Preparation & Recording Flashcards
The standard epoch length used in polysomnography recordings is?
10mm/sec-30 sec epoch or 15mm/sec- 20 sec epoch.
The initial recording equipment calibration for polysomnography should show?
The filters (high, low and 60Hz) and sensitivity for each channel to be the same.
In addition to EEG, EOG and EMG (submental) monitoring what is crucial for the interpretation of a polysomnographic recording in infants?
Behaviors and observation.
Selet from the following the best initial amplifier conditions for a routine polysomnogram?
EMG; LFF-5
HFF-90-120
TC-0.03
EEG/EOG; LFF-0.3
HFF-35
TC-0.4Patient Joe Brown has typical complaints of non restorative sleep. Prior to starting his sleep study he reports that he has recently been treated with sedative medications. During the PSG, you might expect the?
EEG activity to show increased alpha and background fast activity.
Electrode impedance should not exceed?
5,000 ohms
The biological calibration at the start of the PSG should include:
eyes open, eyes closed, look left, look right,up,down,blink eyes 5X slowly;grit teeth,clench jaw or smile; inhale, exhale,hold breath 10 sec; flex left foot,right foot; and documentation of each action.
When calibrating an analog EEG system, it is necessary to?
Allow time for the pens to return to baseline.
An alternating EEG pattern seen in full-term, sleeping (NREM) in fats consisting of both high and low voltage activity is termed?
Trace alternant.
Unequal spacing between lines of the various channels with the amplifiers in the “off” or “standby” position requires an adjustment in the?
Mechanical baseline.
What should be documented on the record at the start of every recording?
Time of recording onset and body position.
What is the minimum recording time required for a polysomnograph from “ lights out” to “lights on”
6.5 hours.
In this illustration, channel “2” needs and adjustment in the?
Electrical baseline
When observing the adult patient during a polysomnography recording, the technologist should document all of the following except:
Facial expression.
The minimum study duration for an accurate assessment of neonatal sleep is?
3 hours and or 2 feeding.
Prior to the sleep study, electrodes are applied to the chin to record EMG activity. These are?
Placed beneath the chin, overlying the mentalis/submentalis muscles.
During the polysomnogram, all of the following should be monitored and documented except?
Sleep stages, physiologic calibrations,and dream content.
The ECG is recorded during sleep for the following reasons except?
to determine the patient’s ejection fraction.
If abnormal EEG waveforms appear during the PSG, the paper speed should be changed to?
60 mm/sec
Why should backup recording electrodes be placed on the patient?
To prevent waking the patient to reapplying electrodes.
The standard chart or paper speed for PSG is?
10 mm/sec.
With eye leads placed at the left outer canthus (1 cm out and 1cm down) and at the right outer can thus (1 cm out and 1 cm up), the eye movements in the diagram are?
eyes closed.
At 10 mm per second, each epoch represents how many seconds?
30 sec.
Short time constants should be used when recording which of the following physiologic variables?
EMG.
Out-of-phase signals in the LOC-A2 and ROC-A1 derivations indicate?
eye movements.
The most appropriate time constant to use when recording respirations is?
1.00 sec.
The eye movements in the diagram could be produced by?
right prosthetic eye.
With the right outer can thus eye lead (ROC) positioned 1cm lateral to and 1cm above the outer canthus, eye opening will result in the ROC becoming?
negatively charged.
Sleep transients recorded with a C3-A1 derivation, rather than a C3-A2 derivation, will result in?
lower amplitude sleep spindles.
The location of electrode “X” is:
F7
A complete absence of effort in respiratory monitoring channels indicates?
a central apnea event.
The most appropriate high frequency filter to use when recording EMG is?
70 Hz.
All of the following devices monitor airflow on a polysomnogram except?
inductive plethysmography utilizing a conductive wire.
All of the following areas must be monitored during routine polysomnography except:
F3-A2
During instrumentation calibration, one pen deflection lagging behind the others requires correction of the?
time axis.
