Domain 1: Clinical Overview, Education, Patient Support

Question 1

What is the importance of Reviewing a patient’s medical records prior to a sleep study?

Answer 1

It’s necessary to evaluate the appropriateness of ordered procedures and treat-ments, for patient identification and safety, as well as to anticipate precautions, interventions, and patient needs
during testing.

Question 2

What are the two types of physician orders?

Answer 2

Written and Verbal

Question 3

What is the purpose of reviewing physicians orders?

Answer 3

To provide clarification of procedures and to help understand a reason for referral.

Question 4

What are examples of things you should look over during the patients history review.

Answer 4

Health/past med history, ROS , Indications for testing, Meds, Allergies, Differential diagnosis.

Question 5

Describe a Sleep Diary

Answer 5

-Shows sleep habits over 2 weeks
-Usually 2 components: before sleep and after awakening.
-Mood scale/med lists/#of arousals
-Used to compare patients perception of sleep to PSG

Question 6

Describe a Pre-Sleep Questionnaire

Answer 6

• Assess the last 24 hours
  -Contains sleep prep, patterns, problems, aids, Medications, Daytime schedule

Question 7

Describe the Stanford Sleepiness Scale

Answer 7

Brief assessment used to measure excessive daytime sleepiness at diff. times during the day.
-Seven descriptors that increase in levels of the day (1-fully alert, 7-Nearing onset of sleep & awake dreaming).

Question 8

Describe the Epworth Sleepiness Scale

Answer 8

Evaluates how likely a person is to fall asleep during a number of activities.
- Rates each activity on a scale of 0 to 3, three being the highest chance of falling asleep.

Question 9

Describe the Sleep -Wake Activity Inventory (SWAI)

Answer 9

Measures different aspects of sleep disorders (EDS, Relaxing ability, Social Desirability).
-9 Statements, scale of 1(always) to 9 (never present)
- Less than 40= EDS, greater than 50=Normal

Question 10

Describe the Berlin Questionnaire

Answer 10

Screening for OSA/progress while on PAP
-14 questions & 3 categories (Category 1=Snoring, Category 2=Daytime fatigue, Category 3=Hypertension)
- High or low risk per findings/ positive in 2 or more is high risk

Question 11

Describe the Fatigue Severity Scale

Answer 11

9 descriptions related to fatigue.
- Scale of 1(Strongly disagree) to 9(Strongly agree)
-9-35=Normal, Greater than 35= Fatigue

Question 12

How do you properly confirm patients’ identification?

Answer 12

• Confirmed by Tech
• Follow company protocols
• 2 Patient identifiers on all Patient records

Question 13

What are the American Medical Associations guidelines for Informed Consents?

Answer 13

-Explanation of diagnosis
- Reason for treatment
- Explanation of risks/benefits
- Alternative options and their risks/benefits

Question 14

What does HIPPA stand for and what is the purpose?

Answer 14

-Health Insurance Portability and Accountability Act
-Protects the privacy of individually identifiable health info, and the confidentiality provisions of the patient safety rules and regulations. This is enforced by the Office for Civil Rights.

Question 15

List Different Types of Body Positions

Answer 15

• Supine
• Prone
  -Lateral

Question 16

List Types of Body Movements and their meanings

Answer 16

• Gait: Mannor of walking or moving on foot
  Extension: movement that increases the angle between two body parts
  Flexion: movement that decreases the angle between two body parts
  Plantarflexion: extension at the ankle
  Dorsiflexion: flexion at the ankle

Question 17

You should have a proper understanding of Anatomical Locations, please list 4 and describe.

Answer 17

Ex. Anterior
Posterior
Ventral
Dorsal
Posterior
Inferior

Question 18

What is the importance of Patient Assessment and Orientation?

Answer 18

Patient assessment helps you monitor the safety and
status of your patient, and determine the patient’s ability
to tolerate and comply with ordered procedures and
treatments. Appropriate orientation and education puts
the patient at ease and allows you to gain the patient’s
support and confidence.

