Guide to Polysomnography: Understanding Filters, Waveforms, and Sleep Stages, Exams of Nursing

Download Guide to Polysomnography: Understanding Filters, Waveforms, and Sleep Stages and more Exams Nursing in PDF only on Docsity! 1 1 RPSGT Exam Questions and Answers 2024 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 2 2 ability to What is an MWT's MOST important use? - Correct answer-Measure patients 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 5 5 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 6 6 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 7 OVERALL AHI 8 OVERALL REM AHI 38 SUPINE REM AHI 28 SUPINE NREM AHI 21 LATERAL NREM AHI 1 LATERAL REM 3 - Correct answer-POSITION THERAPY THE BEST METHOD FOR DETECTING APNEAS AND HYPOPNEAS DURING PAP TITRATION IS TO USE A/AN - Correct answer-AIRFLOW SIGNAL GENERATED BY THE PAP DELIVERY DEVICE THE PRIMARY BENEFIT OF HEATED HUMIDIFICATION IS TO - Correct answer- HELP REDUCE NASAL CONGESTION A SIDE EFFECT OF CPAP IS - Correct answer-AEROPHAGIA THE MOST COMMON REASON FOR CHANGING THE PAP INTERFACE DURING A TITRATION IS - Correct answer-UNACCEPTABLE LEAK VALUE WHAT IS THE RECOMMENDED STARTING PRESSURE FOR PEDIATRIC AND ADULT CPAP TITRATION - Correct answer-4 CMH2O THE PURPOSE OF INTENTIONAL LEAK IS TO - Correct 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 - Correct answer-FOLLOW PROTOCOL FOR SUPPLEMENTAL OXYGEN ACCORDING TO RECOMMENDED GUIDELINES, ADAPTIVE SERVO VENTILATION CAN BE CONSIDERED DURING A TITRATION STUDY WHEN A DOWN TITRATION - Correct 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 - Correct 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 - Correct answer-CHANGE TO BI LEVEL 7 10 10 - Correct 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? - 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 11 11 Stanford Sleepiness Scale - Correct answer-brief assessment used a number of different times a day to determine if people have excessive daytime sleepiness (EDS). Epworth Sleepiness Scale - Correct 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) - Correct 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 - Correct 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) - Correct 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. - Correct answer-5 No smoking is allowed within minutes of starting MSLT nap and no strenuous activity within minutes of a nap. - Correct answer-30;15 Maintenance of Wakefulness Test - Correct 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. - Correct answer-4 Tracheostomy - Correct 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? - Correct answer-greater than or equal to 500 Hz for EOG and greater than or equal to 200 Hz for EMG recording. 12 Initiate Low-Flow Supplemental Oxygen at how many liters per minute when below 85% on ambient room air. - Correct answer-1 liter per minute Monitor SpO2 carefully to ensure it increases to at least % - Correct 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. - Correct 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. - Correct 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. - Correct 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. - Correct answer-1 Ensure that the patient is in what body position during titration for part of the titration period? - Correct answer-supine Respiratory Effort Related Arousal (RERA) - Correct 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. - Correct answer-10 Hypoventilation - Correct 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. - Correct answer- 10 Bruxism - Correct answer-teeth grinding Stages of sleep should be reported in minutes, minutes of latencies, and percentage of - Correct answer-TST 12 SpO2 falls 15 15 Obstructive - Correct answer-Inspiratory effort continues or increases throughout the apneic period. Central - Correct answer-Inspiratory effort is absent during apneic period. Mixed - Correct answer-Inspiratory effort is absent for the initial apneic period but resumes during the second half of the apneic period. Example of Mixed Apnea - Correct answer- How many stages does the normal conduction of the heart have? - Correct answer-4 SA Node - Correct answer-primary pacemaker Purkinje Fibers - Correct answer-stimulate