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AASM Sleep Exam 1 Questions and
Answers 2024/25 Update
1. Following the RECOMMENDED guidelines, which of the following would be an appropriate time to end an MWT? A) No sleep at 20 minutes of recording B) 20 minutes even if sleep occurs earlier C) A single epoch of N D) 3 consecutive epochs of stage N Answer: A) No sleep at 20 minutes of recording 2. Choose the matching definition: Generalized tonic-clonic seizures A) In the preauricular behind the ear B) Continuous positive airway pressure mask C) 3 consecutive epochs of stage N D) Generalized seizure activity with loss of consciousness and muscle contractions Answer: D) Generalized seizure activity with loss of consciousness and muscle contractions 3. Which of these electrode sites is not typically used in a baseline montage? A) Leg EMG B) E C) Arm EMG D) Thoracic belt Answer: B) E 4. Which impedance level is considered acceptable for EMG channels, such as limbs or chin? A) Greater than 15kΩ B) Less than or equal to 10kΩ C) Less than or equal to 5kΩ D) Less than or equal to 25kΩ Answer: B) Less than or equal to 10kΩ 5. During stage N2 sleep, the patient changes position and the tech notes increased snoring and an increasing leak. The tech should:
A) Increasing CPAP B) Reposition and adjust PAP interface C) Decrease pressure release ventilation D) Increase heated humidification Answer: B) Reposition and adjust PAP interface
6. The most common reason for changing the PAP interface during titration is: A) Sustained desaturations B) Low sleep efficiency C) Treatment emergent central apneas D) Unacceptable leak value Answer: D) Unacceptable leak value 7. Using the 10-20 placement system, the C4 lead is located what percentage of the circumference away from the C3 lead? A) 20% B) 30% C) 40% D) 50% Answer: B) 30% 8. The first step in artifact isolation is: A) Correcting the problem by changing channel derivations B) Changing recorder time base to count signal frequency C) Identifying the source of the data responsible for that artifact D) Determining if common signals exist in multiple channels Answer: C) Identifying the source of the data responsible for that artifact 9. Which of the following factors is most likely to cause 60Hz artifact? A) High and unequal electrode impedance B) Incorrect low and high-frequency filter settings C) Incorrect placement of the reference electrodes D) Direct pressure against one of the electrodes Answer: A) High and unequal electrode impedance 10. The tech performs physiologic calibrations in order to: A) Assess the function of the computer keyboard B) Assess the function of the electrical bed C) Verify electrode response commands
16. In normal sleep architecture, stage 2 sleep makes up: A) 5-10% of total sleep time B) 25-30% of total sleep time C) 40-50% of total sleep time D) 50-60% of total sleep time Answer: B) 25-30% of total sleep time 17. The syndrome characterized by prolonged episodes of severe hypoxemia and associated PaCO2 elevation that worsens during sleep is: A) Gastroesophageal reflux B) Pulmonary hypertension C) Obesity hypoventilation D) Upper airway resistance Answer: C) Obesity hypoventilation 18. The two inferior chin electrodes are placed on the: A) Submentalis B) Mental foramen C) Mastoid D) Orbicularis oris Answer: A) Submentalis 19. Twitching movements of the fingers, toes, and mouth that may occur during stage W, non-REM, and REM sleep are known as: A) Bruxism B) Excessive fragmentary myoclonus (EFM) C) REM sleep behavior disorder (RBD) D) Rhythmic movement disorder (RMD) Answer: B) Excessive fragmentary myoclonus (EFM) 20. What is the recommended start pressure for pediatric and adult CPAP titration? A) 3cmH2O B) 5cmH2O C) 4cmH2O D) 6cmH2O Answer: B) 5cmH2O
21. What is the normal range of oxygen saturation? A) 85-90% B) 91-94% C) 95-98% D) 99-100% Answer: C) 95-98% 22. Dopamine agonists, opioids, anticonvulsants, and benzodiazepines are therapeutic interventions for: A) Restless leg syndrome B) Obstructive sleep apnea C) Insomnia D) Circadian rhythm sleep disorder Answer: A) Restless leg syndrome 23. What is the RECOMMENDED number of observed hypopneas needed for a pediatric patient before increasing pressure during a titration? 1. 4 2. 3 3. 1 4. 2 Answer: 4. 2 24. Flow monitoring devices that may be used on patients during a sleep study include all of the following EXCEPT: A) Nasal/oral thermistor or thermocouple B) A pressure transducer airflow C) A transcutaneous carbon dioxide (CO2) monitor D) An end-tidal CO2 monitor Answer: D) An end-tidal CO2 monitor 25. ECG artifact in the EEG channels is BEST confirmed by comparing the: A) Affected EEG channel(s) with an unaffected channel B) Alignment of the QRS complex to the artifact C) Patient's pulse rate to that recorded on the EEG D) Abnormalities on the ECG recording with the artifact Answer: A) Affected EEG channel(s) with an unaffected channel
