Mastery Terminology Flashcards
(105 cards)
1
Q
acoustic pharyngometry
A
a noninvasive technique to assess the upper airway cross-sectional area with sound waves and acoustic reflection
2
Q
aerophagia
A
air entering stomach via esophagus as a result of CPAP, resulting in gas pain, belching, abdominal distension
3
Q
apnea
A
temporary cessation of breathing during sleep of 10 seconds or longer
4
Q
arousals
A
- An abrupt change from a “deeper” stage to a “lighter” stage of sleep, toward wakefulness, with the possibility of awakening as the final outcoming.
- May be associated with increased sympathetic drive and accompanied by increased tonic EMG activity, heart rate, as well as increased number of body movements.
5
Q
awakenings
A
the return to PSG-defined awake state from any NREM or REM sleep stages with a resumption of alertness to environment
6
Q
AHI / apnea-hypopnea index
A
an index of SDB calculated by summation of total number of apneas and hypopneas and dividing by total sleep time (TST) to get average / hour
7
Q
BMI / body mass index
A
a weight-to-height ratio, calculated by dividing weight in kg by the square of one’s height in meters, used as an indicator of healthy weight, obesity, underweight
8
Q
case report
A
a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient; often described as novel occurrence
9
Q
case-control study (cases, controls, exposures)
A
a type of observational study in which two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute
10
Q
central apnea
A
apneas that occur because the brain doesn’t send proper signals to the muscles that control breathing, and the body fails to make an effort to breath
11
Q
CSA / central sleep apnea
A
a disorder compromised predominantly of central apneas
12
Q
complex sleep apnea, now called treatment-emergent central sleep apnea or treatment-emergent CSA
A
a sleep disorder characterized by predominantly obstructive events during a diagnostic sleep study with emergence of CSA during administration of PAP
13
Q
Cheyne-Stokes breathing
A
an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing (apnea). the pattern repeats each cycle, usually taking 30 seconds - 2 minutes
14
Q
CRSWD / circadian rhythm sleep-wake disorders
A
sleep disorders caused by alterations of the circadian time-keeping system, its entrainment mechanisms, or a misalignment of the endogenous circadian rhythm and the external environment, as described in the ICSD-3
15
Q
Class II medical device
A
The 2nd of 3 FDA designated classes of medical devices, based upon the level of control necessary to assure safety and effectiveness. Class II devices are subject to special controls such as labeling requirements, mandatory performance standards, and post-market surveillance.
16
Q
CBT-I / cognitive behavioral therapy for insomnia
A
An approved method for treating insomnia without the use of sleeping pills. CBT-I is aimed at changing sleep habits and scheduling factors as well as misconceptions about sleep and insomnia, that perpetuate sleep difficulties.
17
Q
cohort
A
a group of people treated as a group, whose members share a significant experience at a central period of time or have similar characteristics
18
Q
concentric collapse
A
generally evaluated during DISE (drug-induced sleep endoscopy), a pharyngeal pattern of collapse that occurs from all directions and is used as a means to exclude surgical candidates for Hypoglossal Nerve Stimulation (HGNS) Therapy
19
Q
CPAP / continuous positive airway pressure
A
A treatment for OSA (obstructive sleep apnea) that uses air pressure to counteract negative airway pressures created by the drawing of breath through a collapsible lumen. Pressures are measured in centimeters of water pressure (cm H2O) and are customized to a patient’s individualized needs.
20
Q
APAP / automatic positive air pressure
A
A type of positive air pressure (PAP) machine that is designed to sense the amount of pressure needed at any given time to maintain the airway and deliver as much pressure as needed. Often used to determine the best pressure setting for a CPAP.
21
Q
BPAP / bi-level positive air pressure
A
The most sensitive of the PAP machines, having two algorithms to determine pressure needs, sensing pressure requirements for both inspiratory and expiratory efforts. Do not use “BiPAP,” which is a proprietary name.