the myocardial cells to contract the ventricles Pediatric Sleep scoring rules apply to children _ months post term or older. - Correct answer-2 Sleep Spindles occur at _-_ months or older - Correct answer-2-3 K complexes and slow-wave activity occur at _-_ months or older - Correct answer-4-6 Stages 1, 2, and 3 can be scored in most infants at _-_ months or older. - Correct answer-5-6 REM Sleep - Correct 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? - Correct answer-REM Non-REM and REM cycles occur about every _._-_hours. - Correct answer-1.5-2 What sleep stage are sawtooth theta waves most likely to be present? - Correct answer- REM How many seconds of chin activity in REM for it to be scored as an arousal? - Correct answer-1 Excessive Fragmentary Myoclonus (EFM) - Correct 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. - Correct answer-20 16 . - 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). True or False? Duration of sleep is not important for the MWT - Correct answer-True If there is no reactive alpha waves or age-appropriate DPR, score wake with 16 Pediatric Scoring of Wake uses the rather than the term 'alpha rhythm.' - Correct answer-Dominant Posterior Rhythm (DPR) 17 17 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- 20 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 20 21 21 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 22 22 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 Sleep Efficiency - Correct answer-Ratio of TST to total time in bed 25 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 The appearance of the waveform is --------------------------------- Correct answer-affected by 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 25 26 26 both A Psg may help to differentiate between OSA and Epilepsy, which can result in similar symptoms of choking and EDS. -Some cases may have 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 in patients. -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- 27 occurs when there is an imbalance between the heart's demand for oxygen and the supply. - Correct answer-Myocardial Infarction (MI) 27 Cortisol - Correct 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? - Correct 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. - Correct 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. - Correct answer-3 patient's with may have to sleep sitting upright in chair - Correct answer-COPD Emergency action may be needed if an infant has apneic periods for over seconds. - Correct 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. - Correct answer-pH Sensor What is a co-morbid condition? - Correct 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. - Correct answer-16.5 The 2-4 month old infant sleeps about hours per day - Correct answer-15 The 4-6 month old child sleeps about - hours a night with 2-3 daytime naps with TST of 14.25 hours. - Correct answer-10-11 may relieve symptoms of an Acute Asthma Attack, as patients may become hypoxic. - Correct answer-Bronchodilators With Chronic , permanent damage to the airways may cause decreased oxygen saturation during sleep and disordered sleep. - Correct answer-Asthma If nocturnal is severe, the patient may require supplemental Oxygen (1-2 l/min.) - Correct answer-Hypoxia 30 Patients with SAD who take mood stabilizers shuld be monitored carefully befpre light therapy because it may trigger manic episodes. - Correct answer-Bipolar 30 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 31 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 31 32 32 Pierre Robin Syndrome - Correct 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 . - Correct answer-Compliance Begin CPAP titration at the lowest setting, usally _ cm H2O - Correct answer-5 Increase PAP pressure _ cm H2O at time set intervals, usually about every 15 minutes and observe effects, - Correct answer-1 Titration is done in the second half of the night during a split-night test (at least _ hours). - Correct 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. - Correct answer-90 Upper Airway Resisitance Syndrome (UARS) - Correct 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) - Correct 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) - Correct 