Sleep Disorders and Polysomnography: A Comprehensive Guide, Exams of Nursing

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RPSGT EXAM LATEST 2023-2024 WITH 200+ QUESTIONS AND CORRECT ANSWERS| AGRADE what is the minimum number of diagnostic and therapeutic in a split study? - ANSWER- 2 diagnostic 3 therapeutic what is the most stable stage of sleep respiratory wise? - ANSWER- N3 (NREM is more stable and REM is irregular) What does common mode rejection do? - ANSWER- It is a process that takes input signals and eliminates identical voltages from two different sources (records dissimilar voltages) (higher the CMMR, the more efficient the amplifier) what should the low pass filter for an EEG be if seizures are expected? - ANSWER- 70 Hz (usually 35 Hz) What happens to a waveform is sensitivity is increased? - ANSWER- The vertical size of the wave decreases what is the difference in gain and sensitivity? - ANSWER- Increasing gain increases amplitude and increasing sensitivity decreases the amplitude What is the shortest sleep latency for a MSLT nap? - ANSWER- 15 minutes (longest its 35 minutes) What is HST? - ANSWER- Home sleep test How do you clean ECG electrodes? - ANSWER- Wipe with cleaning agent that is non-corrosive to plastic, air dry, gas sterilization as needed What are the NREM parasomnias? - ANSWER- Confusional arousals, sleepwalking, sleep terror, SRED What are the REM parasomnias? - ANSWER- Nightmares, RBD, sleep paralysis How long does a "short sleeper" sleep? - ANSWER- <6 hours (long: >10) What stage of sleep is CSA more common? - ANSWER- NREM What are SOREMPS? - ANSWER- Occurrence of REM sleep within 15 minutes of sleep onset (<2 = hypersomnia, >2 narcolepsy) What type of narcolepsy is cataplexy present? - ANSWER- Type 1 When is narcolepsy onset age usually? - ANSWER- 10-20 What is the effect of light therapy on circadian rhythms? - ANSWER- Light therapy in the morning, after core body temperature minimum, advances the circadian rhythm (go to bed early, wake up early) What gender does SRED happen in more? - ANSWER- Females What gender does RBD happen more in? - ANSWER- Males (>50) When do disorders of arousal usually disappear? - ANSWER- onset puberty What is another name for "hypnic jerk"? - ANSWER- Sleep start If your patient doesn't have teeth, what mask interface is best for them? - ANSWER- Nasal pillows (Nasal and oral mask require structural teeth support in placement) What is indicated to increase NPPV pressure support by 1-2? - ANSWER- Every 5 minutes of TV is low (6-8ml/kg) Every 5 minutes is O2 sat <90% for z5 minutes and total volume is low Every 10 minutes of Paco remains z10mmHg above goal of sleep PCO2 _< awake PCO2 Every 10 minutes if respiratory muscle rest has not been achieved In BIPAP therapy, time taken to go from EPAP to IPAP is? - ANSWER- Rise Time What can BIPAP VAPS mode NOT treat? - ANSWER- Cheyne-Stokes Breathing What waveforms increase because of benzodiazepines and barbiturates? - ANSWER- Spindles What waves are recorded in the frontal scalp? - ANSWER- Delta and K- Complexe s What waves are recorded in the central scalp? - ANSWER- spindles, vertex, sawtooth waves How does LFF affect time constant? - ANSWER- The lowest LFF with have the highest time constant (inverse relationship) What does aliasing do? - ANSWER- Distorts the signal if the sampling rate is too high (will show incorrect frequency and shape) What is the difference between AC and DC? - ANSWER- AC has both LFF and HFF, DC does not have a LFF When does a child enter sleep via NREM? - ANSWER- 3 months old What does aging do to the circadian phase? - ANSWER- advances it What order do peripheral chemistries decrease in response by sleep stage? - ANSWER- N3, N2, R how does peripheral arterial tonometry (PAT) estimate AHI? - ANSWER- Using sleep time from actigraphy what is the max sampling rate of a CPOX during a level 1 or 3 study? - ANSWER- _<3 sec of heart rate if 80bpm What type of study can ETCO2 only be used in? - ANSWER- Diagnostic What can be best recorded by an oronasal thermal sensor? - ANSWER- Apnea What is fall time constant? - ANSWER- The time it takes for a wave to decay to 37% of max amplitude What is rise time constant? - ANSWER- The time it takes for a wave to rise to 63% of its max amplitude Short time constant should be used to Monitor what channel? - ANSWER- EMG Why is a LFF considered a high pass filter? - ANSWER- because it always high frequencies to pass through a patients oximeter reading during patient calibration is 88%. which of the following would be the appropriate response? - answer- place the probe on the patients earlobe a patient with ondines curse would be expected to have which type of respiratory impairment in sleep - answer- central sleep apnea according to the aasm, intercostal emg activity is an acceptable alternative sesor for recording what parmeter - answer- detection of respiratory effort slow rolling eye movements occuring during stage n1 sleep will best be seen at low filter setting of - answer- 0.3hz a 1.0 hz eeg wave is measured at 15mm