REM periods become shorter and less intense throughout the sleep period?
false.
Sleep staging in infants can be defined as?
indeterminate sleep, active REM sleep, quiet sleep.
When scoring an MSLT, sleep onset is defined as the elapsed time from?
lights out to the first epoch scored sleep.
ASDA criteria for scoring an arousal include?
an EEG frequency shift of at least 3 seconds.
REM sleep tends to predominate?
during the latter third of the sleep period.
When scoring an MSLT, “mean sleep latency”, is defined as the?
average of the sleep latency for all naps recorded.
How many sleep-onset REM episodes in a series of five sleep latency tests are diagnostic of narcolepsy?
2
The following are hallmarks of stage 1 sleep except?
rhythmic 12-14 hertz activity lasting >0.5 seconds.
For the scoring technologist, the primary reason to record eye movement activity is?
All of the above.
Which nap was terminated incorrectly according to established criteria?
Lights out—160 200 -280 340 400
Sleep onset-164–220–0—-342 410
REM onset–170—0—–0—344 412
End -194–260–320–372–440
Nap 2
What is the mean sleep latency, rounded to the nearest minute? Lights out---160 200 -280 340 400 Sleep onset-164--220--0----342 410 REM onset--170---0-----0---344 412 End -194--260--320--372--440
8 minutes
What is the REM latency in Nap 1? Lights out---160 200 -280 340 400 Sleep onset-164--220--0----342 410 REM onset--170---0-----0---344 412 End -194--260--320--372--440
3 minutes.
What is the sleep latency in Nap 2? Lights out---160 200 -280 340 400 Sleep onset-164--220--0----342 410 REM onset--170---0-----0---344 412 End -194--260--320--372--440
10 minutes.
When calculating mean sleep latency, how is Nap 3 scored? Lights out---160 200 -280 340 400 Sleep onset-164--220--0----342 410 REM onset--170---0-----0---344 412 End -194--260--320--372--440
20 minutes.
Does this MSLT meet criteria for a diagnosis of narcolepsy? Lights out---160 200 -280 340 400 Sleep onset-164--220--0----342 410 REM onset--170---0-----0---344 412 End -194--260--320--372--440
yes.
The following waveform is a marker for stage 2 sleep (in the absence of >20% 75uV delta activity?
sleep spindles.
The scoring of stage 3 sleep requires the following?
20 to 50% activity of 2 hertz or slower and greater than 75uV.
A 30-second epoch scored as stage 1 sleep can contain any of the below except?
20 seconds of 75uV 2 Hz activity in the first half of the epoch.
When scoring the MSLT, “REM latency” is defined as the?
time from sleep onset to the first epoch that can be scored as REM.
The adult sleep tracing you are scoring shows sleep spindles and /or K-complexes that stop for seven consecutive, 30 second epochs with stable, relatively high amplitude chin EMG. The period following the last spindle or K-complex should be scored as?
stage 1
Following MSLTs, a mean sleep latency of less than 5 minutes indicates?
a pathological level of daytime sleepiness.
Amplitude criteria for scoring of stage 4 sleep are influenced by?
Electrode resistance,Time constants,Interelectrode distances.
ALL OF THE ABOVE.
The staging of REM sleep requires?
A coincidence of all of the above.
“Sawtooth waves” are?
Seen during REM sleep in some patients.
Delta sleep is?
stages 3 and 4 combined.
Movement time is scored when?
50% of the epoch contains movement artifact and epochs before and after are scored as sleep.
An MSLT nap period during which no sleep is recorded would be scored as?
20 minutes in duration.
Generally in non-REM sleep, the patient will exhibit a decrease in?
Heart rate and blood pressure.
An epoch with 20% delta activity(>75uV combined with relatively high amplitude 7-10Hz activity?
is termed alpha-delta sleep, may be seen in patients with fibrositis, is frequently associated with subjectively “non restorative” sleep.