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 - Correct answer-Round Nasal Masks are not effective for. ..? - Correct answer-mouth breathers and those without teeth Orofacial Masks - Correct 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? - Correct answer-Oral Masks Air Hunger - Correct answer-when some patients feel short of breathe while using positive airway pressure 35 35 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 36 36 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 37 An optimal pressure should have an RDI of? - Correct answer-<5 A good pressure should have an RDI of? - Correct answer-<10 An adequate pressure should reduce baseline RDI by what %? - Correct answer-75% The duration of a titration should be > how many hours? - Correct 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? - Correct 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? - Correct answer-ASV What PAP type has been shown to decrease respiratory events and improve objective sleep measures in patients with central sleep apnea/Cheyne-Stokes respiration,mixed sleep apnea, and complex sleep apnea? - Correct answer-ASV Scoring pediatric periodic breathing - Correct answer-3+ episodes of central apnea, persisting for 3 sec. or more with 20 sec. or less of normal breathing between events Scoring pediatric hypoventilation - Correct answer-> 25% of tst is spent with PCO2 > 50mmHg What is a RERA? - Correct answer-Occurs when the airway narrows during sleep, usually indicated by snoring. What is the Criteria for scoring a RERA? - Correct answer-The sequence of respirations indicates increased respiratory effort or flattening of nasal pressure waveforms with a duration of 10 sec. or more, leading to an arousal from sleep. How do you score hypoventilation? - Correct answer-Based on PCO2 scores on awakening and not on persistent desaturation. PCO2 level increases 10mmHg or more or an increase to > 55mmHg for > 10 mins. immediately after awakening What is the criteria for scoring a RERA for pediatrics with nasal pressure? - Correct answer-1: a decrease in amplitude from baseline. 2: nasal pressure waveforms flatten. 3: there is evidence of snoring, nosing respirations, increased PCO2, or observable increased respiratory effort. 4: duration is 2 or more respirations 37 40 40 2) Burst of muscle activity. Usually lasting 0.1-0.5 sec. with amplitude increased over baseline. What is the criteria for scoring Bruxism? - Correct answer-Increased of cEMG activity at least two times regular amplitude. 1) Phasic (brief): sequence of at least 3 with duration for each 0.25 - 2 sec. 2) Tonic (Sustained) duration of 2 sec. or more How many stages does a normal heart conduction have? - Correct answer-4 What sleep disorder is caused by amphetamine intoxication? - Correct answer-Insomnia Total sleep reduced with increased sleep latency and sleep disturbance. EMG shows increased muscle activity. Stage REM sleep and N3 decreased are a side effects to what type of drug intoxication? - Correct answer-Amphetamines What sleep disorder is caused by Amphetamine withdrawal? - Correct answer- Hypersomnia Prolonged sleeping during the . REM and N3 increased. MSLT shows increased sleepiness during day as well. These are all side effects to withdrawal from which type of drug? - Correct answer-Amphetamines What sleep disorder is caused by caffeine use? - Correct answer-Insomnia Increased wakefulness and decreased sleep are does dependent. PSG shows increased sleep latency and wakefulness and decreased N3. These are side effects to the use of which drug type? - Correct answer-Caffeine What sleep disorder is caused by caffeine withdrawal? - Correct answer-Hypersomnia Increased sleeping and daytime sleepiness are common symptoms for withdrawal from which drug type? - Correct answer-Caffeine What sleep disorder is caused by alcohol intoxication? - Correct answer-Insomnia Acute intoxication: increased sleeping and decreased wakefulness for 3-4 hours with increased N3 and reduced REM sleep. Complete intoxication: decreased N3 increased wakefulness, and increased REM with restlessness and vivid dreams. these are symptoms of intoxication from which drug type? - Correct answer-Alcohol 41 41 What type of sleep disorder is caused by alcohol