peak to peak. the sensitivity is 5uv/mm. the voltage of the wave is - answer- 75uv a cheyne stokes breathing pattern is often seen in patients with - answer- congestive heart failure capnography measures - answer- expired co2 which of the following high frequency filter settings is recommended for recording submental emg - answer- 100hz endoesophageal pressure measurements would be most helpful in evalutating which sleep disorders - answer- sleep related breathing disorders a patient being evaluated for obstructive sleep disordered breathing has atrial fibrillation. what should the tech do - answer- continue to observe and document rhythm which of the following is the most dangerous cardiac rhythm - answer- ventricular fibrillation how would you compute sleep efficiency - answer- total sleep time divided by time in bed x 100 how do you calculate apnea + hypopnea index - answer- # apneas and hypopneas an artifact appears only on channel 3. which electrode is causing the artifact - answer- e2 an artifact seen in only one of the eeg channels is probably due to a problem with the - answer- eeg electrode according to aasm, which of the following is the recommended definition of a hypopnea - answer- decrease of the nasal pressure signal by at least 30% for at least 10 seconds and at least a 4% desaturation a(an)____________ uses selective absorption of light through vascularized tissue to measure ___________________ - answer- pulse oximeter, oxygen saturation a patient scheduled for a psg to rule out parasomnia has a benzodiazepine on their list of medications. what should you expect to see on the psg - answer- decreased stage n3 a benzo is a hypnotic, decreasing sleep latency and % stage n1 impedance is a measure of - answer- resistancer you are preparing a patient for psg who presents with a history of copd. as a tech, you should - answer- be alerted to the possibility of low nocturnal oxygen levels and co2 tetention what type of light is used in a pulse oximeter - answer- infrared and red a patient is scheduled for a psg with tricyclic anti depressant medication on her list of medications. what should you expect to see on her psg - answer- increased rem latency tricyclix antidepressants generally are stage r suppressing ofter increasing rem latency. withdrawal of the medication may lead to an initial rebound of stage r and a shortening of the rem latency a high pass filter is also known as - answer- low frequency filter according to the 10-20 international system of electrode placement, o1 and o2 are located - answer- 5% on either side of oz an arousal in stage r sleep should be scored if - answer- there is a >3 second burst of alhp in the occipital channel and there is a concurrent increase in the chin emg lasting at least 1 second hypercapnia is - answer- elevated carbon dioxide levels in the blood a thermocouple - answer- is susceptible to artifact caused by cpap flow at least three consecutive cycles of cyclical crescendo and decrescendo change in breathing amplitude with an index of 5 or more central apenas or hypopneas or a duration of at least 10 consecutive minutes is the aasm recommended rule for - answer- cheyne stoke's breathing hypoxemia is - answer- decreased oxygenation in the blood if a patient with suspected advanced sleep phase syndrome is studied in the sleep lab at conventional hours (recording time from 10 to 11 p.m. to 6 to 7 a.m) what would you expect to see - answer- prolonged wakefulness at the end of the recording sleep efficiency is defined as - answer- the ratio of all sleep stages to trt rem sleep is associated with which of the following psychologic activity - answer- variable heart rate, irregular respiration, and decrease in tonic muscle activity according to a aasm how many seconds of stable sleep must proceed each arousal - answer- 10 seconds according to the aasm. what is the minimum period of time between limb movements and a plm series - answer- 5 seconds which of the following patients would be most likelyto have a history of cataplexy - answer- a patient with narcolepsy 2-5 % of tst, in a normal young adult, is characteristic of which sleep stage - answer- n1 a plm episode is classified as - answer- at least 4 limb movements lasting 0.5-10 seconds separated by 5-90 seconds according to aasm, what is the minimum recommended digital resolution - answer- 12 bits per sample according to aasm, what is the minimum recommended sampling rate for eeg - answer- 500 hz according to aasm, what is the definition of stage r latency - answer- sleep onset to the first epoch of stage r which of the following epworth sleepiness scale scores would be considered abnormal - answer- 18 according to aasm, what is the frequency range of slow wave activity - answer- 0.5-2 hz a patient is scheduled for a psg & in reviewing his history, you see that he had a previous psg that indicated "rem-related apnea. when would expect to see the highest concentration of respiratory events on his study - answer- during the last third of the study in bi-level positive airway pressure, what