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what is the minimum number of diagnostic and therapeutic in a split study? - ANSWER- 2 diagnostic 3 therapeutic what is the most stable stage of sleep respiratory wise?
- ANSWER- N3 (NREM is more stable and REM is irregular) What does common mode rejection do?
- ANSWER- It is a process that takes input signals and eliminates identical voltages from two different sources (records dissimilar voltages) (higher the CMMR, the more efficient the amplifier) what should the low pass filter for an EEG be if seizures are expected?
- ANSWER- 70 Hz (usually 35 Hz) What happens to a waveform is sensitivity is increased?
- ANSWER- The vertical size of the wave decreases what is the difference in gain and sensitivity?
- ANSWER- Increasing gain increases amplitude and increasing sensitivity decreases the amplitude What is the shortest sleep latency for a MSLT nap?
- ANSWER- 15 minutes (longest its 35 minutes) What is HST?
- ANSWER- Home sleep test How do you clean ECG electrodes?
- ANSWER- Wipe with cleaning agent that is non-corrosive to plastic, air dry, gas sterilization as needed What are the NREM parasomnias?
- ANSWER- Confusional arousals, sleepwalking, sleep terror, SRED What are the REM parasomnias?
- ANSWER- Nightmares, RBD, sleep paralysis How long does a "short sleeper" sleep?
- ANSWER- <6 hours (long: >10) What stage of sleep is CSA more common?
- ANSWER- NREM What are SOREMPS?
- ANSWER- Occurrence of REM sleep within 15 minutes of sleep onset (<2 = hypersomnia, >2 narcolepsy) What type of narcolepsy is cataplexy present?
- ANSWER- Type 1 When is narcolepsy onset age usually?
- ANSWER- 10 - 20 What is the effect of light therapy on circadian rhythms?
- ANSWER- Light therapy in the morning, after core body temperature minimum, advances the circadian rhythm (go to bed early, wake up early) What gender does SRED happen in more?
- ANSWER- Females What gender does RBD happen more in?
- ANSWER- Males (>50)
What is needed to score REM Without Atonia (RWA)?
- ANSWER- Excessive sustained muscle activity in REM and cEMG Excessive TMA in REM and chin or limb EMG 50% of mini epochs contain any chin or limb activity What is a normal PR interval?
- ANSWER- 0.20 seconds What is the Respiratory Event Index equation?
- ANSWER- REI= (# of apneas + hypopneas) x 60 / monitoring time When active equipment is close to patient what kind of artifact occurs? - ANSWER- 60 Hz artifact (can also occur from poor electrode contact, defective wires, inadequate grounding, and it's see in EEG/ECG/EOG/EMG) (fix by fixing electrode and turning off unnecessary electronic equipment) How do you correct ECG artifact seen on other channels?
- ANSWER- Reposition electrodes higher on chest, reposition reference leads (M and M2), Link M1 and M2, re-reference, use QRS filter How do you fix artifact that is "swaying"?
- ANSWER- Wipe away sweat, decrease room temperature, turn on fan and remove blankets, (last resort) increase LFF (can dampen the slow waves) How is OPTIMAL CPAP titration defined?
- ANSWER- RDI <5, supine REM with no arousals How is GOOD CPAP titration defined?
- ANSWER- RDI <10 (or reduction of 50% when RDI baseline is <15), supine REM with no arousals How is ADEQUATE CPAP titration defined?
- ANSWER- RDI >10 (but reduction of >75% from baseline RDI) When do you increase your CPAP?
- ANSWER- Increase by z1 if: z OA, z3 hypopneas, z5 RERAs, z3 minutes of loud snoring (and then wait another 5 minutes before another increase)
When do you increase IPAP and EPAP?
- ANSWER- z2 OA When do you increase only IPAP?
- ANSWER- z3 hypopneas, OR z5 RERAs, OR z3 minutes of loud snoring If your patient doesn't have teeth, what mask interface is best for them? - ANSWER- Nasal pillows (Nasal and oral mask require structural teeth support in placement) What is indicated to increase NPPV pressure support by 1 - 2?
