Correct answer- Maxillomandibular Advancements treats OSA by: One - Correct answer-According to RECOMMENDED guidelines for pediatric CPAP titration, how many hypopneas must occur prior to increasing pressure? Efficacy monitoring - Correct answer-Real time access to PAP compliance data is an example of: Cumulative effect of insufficient sleep - Correct answer-Sleep debt can BEST be described as the: Obstructive Hypopnea - Correct answer-The respiratory event that requires oxygen desaturation and/or an arousal as part of the scoring criteria is: Obesity Hypoventilation - Correct answer-The syndrome characterized by prolonged episodes of severe hypoxemia and associated PaCO2 elevation that worsens during sleep is: Patient Education - Correct answer-What has the LARGEST impact on adherence to PAP therapy? Provide the patient with educational material about sleep apnea - Correct answer-What is the BEST response when a patient asks the technologist if they have sleep apnea and will need to wear a CPAP mask? Historgram - Correct answer-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? 4 cm H2O - Correct answer-What is the RECOMMENDED starting pressure for pediatric and adult CPAP titration? Schedule desensitization - Correct answer-When a patients complains of claustrophobia, is unable to tolerate PAP and requests to end the PSG, the next BEST step is to: Rely on F3-M2 - Correct answer-When intermittent 60 Hz activity occurs in the F4-M1 electrodes during REM sleep, the best IMMEDIATE action would be to: Hypoxemia and hypercapnia - Correct answer-When reviewing a patient's history in preparation for a polysomnogram, physiologic findings suggestive of hypoventilation include: Decrease sensitivity - Correct answer-When the amplitude of a signal exceeds the physical limitations of a channel the MOST important adjustment the technologist can make to optimize waveform display is to: Alcohol consumption prior to testing - Correct answer-Which of the following is the MOST LIKELY cause of a 35 minute REM latency? Conjunctivitis - Correct answer-Which of the following is MOST likely to occur due to an improperly fitting PAP interface? Alcoholic beverages - Correct answer-Which of the following substances can reduce the effectiveness of PAP therapy Position changes - Correct answer-Which of the following would be MOST important to document during a polysomnogram? Increased sleep efficiency - Correct answer-Which of the following is the MOST LIKELY effect of Zolpidem and Zaleplon on sleep architecture? Dislodged system reference electrode - Correct answer-Which of the following can negatively impact all bioelectric channels? There is a potential for electrode contamination - Correct answer-Which of the following BEST describes a referential montage? Soaking in 1:10 bleach and water for 10 minutes - Correct answer-Which process would be an adequate routine procedure for disinfecting cup EEG electrodes after removing adhesive residue, gel and organic material, and washing in warm water and mild detergent? The is one level of pressure for inspiration and expiration - Correct answer-Which statement is true regarding CPAP? Physiological - Correct answer-Which type of calibration is based on a series of patient instructions intended to verify the signal response and qualtiy? Which type of calibration is based on a series of patient instructions intended to verify the signal response and quality? - Correct answer- Physiological What is the MOST LIKELY effect of zolpidem and zaleplon on sleep architecture? - Correct answer-Increased Sleep Efficiency What best describes a referential montage? - Correct answer-There is a potential for electrode contamination. What is most important to document during a PSG? - Correct answer-Position Changes When reviewing a patients history in preparation for a PSG, physiologic finding suggestive of hypoventilation include? - Correct answer-Hypoxemia and Hypercapnia A patients history indicated a diagnosis of overlap syndrome. The technologist can anticipate the patient has? - Correct answer-COPD and OSA The syndrome characterized by prolonged episodes of severe hypoxemia and associated PaC02 elevation that worsens during sleep is? - Correct answer-Obesity Hypoventilation The ability