is the purpose of the pressure drop during exhalation - answer- increased comfort for patients who have trouble exhaling against an incoming pressure a person with delayed sleep phase syndrome is most likely to be - answer- an adolescent central sleep apnea is demonstrated by which of the following - answer- simultaneous cessation of airflow and respiratory effort with a signal deflection of 10mm and an input voltage of 50uv, what would the sensitivity setting be - answer- 5uv What is the "gateway" structure between the body and the cerebral cortex? - ANSWER- Thalamus Which neurochemical increases in REM sleep as well as wake? - ANSWER- Ach Sleep spindles result from the blocking of information between the____________ and the cortex and result from deactivation of the _________. - ANSWER- thalamus, RAS Bright light therapy affects which anatomic structure? - ANSWER- SCN A tonic-clonic seizure represents the mass firing or synchronization of large groups of neurons. Which sleep stage would you LEAST expect to see seizure activity? - ANSWER- REM Pontogeniculate (PGO) waves are an indicator of which sleep stage? - ANSWER- REM The EEG observed in wake and REM are both characterized by what? - ANSWER- Asynchronous EEG, low voltage, and mixed frequency What general term is used to describe cues which synchronize our internal clock to the external environment? - ANSWER- Zeitgebers Which come under the influence of circadian rhythm control? - ANSWER- Body temperature, hormone levels, and K+ levels Destruction of the major endogenous circadian oscillator leads to: - ANSWER- Arrhythmicity The technician observes muscle artifact in a single EEG channel that shares a common reference with other channels. What is the appropriate response? - ANSWER- Re-reference the channel showing artifact by changing the input signal derivation to a back-up exploring electrode The preferred method of correcting undesirable artifacts during the recording process is to: - ANSWER- Change the input signal derivations If 60Hz artifact is observed in one of the channels during the bio-calibration process, the appropriate action should be: - ANSWER- Find the problem source and correct it before beginning the study What factors come into play when deciding to enter the patient's room to correct artifacts? - ANSWER- Importance of electrode channel in scoring, ease at which patient falls asleep, and skill at fixing problem without waking patient Double-referencing (A1+A2) may be useful for? - ANSWER- Reduce EKG artifact in EEG and EOG channels The chief way of excluding undesirable interfacing signals in polysomnograph is accomplished by: - ANSWER- Passing input signal through differential amplifiers Which conditions are most likely to cause electrode-popping artifact? - ANSWER- Pressure against the electrode and poor ground connection Which type of artifact presents as a high frequency artifact? - ANSWER- Muscle If the size of the prepared electrode site is too large, what can occur? - ANSWER- Signal contamination or bridging What is not considered a physiologic artifact? - ANSWER- Popping Which types of artifacts are physiological? - ANSWER- Muscle, respiratory, and cardio ballistic What is one of the contributing causes of EKG artifact in the arm or leg leads? - ANSWER- Voltage differences resulting from increased electrode distances What is the first step in differentiating high frequency artifact caused from muscle vs. a poor electrode connection? - ANSWER- Impedance check What is true regarding the scoring of an epoch containing major body movement? - ANSWER- Alpha coming into the movement constitutes scoring epoch as wake, and N2 coming into movement with no alpha/slow rolling eye movements constitutes scoring the movement epoch as N2 According to the AASM Scoring criteria, what is associated with stage N1 sleep? - ANSWER- Slow rolling eye movements and relatively low-voltage mixed frequency EEG activity What best describes sharp vertex waves (K complex)? - ANSWER- More prominent in later portion of N1 and most prominent in the centrals Which best describes the end of a REM sleep episode? - ANSWER- Sustained increase in the submittal EMG A K complex is observed at the end of epoch 60. Low voltage mixed frequency EEG with increased EMG is observed up through epoch 64. Another k complex is observed at the start of epoch 65. How would you score epoch 61-64? - ANSWER- N2 According to AASM Scoring criteria what is true in regards to scoring wake for epochs with major body movements? - ANSWER- Alpha is present leading into major body movements Which EEG signal will be attenuated the MOST with a high filter setting of 15 Hz? - ANSWER- Beta The technician observes continuous 1-2 Hz brainwave measuring 17mm peak to peak between the 10th and 28th second of the epoch. The sensitivity is set at 5 uv/mm. What would this epoch be scored as? - ANSWER- N3 What features are common to stage N1 and REM? - ANSWER- Low voltage EEG and Asynchronous EEG Describe a K complex - ANSWER- Biphasic, with a minimum of 0.5 second duratio