withdrawal? - Correct answer- Insomnia Distrubance of sleep with an increase in the amount of REM with vivid dreams. after withdrawal insomnia with light restless sleep may persist for a week to years with a N3 deficit. these are symptoms to withdrawal from what drug type? - Correct answer-Alcohol what type of sleep disorder is caused by sedative/hypnotic intoxication? - Correct answer-Hypersomnia Increased sleepiness, decreased wakefulness, and a decrease in REM, with increased sleep spindles are all symptoms for drug intoxication for which drug? - Correct answer- Sedative/ hypnotic What sleep disorder is caused by sedative/ hypnotic withdrawal? - Correct answer-both insomnia and hypersomnia insomnia with a decreased sleep duration and increased sleep disruption, REM rebound as well as anxiety, tremors, and ataxia are all symptoms for withdrawal for which type of drug? - Correct answer-Sedative/hypnotic What sleep disorder is caused by Cocaine intoxication? - Correct answer-Insomnia Sleep is severely compromised, and the Pt. may sleep only for disrupted periods. These are symptoms for intoxication of which drug type? - Correct answer-Cocaine What sleep disorder is caused by Cocaine withdrawal? - Correct answer-Hypersomnia Sleep being very prolonged is a symptom for withdrawal from what type of drug? - Correct answer-Cocaine What sleep disorder is caused by opioid use? - Correct answer-Insomnia Acute use: increased sleepiness, with reduced REM sleep. Chronic use: insomnia with increased wakefulness and decreased sleep time. These are symptoms for use of what drug type? - Correct answer-Opioid What type of sleep disorder is caused by Opioid withdrawal? - Correct answer- Hypersomnia Prolonged sleep is the symptom for the withdrawal of which drug? - Correct answer- Opioid 42 42 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: 45 45 System referencing - Correct answer-The ability to remontage while recording on digital equipment is the result of: Sampling Rate - Correct answer-The amount of space needed to archive digitized data is MOST impacted by: Mild OSA - Correct answer-The BEST candidate for oral appliance therapy would have: Airflow signal generated by the PAP delivery device - Correct answer-The BEST method for detecting apneas and hypopneas during PAP titration is to use a/an: Montage - Correct answer-The electrode array used for recording physiologic activity is referred to as: C3 - Correct answer-The electrode located 30% above the left pre-auricular crease is: Minimize aliasing effect - Correct answer-The importance of selecting sampling rates according to RECOMMENDED guidelines is to: Initate emeregency response system - Correct answer-The MOST appropriate action a technologist would take when there is confirmed ventricular tachycardia lasting greater than 30 seconds is: Low filter - Correct answer-The MOST appropriate setting a technologist would use to control the frequency band of waveforms on a recording is the: Pulse Ox - Correct answer-The MOST COMMON method to monitor blood oxygen saturation during polysomgraphy is: Unacceptable leak value - Correct answer-The MOST common reason for changing the PAP interface during titration is: Measure the patient's ability to resist the urge to fall asleep - Correct answer-The most important reason for performing a MWT is to: REM Sleep Behavior Disorder - Correct answer-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: Help reduce nasal congestion - Correct answer-The PRIMARY benefit of heated humidification is to: Prevent uper airway occlusion - Correct answer-The PRIMARY function of EPAP is to: Wash out CO2 and prevent rebreathing - Correct answer-The purpose of intentional leak is to: 46 46 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 47 47 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" 50 50 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 51 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) 51 52 Oxygen saturation - Correct answer-Mean value and Minimum during sleep Types of breathing patterns - Correct answer-- Hypoventilation with or without CPAP - Cheyne-Stokes breathing (duration, or # of events) - Periodic breathing (children only) - Snoring Narcolepsy - Correct answer-Inability to maintain