to remontage while recording on digital equipment is the result of? - Correct answer-CMR "Common Mode Rejection" According to the recommended guidelines, the device that shold be used to monitor airflow and detect apnea during a PSG is? - Correct answer- Oronasal Thermal Sensor Accoring to the recommended guidelines, what should be included when recording pediatric patients? - Correct answer-End-Tidal C02 What is the most common method to monitor blood O2 saturation during a PSG? - Correct answer-Pulse Oximetry What is the most important reason for performing a MWT? - Correct answer-Measure the patients ability to resist the urge to fall asleep. When the amplitude of a signal exceeds the physical limitations of a channel the MOST important adjustment the technologist can make to optimize the waveform display is to? - Correct answer-Decrease Sensitivity A self-reporting tool used to evaluate subjective sleep quality and disturbance over the previous month is? - Correct answer-Pittsburgh Sleep Quality Index Adult Mild RDI - Correct answer-5 to < 15 Adult Moderate RDI - Correct answer-15 to 30 Adult Severe RDI - Correct answer-more than 30 Child Mild RDI - Correct answer-1 to < 5 Child Moderate RDI - Correct answer-5 to < 10 Child Severe RDI - Correct answer-more than 10 Reason for PAP Titration Referral - Correct answer-Diagnosis of OSA during a PSG (polysomnogram) Adult Minimum CPAP Pressure - Correct answer-4cm H2O Adult Maximum CPAP Pressure - Correct answer-20cm H2O Child Minimum CPAP Pressure - Correct answer-4cm H2O Child Maximum CPAP Pressure - Correct answer-15cm H2O Increase pressure by minimum of no less than minute interval - Correct answer-1cm, 5min Increase both I/E PAP by a minimum of 1cm if CHILD has - Correct answer-1 Obstructive Apnea within 5 or more mins Increase both I/E PAP by a minimum of 1cm if ADULT has - Correct answer-2 Obstructive Apnea within 5 or more mins Reasons to Increase IPAP only in CHILD (list) - Correct answer-1 hypopnea, 3 RERAs, 1min of loud snoring Reasons to Increase IPAP only in ADULT (list) - Correct answer-3 hypopnea, 5 RERAs, 3 min of loud snoring Bi-PAP Optimal, Good, Adequate Titration - Correct answer-Same Parameters as CPAP Supplemental O2 recommended when PT is (short answer) - Correct answer-when SpO2 is less than 88% for 5mins of longer while patient is awake Location to connect O2 on CPAP Equipment (short answer) - Correct answer-Connect through CPAP Tubing by use of adapter or T connector Recommended starting rate for O2 - Correct answer-1 L/min rate of O2 increase (short answer) - Correct answer-Increase 1 L/min with 15 min intervals until pt is with in 88%-94% SpO2 reason to lower O2 (short answer) - Correct answer-When CPAP/Bi-PAP pressure in Increased. Split -Night studies (list/ short answer) - Correct answer-more than 3 hours of Titration time, Should not be performed on children (<12yo), pressure increase with minimum of 2cm with interval of 5 min or more TST: Total Sleep Time - Correct answer-Time in minutes and/or # of epochs of Sleep (not including WASO, Arousals, and TNR) TRT: Total Recording Time - Correct answer-Time in mins Lights out - Lights on Sleep Latency - Correct answer-Time from Lights out to the first epoch of sleep Stage R Latency - Correct answer-Time from Sleep onset to the first epoch of REM WASO: Wake After Sleep Onset - Correct answer-Time(mins) the patient is wake after AFTER sleep onset. including time not connected/recorded. WASO= TRT-SL-TST Sleep Efficiency Percent - Correct answer-TST/TRT x 100 Time in each stage - Correct answer-# of epochs and mins Percent of TST in each stage - Correct answer-Time in stage(n1,n2,n3,R)/TST x 100 Arousal Index - Correct answer-#of arousals x 60 / TST Heart Rate - Correct answer-Average BPM, Highest during sleep, Highest during TRT Bradycardia - Correct answer-If reported; Lowest BPM during TRT Types of Tachycardia - Correct answer--Sinus tachycardia -Narrow complex tachycardia -Wide complex tachycardia Atrial Fibrillation - Correct answer-Report average BPM Arrhythmias - Correct answer-List types of arrhythmias Movement events - Correct answer-- # PLMS and PLMS with arousal - PLMS and PLMArI index ( # of events x 60 / TST) Asystole - Correct answer-Pauses for 3 seconds