- ANSWER- Every 5 minutes of TV is low (6-8ml/kg) Every 5 minutes is O2 sat <90% for z5 minutes and total volume is low Every 10 minutes of Paco remains z10mmHg above goal of sleep PCO2 _< awake PCO Every 10 minutes if respiratory muscle rest has not been achieved In BIPAP therapy, time taken to go from EPAP to IPAP is? - ANSWER- Rise Time What can BIPAP VAPS mode NOT treat? - ANSWER- Cheyne-Stokes Breathing What waveforms increase because of benzodiazepines and barbiturates? - ANSWER- Spindles
Why is a LFF considered a high pass filter? - ANSWER- because it always high frequencies to pass through a patients oximeter reading during patient calibration is 88%. which of the following would be the appropriate response? - answer- place the probe on the patients earlobe a patient with ondines curse would be expected to have which type of respiratory impairment in sleep - answer- central sleep apnea according to the aasm, intercostal emg activity is an acceptable alternative sesor for recording what parmeter - answer- detection of respiratory effort slow rolling eye movements occuring during stage n1 sleep will best be seen at low filter setting of - answer- 0.3hz a 1.0 hz eeg wave is measured at 15mm peak to peak. the sensitivity is 5uv/mm. the voltage of the wave is - answer- 75uv a cheyne stokes breathing pattern is often seen in patients with - answer- congestive heart failure capnography measures - answer- expired co which of the following high frequency filter settings is recommended for recording submental emg - answer- 100hz endoesophageal pressure measurements would be most helpful in evalutating which sleep disorders - answer- sleep related breathing disorders a patient being evaluated for obstructive sleep disordered breathing has atrial fibrillation. what should the tech do - answer- continue to observe and document rhythm which of the following is the most dangerous cardiac rhythm - answer- ventricular fibrillation
how would you compute sleep efficiency - answer- total sleep time divided by time in bed x 100 how do you calculate apnea + hypopnea index - answer- # apneas and hypopneas divided by tst x which high pass filter setting is most appropriate for recording respiration - answer- 0.1hz the purpose of an exhalation port in a cpap circuit is - answer- to vent exhaled c which of the following are characteristic of a pvc - answer- the qrs is wide and bizarre a normal variation in sinus rhythm which is related to respiratory rate and results from vagal tone inhibition describes - answer- sinus arrhythmia a sustained heart rate of >90 beats/minute describes - answer- sinus tachycardia partial av block in which the pr interval increases progressively until there is an atrial impulse without a corresponding ventricular beat describes - answer- mobitz type 1 av block what is the most likely low frequency filter setting of channel 1 - answer- 1.0 hz which channel setting is best for emg recording - answer- 2 chan 2 has a very quich return to baseline, (very short time constat) refer to the 30 second epoch shown here. if the next epoch contains 30 seconds of low voltage, mixed frequency in the 4-7 hz range, and no eye movements, what is the sleep stage of that next epoch? - answer- stage n1 the epoch shown contains a k complex, possible a spindle and less than 20% high amplitude slow waves, making it stage n2 there is an arousal at the end of the epoch. if the following epoch is as descrived, without either a k complex or spindle. it is then stage n a patient has poor extremity circulation that is affecting the accuracy of the pulse oximetry readings from finger probe. which would be the most appropriate action - answer- put the probe on the patients ear
according to aasm, which of the following is the recommended definition of a hypopnea - answer- decrease of the nasal pressure signal by at least 30% for at least 10 seconds and at least a 4% desaturation a patient scheduled for a psg to rule out parasomnia has a benzodiazepine on their list of medications. what should you expect to see on the psg - answer- decreased stage n3 a benzo is a hypnotic, decreasing sleep latency and % stage n impedance is a measure of - answer- resistancer you are preparing a patient for psg who presents with a history of copd. as a tech, you should - answer- be alerted to the possibility of low nocturnal oxygen levels and co2 tetention what type of light is used in a pulse oximeter - answer- infrared and red a patient is scheduled for a psg with tricyclic anti depressant medication on her list of medications. what should you expect to see on her psg - answer- increased rem latency tricyclix antidepressants generally are stage r suppressing ofter increasing rem latency. withdrawal