wakefulness/alertness during major waking episodes of the day, occurring daily for at least 3 months MSLT score of <5mins Parasomnia - Correct answer-Abnormal movements/behavior right before, during, after sleep, or during transition into or out of sleep. Hypersomnia - Correct answer-Increased sleepiness during the day and prolonged nocturnal sleep. PT will have intentional/non-intentional naps) MSLT score of 5-10 mins Hypnagogic Jerk - Correct answer-simple Parasomnia; Sudden, brief jerks of the whole body or on or more segments at sleep onset (sense of falling) Bruxism - Correct answer-simple Parasomnia; quick jerks or grinding movements in the muscles of mastication Periodic limb movements of sleep (PLMS) - Correct answer-simple Parasomnia; repetitive movements occurring ever 5-90 seconds primarily during N-REM sleep. Does not mean Person has RLS Disorders of arousals - Correct answer-N-REM complex Parasomnia; Sleepwalking, confusional arousal, sleep terrors mixture of NREM and wake states. Sleep Related Eating Disorder (SRED) - Correct answer-N-REM complex parasomnia; mixture of NREM and wake states, person will consume anything with partial or no memory of the event. Sleep Paralysis - Correct answer-REM complex Parasomnia; Persistance REM sleep- related atonia into wakefulness. Nightmare Disorder - Correct answer-REM complex Parasomnia; Distressing dreams that have an emotional carryover into wakefulness. can end abruptly with a sudden jerk or yell REM sleep behavior disorder (RBD) - Correct answer-REM complex Parasomnia; complex movements or behaviors during REM sleep when the PT should have complete atonia. 52 55 55 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. 56 56 Stage REM: Continues - Correct answer-All Epochs after REM onset that have LAMF and low EMG amplitude. Epochs without REM that are after an Epoch with REM are still stage R if no K complexes/Spindles are present. Stage REM: Ends - Correct answer-On the Epoch with: K complex Spindle increase in EMG Amplitude Delta waves SEM after an arousal or major body movement in the first half of the epoch. Stage REM: Major Body Movements with no Alpha - Correct answer-If a Major body movement occurs during stage R with out alpha waves in the EEG and is followed by LAMF and low EMG amplitude the epoch is still Stage R. Major Body Movemetns - Correct answer-Movement or Muscle artifact that obscures the EEG for more than half of an epoch (sleep stage cannot be determined) Scoring Epochs with Major Body Movements as awake - Correct answer-If alpha waves are present during or the Epoch directly before or after are scored as W Scoring Epochs with Major Body Movements as sleep - Correct answer-If the Epochs before and after are Stages of sleep and no Alpha is present during, Then the MBM is scored the same as the epoch after it. Age to apply Pediatric sleep staging - Correct answer-Children 2 months post-term or older Pediatric Stage N: - Correct answer-Any Epoch with no recognizable k complexes, spindles, or slow wave activity are scored as Stage NREM(N) Pediatric Stage W: EEG Eyes closed - Correct answer-Posterior Dominant Rhythm(PDR) is present in the occipital region (Frequency varies according to age) Pediatric Stage W: EOG - Correct answer-SEM, REM, Eye blinks, Reading movements Pediatric Stage N1: EEG - Correct answer-LAMF (mostly 4-7hz activity) Vertex sharp waves(V-waves) Pediatric Stage N1: EOG - Correct answer-SEM Pediatric Stage N1: Beginning in PT's WITH PDR - Correct answer-If PDR is slowed or replaced with LAMF 57 57 Pediatric Stage N1: Beginning in Pt's WITHOUT PDR - Correct answer-a. activity in the range of 4-7hz, slowing of background frequency by > or equal to 1-2hz b. SEM c. Vertex Sharp Waves d. Hypnagogic Hypersynchrony e. High amplitude, rhythmic 3-5hz activity Pediatric Stage N2 - Correct answer-Same as Adults Pediactric Stage N3 - Correct answer-Same as Adults Pediatric Stage REM - Correct answer-Same as Adults Infant Stage Transitional (Stage T) - Correct answer-When two or more Sleep stage characteristics contradict each other the epoch is scored as Stage T Infant Stage W: Bahavioral Characteristics - Correct answer-Calm or active, eyes open, scanning eye movements Infant Stage W: Respiration Characteristics - Correct answer-Irregular, rapid, shallow Infant Stage W: EEG Characteristics - Correct answer-Low voltage irregular(LVI), Mixed (M) Infant Stage W: EOG characteristics - Correct answer-Blinking, REM, Scanning movements, brief evey closures (longer than blink) Infant Stage W: EMG - Correct answer-Present, Movement artifacts Infant Stage N: Behavioral characteristics - Correct answer-Reduced movement (relative to wake), eyes closed, periodic sucking, occasional startle. Infant Stage N: Respiration - Correct answer-Regular Infant Stage N: EEG - Correct answer-Trace Alternate (TA), High Voltage Slow(HVS), Sleep spindles or Mixed (M) Infant Stage N: EOG - Correct answer-Eyes closed, no movements Infant Stage N: EMG - Correct answer-Present or Low (relative to wake) Infant Stage R: Behavioral - Correct answer-Eyes closed, small movements Infant Stage R: Respiratory - Correct answer-Irregular 60 60 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 61 61 Sedative/Hypnotic Chronic use and withdrawal - Correct answer-- chronic use: increase tolerance PT will have insomnia -Withdrawal: insomnia, REM rebound, anxiety, tremors and ataxia antiarrhythmics - Correct answer-Disruption of sleep, increase sleepiness Antihistamines - Correct answer-Increased daytime sleepiness and prolonged sleep. Beta Blockers - Correct answer-disruptive sleep, prevents melatonin secretion Bronchodilators - Correct answer-Disruption of sleep, twitching, cramping Corticosteroids - Correct answer-Decrease sleep time, daytime fatigue Diuretics - Correct answer-May lower potassium causing cramps, increase urinary output. Nicotine - Correct answer-Reduced sleep duration and vivid dreams Selective serotonin reuptake inhibitors (SSRIs) - Correct answer-EDS, and sleep disruption Thyroid hormone - Correct answer-Disrupts sleep, heart palpatations, tremors, nervousness History and Physical: Sleep Disorders - Correct answer-obstructive/central apnea, narcolepsy, circadian rhythm disorders, RLS, PLMS, parasomnia, insomnia History and physical: Respiratory Disorders - Correct answer-COPD, Cystic Fibrosis, restrictive lung disease, and asthma History and physical: Neuromuscular Disease - Correct answer-MS, ALS, myasthenia gravis, poliomyelitis, myotonic dystophy. History and physical: Spinal cord injury - Correct answer-Bilateral Diaphragmatic paralysis Morning/Evening Questionnaires - Correct answer-19 questions about time preferences. determines when PT is most awake Morning Questionnair - Correct answer-given after a PSG to determine if Varribles of the sleep lab effected sleep performance. Bed-partner Questionnair - Correct answer-Given to PT's Bed-Partner(roommate). Gives insight to PT's behavior while in sleep that PT may not be aware of. 62 62 Pre Sleep Questionnair - Correct answer-Helps determine if the previous 24hrs were normal for the PT prior to PSG. Technologist may ask additonal questions. Sleep diaries - Correct answer-Has two components: Evening- mood assesment, Medications taken, time of Lights out. Morning- Approximate sleep onset, #of arousals, 1-5 mood scale Stanford Sleepiness scale - Correct answer-Assessment for EDS, 1-7 sleepiness scale used to describe different parts of the day. 4-7 correlates with EDS Epworth Sleepiness Scale - Correct answer-Determines how likely PT will Fall asleep in a given scenario, 0-3 scale. Score of 9or< is high index for sleep. Sleep-Wake Activity Inventory - Correct answer-Nine Statements that the PT will score with 1-9 scale. (1-always present, 9 never present). score of <50 mean sleepiness Fatigue Severity Scale - Correct answer-9 descriptions relating to fatigue, PT will score on 1-7. above 35 suggest high Fatigue Berlin Questionnair - Correct answer-Determines risk of OSA or Progress after treament with PAP device. total of 14 questions in three categories: snoring, Fatigue, hypertension. High risk is positive in 2 or more category. Pittsburgh sleep quality index - Correct answer-19 questions which make up 7 sections that create a global score. This questionnaire help asses the PTs sleep quality after 1 month. STOP-BANG - Correct answer-Obstructive Sleep Apnea screening tool. 8 yes or no questions which every "yes" answer is 1 point. less than 3 is low risk for OSA Bioelectric Signal - Correct answer-Generated by the PT's Tissue and motion and recored by surface electrodes Transduced Signals - Correct answer-Generated by sensors that convert action into electrical signals. Standard Time Scale - Correct answer-1cm/sec Frequency - Correct answer-Waves/cycles per second Amplitude - Correct answer-Vertical height of the wave Determined by voltage Standard Voltage setting - Correct answer-50 microvolts/cm (50 microvolts of signal produce a standard waveform that is 1cm high). 