or longer between heart beats Respiratory Events - Correct answer-# of; Apneas (Ob,C,M), Hypopneas (Ob,C), RERAs Apnea Index - Correct answer-AI; (# obstructive apneas + # central apneas + # mixed apneas) × 60 / TST) Hypopnea Index - Correct answer-HI; (# hypopneas × 60 / TST) Obstructive apnea-hypopnea index (no centrals) - Correct answer-OAHI; (# obstructive apneas + # mixed apneas + # obstructive hypopneas) × 60 / TST) Central apnea-hypopnea index (only centrals) - Correct answer-CAHI; (# central apneas + # central hypopneas) × 60 / TST) RERA Index - Correct answer-# of RERAs x 60 / TST Respiratory Disturbance index - Correct answer-RDI; (# apneas + # hypopneas + # RERAs) × 60 / TST) Oxygen Desaturation index - Correct answer-# oxygen desaturations ≥3% or ≥4% × 60 / TST) distinguishable form background activity, can persists in n2 sleep. Are NOT required to score N1 Stage N1: Beginning in PTs with Posterior Dominate Rhythm - Correct answer-When Posterior Dominate Rhythm(alpha) attenuates and is replaced my LAMF Stage N1: Beginning PT's without Posterior dominant rhythm - Correct answer-a. slowing of background frequency by > or = 1hz b. vertex sharp waves c. SEM comencement Stage N1: Appears - Correct answer-After any epoch with LAMF, no evidence of another sleep stage AND AFTER an arousal or major body movement.. Stage N1: Ends - Correct answer-When Evidence of any other sleep stage apears Stage N1: Arousal during N2 - Correct answer-All epochs after the arousal are N1 until evidence of another sleep stage appear. Stage N1: Arousal during REM - Correct answer-All epochs after the arousal are N1 ONLY if LAMF AND SEM are present Stage N2: EEG - Correct answer-K complex and Sleep Spindle, LAMF in the background K Complex - Correct answer-Sharp negative wave preceding a slow positive wave lasting longer than 0.5 seconds Sleep Spindle - Correct answer-A short burst of rhythmic activity 11-16hz lasting longer than 0.5 seconds Stage N2: EMG - Correct answer-low amplitude, lower than awake and N1. Stage N2: EOG - Correct answer-Commonly there is no movement Stage N2: Onset - Correct answer-a. The Epoch with a K complex or Sleep spindle in the first half OR b. if K complex or sleep spindle occurs in the second half then the next epoch will be the first for N2 Stage N2: Continues - Correct answer-Even with no spindles or K complexes and LAMF is present UNLESS evidence for REM appears without an interrupting Arousal, N1 or N3 Stage N2: Transition into N1 - Correct answer-After an arousal and LAMF is present and/or SEM. Stage N2: Transition into N3 - Correct answer-When an Epoch is 20% or more Slow Wave Sleep (Delta) Stage N2: Transition into REM - Correct answer-If there is Evidence for REM all preceding epochs WITHOUT K complexes or spindles in the second half but contain LAMF are REM Possible drop in EMG tone (not required) Stage N3: EEG - Correct answer-contains Slow wave (Delta) activity, possible to contain k-complex or sleep spindles in first epoch of N3 Delta Waves - Correct answer->75microvolts lasting more than 0.5 seconds and a frequency of 0.5-2hz Stage N3: EMG - Correct answer-Lower Amplitude than N1 or N2 may be equal to REM Stage N3: EOG - Correct answer-Usually no activity Stage N3: Begins - Correct answer-When 20% or more of an epoch is Slow wave sleep. Sleep spindles may persist Stage N3: Ends - Correct answer-After an arousal or major body movement and/or a shift into LAMF in the EEG Stage REM: EEG - Correct answer-LAMF with Saw Tooth Theta waves. Sleep Spindles and K complexes are ABSENT. Saw Tooth Theta Waves - Correct answer-Trains of Sharply contoured or triangular waves at 2-6hz Stage REM: EMG - Correct answer-Muscle tone is at it lowest but Transient Muscle Activity may occur Transient Muscle Activity - Correct answer-Short Irregular burst of EMG acitivty <0.25seconds. may be associated with Eye Movements Stage REM: EOG - Correct answer-Irregular, sharply peaked movements lasting <500msec Stage REM: Begins - Correct answer-The epoch with Rapid Eye Movement and Low EMG amplitude often preceded by LAMF, Sawtooth Theta waves Stage REM: Onset - Correct answer-The First Epoch (and all others after it) with LAMF and WITHOUT K complexes/Sleep Spindles or an arousal that precede a