22
Q
Cross sectional survey
A
a study design that examines the relationship between disease (or health-related state) and other variables of interest as they exist in a defined population at a single point in time, or over a short period of time (e.g. calendar year)
23
Q
DSPS / delayed sleep phase syndrome
A
a chronic dysregulation of a person’s circadian rhythm compared to those of a general population and societal norms
24
Q
digeridoo
A
a wind instrument thought to reduce risk of OSA by exercising the the oropharyngeal muscles
25
DISE / drug-induced sleep endoscopy
also known as VSN video sleep nasoendoscopy, a method for studying the dynamic upper airway in a sedated patient by use of a short acting drug, usually propofol (Diprivan), and flexible endoscopy that has been shown to be helpful in determining the level(s) and characteristic of airway collapse
26
efficacy
The ability to produce a desired or intended result. In sleep medicine, often intended to mean the ability of a treatment to reduce the degree of disease, independent of patient compliance or adherence to therapy.
27
EHR, EMR electronic health or medical record
the comprehensive patient health information that can be shared between providers and health systems
28
EDS / excessive daytime sleepiness
characterized by persistent sleepiness and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep
29
EPAP / expiratory positive airway pressure
A method of increasing inter-lumen airway pressure by creating resistance to expiration. This increase in pressure may then help prevent collapse at the start of inspiration.
30
endothelial dysfunction
a well-established response to cardiovascular risk factors and precursor to development of atherosclerosis
31
facility accreditation
a voluntary process created by the AADSM to recognize competency and support delivery of optimal care to sleep-disordered breathing patients
32
guideline
The second highest strength of recommendation in healthcare, based upon GRADE approach (Grading of Recommendations Assessment, Development and Evaluation), a method that combines the certainty of evidence (also known as quality of evidence) with value judgments regarding benefits and harms of alternative care options
33
HSAT / home sleep apnea test
A portable sleep study tool that is used for the diagnosis or assessment of obstructive sleep apnea without the determination of sleep stage, sleep time, or sleep quality, also called "Unattended Sleep Study," "limited Channel Sleep Testing," and "Out of Center Testing." The AASM recognizes that not all such studies are performed at home; however, "home" is included in the term because that is where the vast majority of patients undergo these tests.
34
hypnogram
In polysomnography, a graph that represents the stages of sleep as a function of time. It was developed as an easy way to present the recording of the brain wave activity from an electroencephalogram *EEG) during a period of sleep.
35
HGNS Therapy / hypoglossal nerve stimulation therapy
A surgically-placed device treatment for OSA using unilateral inspiratory stimulation to the medial branch of the hypoglossal nerve triggered by inspiratory effort
36
hypopharynx
A part of the throat (pharynx) and airway that lies beside and behind the larynx. The hypopharynx is the entrance into the esophagus and is continuous with and below the oropharynx.
37
hypopnea
abnormally slow or shallow breathing with inadequate passage of air, decrease in airflow lasting longer than 10 seconds, 30% reduced airflow, and at least 3% desaturation, or an arousal (CMS guidelines: 4%)
38
hypercapnia
a description of excessive CO2 in the bloodstream, typically caused by inadequate respiration
39
hypersomnia
use only when referring to a disorder characterized by excessive sleepiness (e.g., idiopathic hypersomnia), as defined in the ICSD
40
hypersomnolence
excessive sleepiness during the normal wake period, as described in the ICSD
41
hypoxia
A lower-than normal concentration of oxygen in arterial blood, as opposed to anoxia, a complete lack of blood oxygen. Hypoxia will occur with an interruption of normal respiration.
42
Insomnia, chronic insomnia disorder
Insomnia present at least 3 months, as described in ICSD-3. Short-term insomnia can be called "adjustment insomnia" or "acute insomnia."
43
Insulin resistance
The diminished ability of cells to respond to the action of insulin transporting glucose (sugar) from the bloodstream into muscle and other tissues. Insulin resistance typically develops with obesity and heralds the onset of Type II diabetes.
44
Kleine-Levin syndrome
The sleep disorder characterized by relapsing and remitting episodes of severe hypersomnolence in association with cognitive, psychiatric, and behavioral disturbance
45
LOMN / letter of medical necessity
A document explaining the physician's rationale and clinical decision-making in recommending a therapy. Sometimes needed as supporting documentation in addition to a prescription for therapy in order to prior authorize or process a claim for payer reimbursement.
46
Lingual frenectomy
the removal or release through dissection of a band of tissue (the lingual frenulum) connecting the underside of the tongue with the floor of the mouth
47
- MAD/MAS/MAA
| - MRD/MRS/MRA
- Mandibular Advancement Device / Splint / Appliance
| - Mandibular Repositioning Device / Splint / Appliance
48
OA / Oral appliance
A device worn in the mouth that is used to treat sleep-disordered breathing (SDB) including: OSA, UARS, and snoring. Thought to work by preventing or reducing soft tissue collapse in the back of the throat at the level of the tongue and soft palate.