65 z10mmHg increase during sleep compaired to awake lasting z10min Cheyne-Stokes Breathing - Correct answer-Episodes of z3 consecutive central apneas/hyponeas separated by a crescendo-decrescendo change in breathing amplitude lasting z40seconds AND z5 central apnea/hypopneas per hour of sleep recorded over z2hours Ages to use Pediatric Respiratory Scoring rules - Correct answer-Anyone younger than 18. Children z13yr may use adult rules Children Apena: General Parameters - Correct answer-Drop is signal size by z90% for at least the minimum duration specified by obstructive/central/mixed criteria Children Apnea: Obstructive - Correct answer-Meets Criteria for apnea and last the same duration as 2 breaths during baseline AND is associated with respiratory effort during absent airflow. Children Apnea: Central - Correct answer-Meets apnea criteria with absent Inspiratory effort AND one of the follow is present: -event last z20sec -even lasts duration of two normal breaths with z3% desat or and arousal -two breath duration with decrease is heart rate (50BMP for 5sec or 60BPM for 15sec) Children Apnea: Mixed - Correct answer-meets criteria for apnea for duration of 2 normal breaths and is associated with no effort and effort. Children Hypopnea: General parameters - Correct answer-Decrease is signal height by z30% for 2 breath duration with z3% desaturation or associated with an arousal Children Hypopnea: Obstructive - Correct answer-Criteria for hypopnea is met and is any of the following occur: -snoring during the event -inspiratory flattening on nasal pressure or papflow -thoracoabdominal paradox occurs during the event Children Hypopnea: Central - Correct answer-Hypopnea Criteria is met and NONE of the Obstructive hypopnea criteria is met. Children RERAs - Correct answer-When a sequence of breaths lasting z2 normal breath duration that result in an arousal and are characterized by one of the following: -snoring -increase respiratory effort -flattening of inspiratory part of the Pressure/PAP signal -increase in PCO2 above baseline 65 66 66 Children Hypoventilation - Correct answer-When >25% of TST contains a PCO2 of >50mmHg Children Periodic Breathing - Correct answer-z3 episodes of central pauses in respiration lasting >3sec that are separated by 20 or less seconds of normal breathing. MSLT - Correct answer-Multiple Sleep Latency Test: used to measure tendency to fall asleep. May diagnose Narcolepsy and Hypersomnia. MLST Montage - Correct answer-Required Optional: all other leads - EEG - EOG - ECG -cEMG MSLT Procedure: When to start - Correct answer-1.5 - 3hrs after a PSG MSLT Procedure: Naps - Correct answer-MSLT consists of 5 nap periods separated by breaks that are 2 hours long MSLT Procedure: PT preparation - Correct answer-- PT should keep a 2 week sleep diary - Stimulants or sleep altering medications should be discontinued 2 weeks prior - PT must put on casual clothes MSLT Procedure: Before each nap - Correct answer-- PT uses bathroom if needed - no smoking 30 mins before -no exercise 15 mins before - Biocalibrations MSLT Procedure: During the nap - Correct answer-- PT attempts to fall asleep with lights out while lying in bed - If no sleep is recorded Nap ends after 20 mins (SL is 20mins) - If PT sleeps study ends 15 mins after sleep onset MSLT Procedures: After each nap - Correct answer-- PT gets out of bed - Lights are on - Monitor PT to prevent sleeping during the break MSLT Procedure: Ends - Correct answer-After 5th nap is concluded May end after 4 naps if no REM is recorded in any NAP. MSLT Diagnosis - Correct answer-Sleep latency averaging 5mins or less means and had at least 2 Sleep Onset REM Periods, then the PT is Narcoleptic. 67 67 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