Rapid Eye Movement with low EMG Amplitude. Infant Stage R: EEG - Correct answer-Low voltage irregular (LVI) or Mixed (M) infant Stage R: EOG - Correct answer-REMS or No eye movements (only after Definite REM) Infant Stage R: EMG - Correct answer-low, Transient Muscle activity(TMA) may occur Infant EEG Characteristics: Trace Alternate (TA) - Correct answer-At least 3 alternating runs of bilateral Symmetrical synchronous High voltage, 1-3hz delta activity that last 5- 6sec, ALTERNATING WITH lower amplitude 4-7hz theta activity lasting 4-12 secs Infant EEG Characteristics: Low Voltage irregular (LVI) - Correct answer- Continuous LAMF WITH Delta and Predominately Theta activity. Infant EEG Characteristics: High Voltage Slow (HVS) - Correct answer- Continuous Symmetrical High voltage 1-3hz delta activity Infant EEG Characteristics: Mixed (M) - Correct answer-Both high voltage and low voltage happening non-periodically, Lower voltage than HVS Infant EEG Characteristics: Sleep Spindles - Correct answer-12-14hz activity prominently in the central region, ONLY in Stage N sleep. Progesterone - Correct answer-Hormone that causes drowsiness especially in the first trimester of pregnancy Pregnancy effect on sleep - Correct answer-Total Sleep time decreases, Shortness of breath, Insomnia, Sleep apnea. Cardiac Output - Correct answer-The amount of blood that is pumped through the ventricles in one minute Stroke volume - Correct answer-Amount of blood EJECTED by the ventricle in one contraction Vascular resistance - Correct answer-The amount of resistance that must be overcome to push blood through the circulatory system Systemic circulation - Correct answer-The flow of Oxygenated blood away from the heart and Deoxygenated blood back to the heart. Systemic Vascular Resistance - Correct answer-The amount of resistance in systemic circulation Pulmonary Circulation - Correct answer-The flow of Deoxygenated blood away from the heart To the lungs and oxygenated blood back to the heart. Pulmonary vascular resistance - Correct answer-The amount of resistance in the pulmonary circulation Cardiac Index - Correct answer-A measure of Cardiac performance in relation to the size of the individual. measures in L/min/squared meter Excessive Fragmentary myoclonus - Correct answer-at least 5 twitching movements that occur every minute for 20 mins during NREM sleep Hypnagogic foot tremor - Correct answer-HFT: A minimum of 4 HFT burst are needed to make a train. frequency of the burst range from .3hz- 4.0hz Rhythmic movement disorder - Correct answer-Involuntary, repetitive movements that range between .5hz-2.0hz. 4 movements are required to mark a single cluster of movements. Periodic Leg Movements in Sleep: Single event - Correct answer-PLMS: Duration range from .5-10 seconds, increase of z8uv, the end begins when there is at least .5 seconds of EMG tone that is no more than 2uv higher than resting EMG amplitude. PLMS Series - Correct answer-at least 4 LM events are needed to become a series, LM events with in the SAME series can be 5-90 seconds apart. LM events on different legs that happen within 5seconds of each other count as a SINGLE movement PLMS and Arousals - Correct answer-Arousals and LMs that occur in a PLM series should be considered associated with each other if both happen simultaneously, overlap, or is there is <.5secs between the two events. Temporal Lobe Epilepsy - Correct answer-Seizures that occur primarily in the temporal lobe lennox-gestaut syndrome - Correct answer-non specific Severe Seizures during childhood usually in PTs younger than 8years old, Mental Retardation, slow (less than 2.5hz) spike wave like pattern on the EEG Landau-kleffner - Correct answer-Deterioration of the language part of the brain. contains multifocal spikes and spike wave discharges. Generalized Anxiety Disorder - Correct answer-Increase in Stage 1 Non- REM sleep. Difficulty falling asleep, decreased REM sleep Hypothalamus - Correct answer-Responsible for production of hormones that regulate sleep, hunger, thirst, sex drive, and release of other hormones. Creates homeostasis and controls autonomic functions hypocampus - Correct answer-center for memory, emotion, and autonomic nervous system Mamillary bodies - Correct answer-Important