of the medication may lead to an initial rebound of stage r and a shortening of the rem latency a high pass filter is also known as - answer- low frequency filter according to the 10 - 20 international system of electrode placement, o1 and o2 are located - answer- 5% on either side of oz an arousal in stage r sleep should be scored if - answer- there is a >3 second burst of alhp in the occipital channel and there is a concurrent increase in the chin emg lasting at least 1 second hypercapnia is - answer- elevated carbon dioxide levels in the blood a thermocouple - answer- is susceptible to artifact caused by cpap flow a(an) uses selective absorption of light through vascularized tissue to measure - answer- pulse oximeter, oxygen saturation
at least three consecutive cycles of cyclical crescendo and decrescendo change in breathing amplitude with an index of 5 or more central apenas or hypopneas or a duration of at least 10 consecutive minutes is the aasm recommended rule for - answer- cheyne stoke's breathing hypoxemia is - answer- decreased oxygenation in the blood if a patient with suspected advanced sleep phase syndrome is studied in the sleep lab at conventional hours (recording time from 10 to 11 p.m. to 6 to 7 a.m) what would you expect to see - answer- prolonged wakefulness at the end of the recording sleep efficiency is defined as - answer- the ratio of all sleep stages to trt rem sleep is associated with which of the following psychologic activity - answer- variable heart rate, irregular respiration, and decrease in tonic muscle activity according to a aasm how many seconds of stable sleep must proceed each arousal - answer- 10 seconds according to the aasm. what is the minimum period of time between limb movements and a plm series - answer- 5 seconds which of the following patients would be most likelyto have a history of cataplexy
- answer- a patient with narcolepsy 2 - 5 % of tst, in a normal young adult, is characteristic of which sleep stage - answer- n a plm episode is classified as - answer- at least 4 limb movements lasting 0.5- 10 seconds separated by 5-90 seconds according to aasm, what is the minimum recommended digital resolution - answer- 12 bits per sample according to aasm, what is the minimum recommended sampling rate for eeg - answer- 500 hz according to aasm, what is the definition of stage r latency - answer- sleep onset to the first epoch of stage r
what is the purpose of the msds - answer- details safe handling of chemical products used in the workplace a patient is referred to the sleep lab who injects themselves with insulin for diabetes. while cleaning the set up area, the tech is accidently stuck with the needle, left by the patient. what is the first thing that the tech should do. - answer- wash the area of the stick with soap and water what property of the eye makes it a dipole - answer- a difference in electrical potential between the cornea and retina which of the following are psg characteristics of rem behavior disorder - answer- sustained chin emg during stage r or increased transient muscle activity in the chin or left emg during stage r what is the purpose of standard precautions - answer- reduce the risk of transmission's of blood-borne pathogens and pathogens from moist body substances a popular acronym for remembering fire safety is race. what does the letter c stand for - answer- contain sleep paralysis - answer- usually lasts a few seconds to a few minutes a class c fire involved electrical equipment. if the equipment can't be unplugged what type of fire extinguisher should be utilized - answer- carbon dioxide or dry chemical extinguisher a 30 second epoch of stage r is followed by an epoch with no change in the chin emg, no rapid eye movements, five seconds of alpha and a spindle in the second half of the epoch, how should the second epoch be scored - answer- stage n nrem arousal require a concurrent change in the eeg and the - answer- only eeg change is required according to a aasm what is required for an optimal pap titration - answer- ahi of less than 5, and at least 15 minutes of supine stage r without frequent spontaneous arousals according to the nyquist criterion the sampling rate should be at least - answer-