49
MWT / Maintenance of Wakefulness Test
A daytime polysomnographic procedure that measures a person's ability to stay awake in soporific circumstances (circumstances that induce drowsiness), i.e., "wake tendency." Generally scheduled for the daytime following an overnight Polysomnogram study and administered in response to a patient's complaint of extreme daytime sleepiness or suspicion of narcolepsy.
50
Mallampati score
A classification system of the oral pharynx created by an anesthesiologist. The higher the score, the more difficult endotracheal intubation was predicted to be. Based on a visual inspection of the oral pharynx, the original scoring included only Class I - III. Now considered to be predictive of a higher incidence of OSA, the Modified Mallampati Scoring is performed with patient sitting, mouth maximally opened, tongue fully protruded, without phonation, and includes four classes as follows:
- Class I: Soft palate, uvula, fauces, pillars visible
- Class II: Soft palate, major part of uvula, fauces visible
- Class III: Soft palate, base of uvula visible
- Class IV: Only hard palate visible
* fauces = portion between palatoglossal (front) arch and palatopharyngeal (back) arch where the palatine tonsils are housed; it is "the narrow passage between the mouth and the pharynx"
* the pharynx is superior to the esophagus, subdivided into nasopharynx, oropharynx, laryngopharynx (adjacent to larynx, superior to esophagus)
51
MMI / maximum medical improvement OR MMB / maximum medical benefit
A description originating from calculation of worker's compensation benefits indicating that no further healing or improvement is deemed possible. When administering treatment of varying or unpredictive efficacy, it is used to describe the best outcome of that approach given the present circumstances.
52
MDA / mean disease alleviation
A theoretical construct relating the product of objective compliance and therapeutic efficacy. Regarding use of Mandibular Advancement Devices to treat OSA, it is posited that 100% compliance x 50% efficacy produce a MDA equivalent to use of the CPAP therapy of poorer compliance but superior efficacy.
53
metabolic syndrome
A cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type II diabetes. Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.
54
meta analysis
A statistical approach to combine the results from multiple studies in an effort to increase power (over individual studies), improve estimates of the size of the effect and/or resolve uncertainty when reports disagree.
55
MT monitoring time
Total recording time minus periods of artifact and time the patient was awake as determined by actigraphy, body position sensor, respiratory pattern, or patient diary, as defined in the AASM Scoring Manual Version 2.2. Monitoring time is used to calculate the respiratory event index (REI) for home sleep apnea testing (HSAT).
56
Multiple Sleep Latency Test (MSLT)
A polysomnographic test used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep (sleep latency) with presence or absence of stage REM noted. This test is the standard tool to identify narcolepsy and idiopathic hypersomnia and consists of four or five 20-minute nap opportunities set two hours apart.
57
myofunctional therapy / orofacial myotherapy
Orofacial Myofunctional Therapy consists of neurological re-education exercises to assist the normalization of muscle function.
58
narcolepsy Type 1
Asleep disorder characterized by excessive daytime sleepiness, cataplexy and/or low or absent cerebrospinal fluid (CSF) hypocretin-1 levels.
59
narcolepsy Type 2
Asleep disorder characterized by excessive daytime sleepiness, without cataplexy, with unmeasured or normal cerebrospinal fluid (CSF) hypocretin-1 levels.
60
nasal speculum
An instrument used to widen the opening of a nostril so the inside can be more easily visualized.
61
nasopharynx
A region of the human airway situated immediately above the soft palate, continuous with the velopharynx below it.
62
night terrors
A parasomnia involving events that are often accompanied by a cry or piercing scream, with autonomic nervous system and behavioral manifestations of intense fear.
63
obstructive sleep apnea (OSA)
A sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.
- Mild: demonstrating an AHI of 5-15
- Moderate: demonstrating an AHI of 15-30
- Severe: demonstrating an AHI of greater than 30
64
oropharynx
A region of the human airway situated immediately behind the tongue, directly below and continuous with the velopharynx, directly above and continuous with the hypopharynx.
65
ORANGE Registry
Oral Appliance Network on Global Effectiveness, a partnership between centers with research interest and established expertise in use of oral appliances used to treat sleep disordered breathing.