in Recollective memory Posterior pituitary gland - Correct answer-produces antidiuretic hormone that promps kidneys to absorb more water from the blood Hypsarrhythmia - Correct answer-In the Periods between seizures, EEG shows Irregular and disorganized activity in the EEG. no distinguishable pattern, often seen in Infantile Spams Hematocrit - Correct answer-Measure of the percentage of red blood cells in 100ml of blood Alcohol Intoxication - Correct answer-- While intoxicated Decrease sleep latency, PT has increase N3 and reduced REM. - After being intoxicated Reduced N3 and Increased REM Alcohol Withdrawal - Correct answer-Insomnia, Disturbed sleep, ^REM, vDelta Amphetamines Intoxication - Correct answer-Total sleep is reduced, Deep sleep Reduced, increase sleep latency, Increase EMG activity Amphetamines withdrawl - Correct answer-Increased TST, increase deep sleep, excessive daytime sleepiness (EDS) Cocaine Intoxication - Correct answer-PT May only sleep for short, disrupted periods Cocaine withdrawal - Correct answer-Sleep is prolonged Opioids: Acute Vs Chronic - Correct answer--Acute: Increase in sleepiness with reduced stage R - Chronic: increase tolerance = Insomnia, reduced TST Opioid Withdrawal - Correct answer-prolonged sleep sedative/hypnotic intoxication - Correct answer-Initial Increase in sleepiness, decrease of REM and increase sleep-spindle activities microvolts of signal produce a standard waveform that is 1cm high). Sensitivity Setting - Correct answer-Adjust the visual height of the wave without changing the Time constant or Voltage Filters - Correct answer-Used to Isolate Bandwidths and reduce outside interference. Low-Frequency Filters - Correct answer-Used to eliminate signals below the normal bandwidth High-Frequency filters - Correct answer-Used to eliminate signals above Normal bandwidth 60 Hz notch - Correct answer-Used to remove Signals in 50-60hz range without affecting other frequencies Band-pass filters - Correct answer-only record signals within a particular range Sample Rate: EEG - Correct answer-Desirable: 500 hz Minimal: 200 hz Sample Rate: EOG - Correct answer-Desirable: 500 hz Minimal: 200 hz Sample Rate: EMG - Correct answer-Desirable: 500 hz Minimal: 200 hz Sample Rate: ECG - Correct answer-Desirable: 500 hz Minimal: 200 hz Sample Rate: Airflow - Correct answer-Desirable: 100 hz Minimal: 25hz Sample Rate: Oximetry - Correct answer-Desirable:25 hz minimal: 10hz Sample Rate: Nasal Pressure, EtCO2, PAP - Correct answer-Desirable: 100 hz Minimal: 25 hz Sample Rate: Body position - Correct answer-1hz Sample Rate: Snore sounds - Correct answer-D: 500hz M:200hz Sample Rate: Chest/abdominal movements - Correct answer-D: 100 hz M: 25 hz EEG Filters - Correct answer-L: 0.3 hz H: 35 hz EOG Filters - Correct answer-L: 0.3 hz H: 35 hz EMG Filters - Correct answer-L: 10hz H: 100hz ECG Filters - Correct answer-L: 0.3hz H: 70hz Flow and Respiratory effort Filters - Correct answer-L: 0.1hz H: 15hz snore Filters - Correct answer-L: 10hz H: 100hz Respiratory Event Duration - Correct answer-measure from the lowest point before the first wave of an event to the beginning of the first wave of normal breath. Devices to measure Apnea Duration - Correct answer-Oralnasal thermal sensor or PAP device Flow signal Devices used to measure Hypopnea Duration - Correct answer-Nasal Pressure or PAP device Flow Adult Apnea: General parameters - Correct answer-z90% decrease in baseline wave size for z10sec SpO2 Desaturation is not necessary Adult Apnea: Obstructive - Correct answer-Meets criteria for Apnea and is associated with continued inspiratory effort during event Adult Apnea: Central - Correct answer-Meets criteria for Apnea and is associated with ABSENT inspiratory effort Adult Apnea: Mixed - Correct answer-Meets criteria for apnea and is associated with absent inspiratory effort followed by resumption of effort. Adult Hypopnea: General parameters - Correct answer-z30% decrease is wave size lasting z10sec with z3% or z4% desaturation or if the event is associated with an arousal (note wether you are using 3% or 4%) Adult Hypopnea: Obstructive - Correct answer-If Criteria for Hypopnea is met and ANY of the following occur: snoring during the event flattening of the flow signal