Limb movements must include the following to qualify as PLMS?
four or more consecutive movements.
An obstructive apnea is scored when?
cessation of airflow is accompanied by continued effort.
Sleep latency is calculated?
From lights out until the first 3 consecutive epochs of stage 1 sleep or any other sleep stage epoch.
Total sleep time is?
total of non-REM +REM sleep time.
The percentage of stage REM is based on the?
total sleep time.
When scoring the PSG, the REM latency is generally calculated?
from sleep onset.
Scoring of an obstructive hypopnea may be aided greatly by?
Esophageal pressure measurements, intercostal EMG recording, diaphragmatic EMG.
Sleep efficiency is?
the ratio of total sleep time to time in bed.
The duration of an apenic episode is calculated from the?
end of exhalation to the beginning of the next inhalation.
Body movement(s)?
are discrete physiologic events, which can occur during stages or movement time.
The average number of apneas + hypopneas per hour of sleep is the?
respiratory disturbance index.
The formula for calculation of the PLM arousal index is?
the number of PLMS with arousal time 6 divided by total sleep time.
The occurrence of multiple K-complexes at the termination of an apnea without an accompanying EEG frequency shift?
does not meet criteria for scoring of an arousal.
The major goal for defying movement arousals is to?
signal the possibility of a stage change.
Sleep stage percentages may be calculated by using?
total recording time (dark time),total sleep time(total non-REM+total REM), sleep period time (time from sleep onset to sleep offset including intervening arousals)
A REM latency of ———————– would be considered normal in an adult.
90 - 120 minutes.
The total time scored as wakefulness occurring between sleep onset and the final wake up is called?
wake time
REM cycles are calculated?
from the end of one REM period to the beginning of the next.
REM sleep occurring at 7.5 minutes after sleep onset is?
defined as sleep onset REM (SOREM)
When scoring an apnea/hypopnea event of short duration the technologist may notice?
no evident desaturation.
While recording at a sensitivity setting of 5 uV/mm, in order for slow wave to meet R & K scoring criteria for stages 3 or 4 sleep, how many millimeters in amplitude must they measure?
15 mm.
EMG from which muscle groups are used as a criterion for staging REM sleep?
mentalis/submentalis.
During this stage of sleep, the EEG converts to a relatively low-voltage, mixed-frequency pattern, theta activity appears, and eye movements became slow, rolling and disconjugate?
stage 1
These two stages are often combined and termed “slow-wave sleep” (SWS)?
3 and 4
When scoring stage 3 sleep, the amplitude and frequency of the slow waves must be a minimum of?
75uV, and < 2 Hz.
Sleep spindles and K-complexes appear on the EEG what stage of sleep?
stage 2
REM sleep is associated with dreaming and fleeting eye movements as well as?
muscle twitching, a generalized decrease in body tone, irregular respiration, heartbeat, and blood pressure.
Sleep spindles?
are 9-13cps waveforms,wax and wane in amplitude,are at least 0.5 second in duration.
Stage 2 sleep makes up aha percentage of the total sleep time in healthy young adults?
45-55%
When scoring the PSG of an apneic patient, the respiratory disturbance index reflects the?
average number of respiratory events per hour of sleep.
The scoring of a hypopnea requires?
an amplitude reduction in respiratory channels, a drop in 02 saturation.
Arousal thresholds are higher in stage 2 than in stage 1.
true.
REM sleep makes up what percentage of the total sleep time in healthy young adults?
20-25%
K-complexes?
have an initial negative deflection, followed by a positive deflection.
In normal, healthy, young adults, sleep is entered through—————–sleep, whereas infants normally enter sleep through————-sleep.
NREM,REM
The intermittent demostration of sinus block on the ECG should alert the technologist to?
document the occurrence for the polysomnographer.
Before any standard CPR techniques are started on a patient, “Basic Life Support” (BLS) protocols require the healthcare provider to?
establish the patient’s unresponsiveness.