66
oxidative stress
An imbalance between the production of free radicals and the ability of the body to counteract or detoxify their harmful effects through neutralization by antioxidants.
67
oxygen nadir
During a sleep study, the lowest recorded saturation of oxygen the blood stream as generally measured by a pulse oximeter.
68
P-value
A measure of statistical significance, reflecting the probability that an occurrence happened by chance alone or by a given event, the probability of getting the result observed (or a more extreme result) if the null hypothesis is true.
69
phenotype
The outward, visible or measurable expression of the hereditary constitution of an organism.
70
PP Policies and Procedures / Policy and Procedures Manual
Necessary documentation for AADSM Facility Accreditation outlining the professional standards and practices followed by that facility.
71
polysomnogram (PSG)
Also called an attended sleep study, is a test used to diagnose sleep disorders by recording brain waves, blood O2 levels, heart rate, breathing, plus eye and leg movements.
72
split-night study
A PSG performed in two parts where usually the first part is a baseline study of a patient with known or suspected SDB without any intervention, and the second part is performed with application of therapeutic intervention, generally CPAP.
73
titration study
A full night or partial night of a Split Night Study where therapeutic intervention is applied and adjusted for the best outcome of disease elimination. In the case of CPAP titration, pressures are increased until apneas and hypopneas are reduced to the lowest possible levels. Titration studies can also be performed using a MAD/OA in which the patient is awakened as asked to advance their device.
74
pneumatic splinting
A phrase borrowed from inflatable medical devices that stabilize injuries to joints and extremities (ie sprains), also used to describe the ability of positive air pressure to inflate the airway during end expiration and subsequent inspiration.
75
psychomotor vigilance task (PVT)
A sustained-attention, reaction-timed task that measures the speed with which subjects respond to a visual stimulus. Research indicates increased sleep deficit correlates with deteriorated alertness, slower problem-solving, declined psycho-motor skills, and increased rate of false responding. However, it was shown that motivation can counteract the detrimental effects of sleep loss for up to 36 hours and skew test results.
76
pterygomandibular raphe
A ligamentous band of fascia that extends from the hamulus of the medial pterygoid plate to the mandibular mylohyoid ridge.
77
pulse oximeter
An oximeter that measures the proportion of oxygenated hemoglobin in the blood in pulsating vessels, especially the capillaries of the finger or ear.
78
RCT / Randomized Control Trial (double blind, single blind)
An epidemiologic experiment in which subjects are allocated randomly into groups (in order to minimize risk of bias) to receive or not receive a therapeutic or preventive intervention. An experimental group receives the drug or procedure; a placebo group’s treatment is disguised to resemble the drug or procedure being investigated. A control group receives nothing. Members of each group are prevented from knowing whether they are receiving active therapy.
79
double blind
Pertaining to an experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving.
80
single blind
Pertaining to an experiment in which information that could impact the outcome is withheld from subjects of the study.
81
rapid maxillary expansion (RME)
Referring to several methods of orthodontic and/or surgical correction of the midface, consisting of enlargement of the dental arch and widening of the palate.
82
restless legs syndrome (RLS)
Note that “legs” is plural. A condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you're sitting or lying down. Moving eases the unpleasant feeling temporarily. Also known as restless legs syndrome/Willis-Ekbom disease (RLS/WED).
83
Respiratory Disturbance Index (RDI)
A formula used in reporting polysomnography (sleep study) findings. Like the AHI, it reports on respiratory events during sleep, but unlike the AHI, it also includes respiratory effort related arousals (RERAs) or more simply AHI + RERA = RDI.
84
Respiratory Effort-Related Arousals (RERAs)
A form of sleep disordered breathing (SDB) in which there is partial collapse of the airway resulting in greater effort required for air passage to the lungs. Generally considered to be on a continuum of airway collapse between snoring and Hypopneas.
85
Respiratory Event Index (REI)
Used for Home Sleep Apnea Testing (HSAT), the total number of respiratory events scored x 60 divided by monitoring time MT.
86
Sensitivity (re: study results)
In medical diagnosis, the ability of a test to correctly identify those with the disease or condition (true positive rate).
87
Sleep Disordered Breathing (SDB)
A general term for breathing difficulties occurring during sleep that encompasses both sleep-related breathing disorders and other abnormalities of respiration during sleep that do not meet the diagnostic criteria for disorder (e.g., snoring). SDB can range from frequent loud snoring to Obstructive Sleep Apnea (OSA) a condition involving repeated episodes of partial or complete blockage of the airway during sleep.