paradoxical movement in the thoracoabdminal channels during the event Adult Hypopnea: Central - Correct answer-Criteria for hypopnea is met and NONE of the Obstructive criteria are present.. Adult Respiratory Effort-Related Arousal (RERA) - Correct answer-Must result in an arousal and is characterized by increased respiratory effort or flattening of inspiratory portion of nasal pressure or pap flow. DOES NOT meet criteria for Apnea or Hypopnea. Adult HYPOventilation - Correct answer-Increase in arterial PCO2 to a value of >55mmHg for z10mins OR MWT - Correct answer-Maintenance of wakefulness test; Measures PT's ability to stay awake MWT Procedure: Trials - Correct answer-MWT consists of 4 trials lasting 40 mins each with 2 hour intervals MWT Procedure: Begins - Correct answer-1.5 to 3 hrs after PT's normal wakeup time MWT Procedure: Before each trial - Correct answer-- PT uses bathroom if needed - Biocalibrations - PT is seated up right facing away from a dim light source MWT Procedure: During and End of trial - Correct answer-- PT must stay awake for 40mins - If patient falls asleep, Wake PT and end trial *IF z3 Epochs of N1 or 1 epoch of any other sleep stage occur MWT Diagnosis - Correct answer-Sleep Latency less than 8mins is considered abnormal plethysmograph - Correct answer-A device use to measure changes in volume within an organ or the whole body PAP compliance data - Correct answer-Data that is transmitted by the PAP device to the doctor or insurance companies so that PAP use can be tracked. Chronotherapy - Correct answer-Treatment of an illness or a disease that takes into account the body's natural rhythm and cycles. Insufflation - Correct answer-act of blowing somthing (gas, powder, vapor) into the body paradoxical insomina - Correct answer-Sleep State Misperception, PT is getting more sleep than they think. pulmonary hypertention - Correct answer-Increase pressure for oxygenated blood leaving the lungs towards the heart and into the body. epileptiform discharge - Correct answer-An uncommon EEG pattern that is distinguishable from background EEG and is periodic/almost periodic and associated with PT's with epilepsy Normal Sleep Latency/Efficiency - Correct answer-<30mins , 80% efficiency Normal REM Latency - Correct answer-60-120 mins Holter Monitor - Correct answer-A portable device that continuously monitors the heart Gain vs Sensitivity - Correct answer-Increasing Gain is when amplitude is added to the input signal from a power source thus creating a higher output signal from an amplifier. Sensitivity Increases the pen deflection without changed the input/output signal or the time constant (visual size of the wave) Pickwickian syndrome - Correct answer-A.K.A. Obesity Hypoventilation Syndrome, PT is unable to breath rapidly enough or deep enough resulting in low oxygen and high CO2. Stridor - Correct answer-A harsh Vibrating noise during breathing due to obstruction in the windpipe or lungs Oral Appliance for OSA - Correct answer-Designed to relieve upper airway obstruction Oral Appliance: appropriate candidates - Correct answer-- Mild to moderate OSA - Treatment beyond behavior modification (weightloss, abstinence from alcohol, etc.) - PT's the prefer an oral appliance rather than a PAP device - Non-adherence with PAP therapy or non-responsivness to therepay Oral appliance Advantage - Correct answer-Easier to use, more portable, quiet, require no power source Oral Appliance Contraindication - Correct answer--If PT requires rapid initiation of treatment for severe symptomatic OSA, Active Cardiovascular comorbidities. - PT with prolonged low SaO2 - PT with Dental conditions that would prevent appliance retention in the mouth. Types of Oral Appliances - Correct answer-- Mandibular Advancement splints - Tongue retaining device Mandibular Advancement Splints - Correct answer-Most common oral appliance, Enlarge airway by re positioning anatomical features. Tongue Retaining device - Correct answer-uses suction to move tongue to enlarge air way. Esophageal pH Monitoring - Correct answer-Used on PTs with symptoms suggestive of GERD. Complex Sleep Apnea - Correct answer-During a CPAP titration if Increasing the pressure eliminates Obstructive apnea but Central apneas begin to apear.