Question 19

Please give examples of education and assessment techniques.

Answer 19

• Cardio-Respiratory Assessment
• Mental Status Evaluation
  -Pain Assessment
• Physical Needs and Accommodations
• Ability to comply with treatments
• Patient edu. in procedures, facility, potential therapy , post procedures.

Question 20

How many classifications are their in the International Classification of Sleep Disorders.

Answer 20

• 8 Major classifications and each has a number of subcategories

Question 21

List classifications of the ICSD

Answer 21

1. Insomnia
2. Sleep Related Breathing Disorders
3. Hypersomnia’s of Central Origin
4. Circadian Rhythm Sleep Disorder
5. Parasomnias
6. Sleep Related Movement Disorders ‘
7. Isolated Symptoms, Apparently Normal Variants, and Unresolved Issues
   - Other Sleep Disorders

Question 22

Classification 1: Insomnia
Describe characteristics of disorders that produce a complaint of insomnia and how many disorders are identified?

Answer 22

• Persistent difficulty w/sleep initiation, duration, consolidation, or quality
  -Occurs despite adequate time and opportunity for sleep
• Results in some form of daytime impairment
• 11 disorders identified

Question 23

Classification 2: Sleep Related Breathing Disorder
Describe characteristics of class 2 disorders and how many disorders are identified?

Answer 23

• Characterized by disordered respiration during sleep
• 4 sub categories with 14 disorders listed

Question 24

Classification 3: Hypersomnia’s
Describe characteristics of class 3 disorders and how many disorders are identified?

Answer 24

• Primary complaint is daytime sleepiness, there’s no general diagnostic criteria listed
• 12 Disorders in this on category

Question 25

Classification 4: Circadian Rhythm Sleep Disorders
Describe characteristics of class 4 disorders and how many categories are identified

Answer 25

• Arises when physical environment is altered relative to internal circadian timing or circadian timing system is altered relative to the external environment
• 9 categories

Question 26

Classification 5: Parasomnias
Describe characteristics of class 5 disorders and how many categories and disorders are identified.

Answer 26

• Undesirable physical events or experiences that occur during entry/within/arousals from sleep.
• Abnormal sleep related movements, behaviors, emotions, perceptions, dreaming
  -4 categories with 15 disorders

Question 27

Classification 6: Sleep Related Movement Disorders
Describe characteristics of class 6 and how many categories and how many disorders are identified.

Answer 27

• Characterized by stereotyped movements that disturb sleep or monophasic movements like leg cramps
• 8 disorders

Question 28

Classification 7: Isolated symptoms, Apparently Normal Variants and Unresolved Issues
Describe and list disorders.

Answer 28

• Lie between normal and abnormal sleep
  -EX. Light intermittent snoring
• 9 Disorders

Question 29

Classification 8: Other Sleep Disorders
Describe and list categories.

Answer 29

• Cannot be classified in other groups. Overlaps categories, Insufficient data to establish another diagnosis, new disorder not yet described well enough.
• 3 Categories

Question 30

List Common Psychiatric Drugs and their effect on PSG Testing.

Answer 30

• Amitriptyline, doxepin, imipramine, trimipramine, clomipramine, desipramine, nortriptyline, protriptyline.
  -Increase TST and PLMs, Decrease W and REM

Question 31

What are the common effects of SSRIs on sleep?

Answer 31

-In general, it will increase W, Decrease TST and REM. (may increase PLMs)

Question 32

What are common effects of cardiac drugs on sleep?

Answer 32

• In general, will increase W, TWT, S1 and decrease REM, SWS, TST

Question 33

What are common effects of Seizure Drugs on sleep?

Answer 33

In general, will decrease SL, SWS, REM. Possibly will increase spindle activity.

Question 34

What are aspects of patient and caregiver education?

Answer 34

• Sleep hygiene, Importance of therapy and sleep disorders

Question 35

What are aspects of compliance support for patients?

Answer 35

• Discussing desensitization techniques, Education of PAP application and mechanics, and discussing compliance reports and how to read them.