88
sleep efficiency
Total Sleep Time (TST) divided by Time in Bed (TIB).
89
Sleep-Related Breathing Disorder (SRBD)
Sleep disorders characterized by abnormalities of respiration during sleep, as described in the ICSD-3. Snoring is not a SRBD.
90
Sleep Onset Latency (SOL)
The duration of time from “lights out” to onset of sleep.
91
sleep stages
Distinctive stages of sleep, best demonstrated by PSG recordings of the electroencephalogram, electrooculogram and electromyogram.
92
nREM / non-Rapid Eye Movement Sleep
- Stage 1: Commonly referred to as light sleep. The stage between wakefulness and sleep. Sudden twitches and sensation of falling are common. A person awakened during this stage will often believe they have not slept at all. 5% of sleep time.
- Stage 2: Characterized by rhythmic brain wave activity known as Sleep Spindles and K-Complexes that suppress response to outside stimuli and aid in memory consolidation and information processing. Body temperature and heart rate drop. 45-50% of sleep time.
- Stage 3: Commonly defined as deep sleep, delta sleep, or slow wave sleep (SWS) with a high awakening threshold (difficult to awaken). Brain temperature, breathing rate and blood pressure are at their lowest. This is the stage where night terrors, sleep-walking/talking and bedwetting occur.
93
REM / Rapid Eye Movement Sleep
The stage of sleep with the highest brain activity, characterized by enhanced brain metabolism and vivid hallucinatory imagery or dreaming. There are spontaneous rapid eye movements, suppressed muscle activity and low awakening threshold (easily awakened). REM stage is 20-25% of total sleep time in adults. Also called paradoxical sleep, as it mimics being awake. It is believed to be associated with memory consolidation and mood stabilization, and the ability to learn complex tasks. REM stage dominates the later half of the sleep period, especially the hours before awakening.
94
Specificity (re: study results)
In medical diagnosis, the ability of a test to correctly identify those without the disease or condition (true negative rate).
95
standard
Also see Guideline, the highest strength of recommendation in healthcare, based upon the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation),a method that combines the certainty in evidence (also known as quality of evidence) with value judgements regarding benefits and harms of alternative care options.
96
Stark Law
A set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.
97
suprachiasmatic nucleus
Each of a pair of small nuclei in the hypothalamus of the brain, above the optic chiasma, thought to be concerned with the regulation of physiological circadian rhythms.
98
Systematic review (contrast meta-analysis)
A summary of the results of available high-quality healthcare studies (controlled trials) that provides a high level of evidence on the effectiveness of healthcare interventions. A Systematic Review answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria. /// A meta-analysis is the use of statistical methods to summarize the results of these studies.
99
telemedicine
A legal patient/clinician encounter using electronic communication, as defined in the AASM Position Paper for the Use of Telemedicine for the Diagnosis and Treatment of Sleep Disorders.
100
tensor veli palatini
A ribbon-like muscle that tenses and elevates the soft palate to help prevent upward movement of food in the pharynx during swallowing. Also functions as part of the mechanism that equalizes pressure in the Eustachian tube during yawning.
101
Tongue Retaining Device (TRD) / Tongue Stabilizing Device (TSD)
Any of a variety of devices that may be used alone or as an attachment to a tooth retained Mandibular Advancement Device, that holds the tongue forward with negative pressure created by air displacement within a flexible tongue compartment.
102
Upper Airway Resistance Syndrome (UARS)
A sleep disorder characterized by airway resistance to breathing during sleep. A medical diagnosis of SDB that implies a lack of or limited number of Apneas. The primary symptoms include daytime sleepiness and excessive fatigue.
103
velopharynx
A region of the human airway situated immediately behind the soft palate, directly below and continuous with the nasal pharynx, directly above and continuous with the oropharynx.
104
Wisconsin Sleep Cohort Study
A landmark prospective population-based study, beginning in 1988, undertaken to follow individuals assessed for Sleep Disordered Breathing with Polysomnography, collecting data on mortality and treatment with CPAP. Notably, patients were recruited from employee database of Wisconsin state agencies, not from pool of patients already actively seeking treatment in the medical system.
105
zeitgeber
A cue given by the environment, such as a change in light, temperature, or meal time, to reset the internal body clock.