Which waveform occurs at it's maximum amplitude in the central region of the brain? - ANSWER- Spindles and K complexes Circadian rhythm control falls primarily under the control of what? - ANSWER- Suprachiasmatic Nucleus (SCN) On a 24 - hour cycle, the level of alertness is closely linked to what? - ANSWER- Body temperature In what area of the brain do most seizures occur? - ANSWER- Temporal What structure is primarily involved in the control of wakefulness or alertness? - ANSWER- Reticular activating system (RAS) What is the "gateway" structure between the body and the cerebral cortex? - ANSWER- Thalamus Which neurochemical increases in REM sleep as well as wake? - ANSWER- Ach Sleep spindles result from the blocking of information between the and the cortex and result from deactivation of the. - ANSWER- thalamus, RAS Bright light therapy affects which anatomic structure? - ANSWER- SCN A tonic-clonic seizure represents the mass firing or synchronization of large groups of neurons. Which sleep stage would you LEAST expect to see seizure activity? - ANSWER- REM Pontogeniculate (PGO) waves are an indicator of which sleep stage? - ANSWER- REM The EEG observed in wake and REM are both characterized by what? - ANSWER- Asynchronous EEG, low voltage, and mixed frequency What general term is used to describe cues which synchronize our internal clock to the external environment? - ANSWER- Zeitgebers Which come under the influence of circadian rhythm control? - ANSWER- Body temperature, hormone levels, and K+ levels
What is one of the contributing causes of EKG artifact in the arm or leg leads? - ANSWER- Voltage differences resulting from increased electrode distances What is the first step in differentiating high frequency artifact caused from muscle vs. a poor electrode connection? - ANSWER- Impedance check What is true regarding the scoring of an epoch containing major body movement? - ANSWER- Alpha coming into the movement constitutes scoring epoch as wake, and N2 coming into movement with no alpha/slow rolling eye movements constitutes scoring the movement epoch as N According to the AASM Scoring criteria, what is associated with stage N1 sleep? - ANSWER- Slow rolling eye movements and relatively low-voltage mixed frequency EEG activity What best describes sharp vertex waves (K complex)? - ANSWER- More prominent in later portion of N1 and most prominent in the centrals Which best describes the end of a REM sleep episode? - ANSWER- Sustained increase in the submittal EMG A K complex is observed at the end of epoch 60. Low voltage mixed frequency EEG with increased EMG is observed up through epoch 64. Another k complex is observed at the start of epoch 65. How would you score epoch 61 - 64? - ANSWER- N According to AASM Scoring criteria what is true in regards to scoring wake for epochs with major body movements? - ANSWER- Alpha is present leading into major body movements Which EEG signal will be attenuated the MOST with a high filter setting of 15 Hz?
- ANSWER- Beta The technician observes continuous 1 - 2 Hz brainwave measuring 17mm peak to peak between the 10th and 28th second of the epoch. The sensitivity is set at 5 uv/mm. What would this epoch be scored as? - ANSWER- N What features are common to stage N1 and REM? - ANSWER- Low voltage EEG and Asynchronous EEG
Describe a K complex - ANSWER- Biphasic, with a minimum of 0.5 second duration A low filter is set at 1Hz. What will occur? - ANSWER- Signals at 1 Hz will be attenuated and may lead to an under scoring of SWS A scoring tech notices the EEG montage is set up with sensitivities of 5 uv/mm. During the testing of an infant, they notice 1 - 2 Hz frequent with pen deflections of 20mm. What is true in regards to the situatation above? - ANSWER- EEG voltage criteria meet specifications for SWS and changing the sensitivity to 10 uv/mm should produce 10 mm pen deflections. In a 30 second epoch, a single k complex occurs at the 10th second points. The preceding and succeeding epochs are REM. This epoch is scored as: - ANSWER- REM Alpha and Delta sleep are associated with what? - ANSWER- Fibromyalgia According to the accepted sleep scoring standards, if other scoring criteria are met, which of the following activities would be considered an event when each is 0. seconds of duration? A. PLM B. Arousal C. Spindle D. K complex - ANSWER- PLM, spindle, and K-complex True or False: Alpha may be present in REM - ANSWER- True You are asked to score a study where the ROC and LOC electrodes are placed out and down from the outer corner of each eye and referenced to Fpz. What will the waves on these channels do when the patient looks up? - ANSWER- Both channel waves will move upwards What stage is this? Alpha (>50% epoch) - ANSWER- Wake What stage is this? Delta (60% epoch) - ANSWER- N What stage is this? PGO waves - ANSWER- REM What stage is this? Vertex waves - ANSWER- N
The PSG for a patient with obesity hypoventilation syndrome (OHS) would commonly show: - ANSWER- Increased baseline respiratory rates and profound O2 desaturations with REM A bio-calibration routine is used for: - ANSWER- Confirming that all the wires/electrodes are working properly, verify correct signals, establish a baseline reference for all channels