Answer: C) Respiratory effort present at the start of the event where the effort ceases in the second half of the event
31. What are antihistamines used for? What is an example medication of an antihistamine? A) Used to treat allergies B) Benadryl/Claritin/Allegra C) Follow protocol for supplemental oxygen D) Used to treat bipolar Tegretol/Lithium Answer: A) Used to treat allergies Answer: B) Benadryl/Claritin/Allegra 32. The ability of an amplifier to cancel external interference that is common to both input signals is called: A) High frequency filter B) Sampling rate C) System referencing D) Common mode rejection Answer: D) Common mode rejection 33. A patient's chart indicates that they use 3.0L/min of oxygen at home. The tech notes that the physician's orders for the PSG specify starting the study without supplemental oxygen and to add 1.0L/min oxygen if the SpO2 is less than 89%. The BEST action for the tech is to: 1. Leave the patient on 3.0L/min for the study 2. Start the study at 1.0L/min 3. Call the physician for confirmation 4. Follow the physician's orders Answer: 4. Follow the physician's orders 34. Which two channels on the PSG montage show the highest amplitude of slow-wave sleep? A) F3-A2 and F4-A B) O1-A1 and O2-A C) C3-A2 and C4-A D) Cz-O2 and Pz-Oz Answer: C) C3-A2 and C4-A 35. Which of the following is a process performed by a differential amplifier?
A) Recording the differences in the voltages of two inputs B) Recording the differences in the voltages of the active input and ground C) Recording the differences in the voltages of an exploring electrode and the patient ground connection D) Recording only identical voltages received by its two inputs Answer: A) Recording the differences in the voltages of two inputs
36. What effects do benzodiazepines have on sleep? Decreases: Slow-wave sleep (SWS), Wake after sleep onset (WASO), REM, N3, PLM, Arousals Increases: Sleep efficiency (SE), Total sleep time (TST), N1, N2, Sleep spindles, Restless leg, Sleep apnea, Daytime sleepiness Answer: Decreases: SL, WASO, REM, N3, PLM, Arousals Increases: SE, TST, N1, N2, Sleep spindles, Restless leg, Sleep apnea, Daytime sleepiness 37. The patient's medical history indicates the patient has been taking tricyclic antidepressants for the past 5 years. The tech should anticipate the patient may have an increased likelihood of: A) Complex partial seizures B) Central sleep apnea C) REM sleep behavior disorder D) Restless leg syndrome Answer: D) Restless leg syndrome 38. What is the total daily sleep requirement (including both nighttime and daytime naps) for a two-year-old infant? A) 9.5 hours B) 10.25 hours C) 11 hours D) 13 hours Answer: D) 13 hours 39. Which of the following is FALSE with regard to liquid oxygen? A) It is stored at -183 degrees C in special cryogenic containers B) It is maintained at 18 psi C) As tanks slowly warm, the oxygen evaporates D) Touching the fill valve can result in burns Answer: B) It is maintained at 18 psi
patients Answer: C) It reduced the RDI to less than 5 for at least 15 minutes duration without supine sleep seen at the selected pressure
45. During CPAP titration at 10 cm H2O, SpO2 values range between 80-85% for 10 minutes despite the absence of respiratory events. What is the BEST action for the tech to take? A) Follow protocol for supplemental oxygen B) Add a backup rate C) Increase CPAP to 15 cm H2O D) Contract to on-call physician for ABG order Answer: A) Follow protocol for supplemental oxygen 46. What is it called when a person goes to bed early in the evening and wakes up early in the morning? A) Delayed sleep phase syndrome B) Non-24 hour sleep-wake disorder C) Shift work sleep disorder D) Advanced sleep phase syndrome Answer: D) Advanced sleep phase syndrome 47. The proper way to score a major body movement-dominated epoch in a recording is described by which of the following? A) If an alpha rhythm is present for part of the epoch, score as stage wake B) If no alpha rhythm can be discerned, but an epoch of stage wake either precedes or follows the epoch with a major body movement, score as stage wake C) If no alpha rhythm and no stage wake precedes or follows the epoch, score the epoch as the same stage as the epoch that follows it D) All of the above statements are true about scoring major body movement epochs Answer: D) All of the above statements are true about scoring major body movement epochs 48. To stage an epoch as N3 sleep, in what percentage of the epoch MUST its identifiers be present? A) 20% B) 30% C) 80% D) 100% Answer: C) 80% 49. What are antipsychotics used for? What are some examples of antipsychotic medications?
A) Used to treat allergies B) Benadryl/Claritin/Allegra C) Used to treat psychosis, primarily schizophrenia D) Risperidone/Clozapine Answer: C) Used to treat psychosis, primarily schizophrenia Answer: D) Risperidone/Clozapine
50. True statements about how a tech should respond when a patient experiences a seizure include all of the following EXCEPT: A) Remove any objects nearby that could injure the patient B) Hold the patient down to prevent injury C) Avoid placing anything in the patient’s mouth or prying the mouth open D) Avoid giving liquids during or just after the seizure Answer: B) Hold the patient down to prevent injury 51. All are potential causes of central sleep apnea EXCEPT: A) Congestive heart failure B) Brain stem injury C) Obesity D) Neurological disease Answer: C) Obesity 52. Which of the following medications is used to treat narcolepsy? A) Ambien B) Mirapex C) Dextroamphetamine D) Aspirin Answer: C) Dextroamphetamine 53. The normal Heart Rate is: A) 80-100 bpm B) 60-100 bpm C) 40 bpm D) >100 bpm Answer: B) 60-100 bpm 54. During PAP titration, the pressure should be increased until which of the following combinations of events are eliminated?
D) 10 minutes Answer: A) 30 seconds
60. What is the RECOMMENDED minimum and maximum IPAP-EPAP differential? A) 5 min/10 max B) 4 min/12 max C) 0 min/10 max D) 4 min/10 max Answer: D) 4 min/10 max 61. How do you calculate Total Recording Time (TRT)? A) Lights on - Lights out / 2 B) Lights on - Lights out / 4 C) Lights on + Lights out / 4 D) Lights on - Lights out / 0 Answer: A) Lights on - Lights out / 2 62. Asking the patient to look left/right and up/down during biocalibrations is intended to mimic which common situation found during healthy sleep? A) Eye movements in REM sleep B) Seizure activity C) Gently rolling eyes seen in stage N1 sleep D) Bruxism Answer: A) Eye movements in REM sleep 63. What effect do beta blockers have on sleep? Decreases: REM density Increases: REM latency, Slow wave sleep (SWS), Total sleep time (TST) Answer: Decreases: REM density Increases: REM latency, SWS, TST 64. According to the proper discharge procedures, after a sleep study has been completed, the tech should soak and air-dry which of the following pieces of equipment? A) Snap electrodes B) Continuous positive airway pressure mask C) Snore microphone D) Body position sensor Answer: B) Continuous positive airway pressure mask
65. The best way to eliminate artifact is by: A) Adjusting the filters B) Going to the problem source and replacing and reapplying the affecting leads C) Doing nothing, as they tend to resolve on their own D) Stopping the study and reapplying all the leads Answer: B) Going to the problem source and replacing and reapplying the affecting leads 66. What is an example of a Barbiturate medication? What is a barbiturate used for? A) The application of a ground lead wire placed on the head for the PSG B) Clonazepam/diazepam C) Brevital/Surital D) Used as a depressant and anticonvulsant Answer: C) Brevital/Surital Answer: D) Used as a depressant and anticonvulsant 67. Adaptive servo ventilation is an effective treatment for which of the following disorders? A) Obesity hypoventilation syndrome B) Nocturnal asthma C) Hunter-Cheyne-Stokes breathing pattern D) Congenital central hypoventilation syndrome Answer: C) Hunter-Cheyne-Stokes breathing pattern 68. A patient is snoring on CPAP 11 cm H2O. What is the best course of action for the tech to take? A) Lower the CPAP to 10 cm H2O B) Switch to BIPAP 15/10 cm H2O C) Raise the CPAP to 12 cm H2O D) Do nothing. Snoring is not treated by CPAP Answer: C) Raise the CPAP to 12 cm H2O 69. What can be done to improve sweat sway artifacts on the EEG and EOG channels? A) Increase the temperature in the room B) Add extra paste to the electrodes C) Decrease the temperature in the room, and turn on a fan D) Reapply the affected electrodes Answer: D) Reapply the affected electrodes
75. What effects do mood stabilizers like Tegretol and Lithium have on sleep? A) Tegretol decreases: REM density B) Tegretol increases: Sleep onset latency C) Lithium decreases: REM sleep D) Lithium increases: REM latency, slow wave sleep Answer: A) Tegretol decreases: REM density B) Tegretol increases: Sleep onset latency C) Lithium decreases: REM sleep D) Lithium increases: REM latency, slow wave sleep 76. What would increase the resolution of EEG spikes and improve the definition of high frequency activity? A) Decreasing the sensitivity B) Recording with a high sampling rate C) Using a 100μv input voltage D) Applying 50/60 Hz filter Answer: B) Recording with a high sampling rate 77. What is a sedative-hypnotic used for? A) Clonazepam/diazepam: Anxiety, Insomnia, and Seizures B) Benadryl/Claritin/Allegra: Used to Treat Allergies C) Insomnia/anxiety: Used to treat mood disorders D) Tegretol/Lithium: Used to Treat Bipolar Answer: A) Clonazepam/diazepam: Anxiety, Insomnia, and Seizures 78. Criteria necessary to score an arousal in NREM sleep include all of the following EXCEPT: A) A concurrent increase in chin EMG B) 10 seconds of sleep prior to the arousal C) The arousal must last at least 3 seconds D) Frequencies greater than 16 Hz, which are not spindles, must occur Answer: D) Frequencies greater than 16 Hz, which are not spindles, must occur 79. Total number of respiratory events: Obstructive apneas = 14 Central apneas = 2 Mixed apneas = 4 Hypopneas = 16 Total sleep time: 240 minutes
What is the apnea index (AI)? A) 20/hr B) 4/hr C) 5/hr D) 9/hr Answer: B) 4/hr Explanation: AI = (Total apneas / Total sleep time) x 60 = (14 + 2 + 4) / 240 x 60 = 4/hr
80. Which of the following is needed to calculate the apnea/hypopnea index? A) Total number of limb movements B) Oxygen desaturation index C) Total sleep time D) Number of heart beats per hour of sleep Answer: C) Total sleep time 81. In generalized anxiety disorder, polysomnography is characterized by which of the following? A) Increased stage 1 non-REM sleep B) Increased REM density C) Quick onset of sleep D) All of the above Answer: D) All of the above 82. A side effect of CPAP is: A) Aerophagia B) Intentional leak C) Hyperventilation D) CO2 retention Answer: A) Aerophagia 83. The standard paper speed used for a sleep study is: A) 30mm/sec B) 10mm/sec C) 5mm/sec D) 1mm/sec Answer: A) 30mm/sec 84. What is the recommended number of observed apneas needed for an adult patient before increasing the pressure during a titration?
D) Used to treat major depression and anxiety Answer: D) Used to treat major depression and anxiety
90. NPSG stands for: A) Nighttime polysomnogram B) Nocturnal patient sleep graph C) Normal polysomnogram D) Nocturnal polysomnogram Answer: D) Nocturnal polysomnogram 91. Which of the following is NOT a way to decrease the amount of condensation in humidifier tubing? A) Using heated tubing B) Reducing the level of humidification C) Insulating the tubing D) Decreasing room temperature at night Answer: D) Decreasing room temperature at night 92. The most desirable sampling rate for the respiratory airflow signal is: A) 1Hz B) 25Hz C) 100Hz D) 500Hz Answer: C) 100Hz 93. What effects does nicotine have on sleep? A) Decreases: Sleep onset latency, REM density B) Increases: Wakefulness, Shallow breathing, Stimulates brain wave activity C) Decreases: REM latency D) Increases: Total sleep time, REM sleep Answer: B) Increases: Wakefulness, Shallow breathing, Stimulates brain wave activity 94. What effect do opioids/opiates have on sleep? A) Decreases: REM density, Slow wave sleep, Total sleep time, Sleep efficiency B) Increases: Wakefulness, Stage 1 sleep C) Decreases: Sleep onset latency D) Increases: REM latency Answer: A) Decreases: REM density, Slow wave sleep, Total sleep time, Sleep efficiency
95. What effects do Barbiturates have on sleep? A) Decreases: Sleep latency, Wake after sleep onset, N1, N3, REM B) Increases: Stage 2 sleep, TST, Sleep efficiency C) Decreases: REM density D) Increases: Slow wave sleep, REM latency Answer: A) Decreases: Sleep latency, Wake after sleep onset, N1, N3, REM 96. Which of the following statements about the removal of paste residue from the patients in the morning is true? A) The paste never needs to be removed B) Only remove the paste if the patient asks C) Remove the paste if the patient is physically unable D) Always remove remnants of paste from the patient's body Answer: D) Always remove remnants of paste from the patient's body 97. What is an antidepressant used for? A) Used to treat physical pain and discomfort B) Used to treat depression, anxiety, PTSD, and OCD C) Used to enhance memory and cognitive function D) Used to induce sleep and manage insomnia Answer: B) Used to treat depression, anxiety, PTSD, and OCD 98. Which of the following constitutes good sleep hygiene? A) Drinking alcohol before going to bed B) Watching TV in bed right before trying to go to sleep C) Getting up to do something relaxing after 20 minutes in bed D) Taking naps during the day Answer: C) Getting up to do something relaxing after 20 minutes in bed 99. The artifacts that are most likely to cause high-amplitude, low-frequency waves seen on the EEG are: A) EKG artifact B) 60 Hz artifact C) Respiratory artifact D) EOG artifact Answer: C) Respiratory artifact
