PSG T. Prep Flashcards
1
Q
What is the maximal value for electrode impedances for EEG?
A
5000 Ohms
2
Q
What is the minimum digital resolution?
A
12 bits per sample
3
Q
What are the minimal and desirable sampling rates for EEG, EOG, EMG and ECG?
A
Minimal 200 Hz and Desirable 500 Hz
4
Q
What are the LFF and HFF for EEG channels?
A
0.3 Hz and 35 Hz
5
Q
What are the LFF and HFF for EOG channels?
A
0.3 Hz and 35 Hz
6
Q
What are the LFF and HFF for EMG channels?
A
10 Hz and 100 Hz
7
Q
What are the LFF and HFF for ECG channels?
A
0.3 Hz and 70 Hz
8
Q
What are the LFF and HFF oronasal thermal flow and thoracoabdominal belt signals?
A
0.1 Hz and 15 Hz
9
Q
What are the LFF and HFF nasal pressure channels?
A
0.03 Hz and 100 Hz
10
Q
What are the LFF and HFF for snoring channels?
A
10 Hz and 100 Hz
11
Q
For EEG, _____ Hz sampling rate and HFF settings may be increased.
A
500
12
Q
Higher sampling rates on channels for EOG, EMG, ECG _________ define waveforms.
A
better
13
Q
Which channel is exempt from the digital resolution standard?
A
Body position
14
Q
Which channel can have a lower sampling rate?
A
Snoring channel
15
Q
Which channel(s) can have impedances of 10 kOhms?
A
Limb EMG
16
Q
What is the required display size for scoring and review of sleep data?
A
15 in screen, 1600 horizontal pixels, 1050 vertical pixels
17
Q
Each channel must have its own ________ ____ ________.
A
50/60 Hz filter
18
Q
Recommended montage derivation for EEG is:
A
F4-M1, C4-M1, O2-M1 with F3, C3, O1 and M2 as backups.
19
Q
Standard electrode positions used are part of the _________ system.
A
10-20
20
Q
M1 and M2 refer to which electrode placements?
A
left and right mastoid processes
21
Q
__ - __ is NOT appropriate for measuring the amplitude of frontal activity for determination of slow wave activity.
A
FZ-CZ
22
Q
Recommended EOG derivation and placement are:
A
E1-M2, E2-M2 with placements of E1 1 cm below and 1 cm lateral left outer canthus; E2 1 cm above and 1 cm lateral right outer canthus.
23
Q
Conjugate eye movements result in ____ __ _____ deflections.
A
Out of phase
24
Q
Acceptable derivations for EOG channels allow for detection of ______ eye movements.
A
Directional
25
How many electrodes are required for chin EMG?
3
26
The preferred abbreviations for sleep stages are:
W, N1, N2, N3 and R
27
Epochs are described as sleep if they contain: ____ seconds of sleep sequentially OR at least ______ of the epoch is ________.
30, half, sleep
28
Slow waves in sleep are defined as:
0.5-2.0 Hz AND minimum amplitude of 75 uV in Frontal channels
29
Define the four main frequencies of waveforms on EEG: delta, theta, alpha, beta
Delta 0-3.99 Hz, Theta 4-7.99 Hz, Alpha 8-13 Hz, Beta faster than 14 Hz
30
Wakefulness on EEG channels is defined as:
alpha rhythm posterior dominant in the occipital region with eye closure and attenuation to eye opening
31
Wakefulness is demonstrated in EOG, as: (include description of 4 types of eye movements)
1) Eye blinks - vertical eye movements 0.5-2 Hz; 2) Reading eye movements - slow followed by rapid phase
3) Rapid eye mvmts (REM) - irregular lasting <500 msec
4) Slow eye mvmts (SEM) - more regular, lasting >500 msec
32
Wakefulness is scored when the following conditions are met:
a) more than 50% of epoch is alpha in the occipital region
b) AND/OR any of the following: 1) eye blinks, 2) REM with normal chin muscle tone, 3) Reading eye movements
33
Time away from equipment is scored as ______.
wake
34
Stage N1 sleep is defined as:
1) Slow eye movements (SEM)
2) Low amplitude mixed frequency activity EEG (LAMF) (theta)
3) Vertex sharp waves (V waves) central region
4) Sleep onset - first epoch of any stage other than Wake (W)
35
LAMF is
Low amplitude mixed frequency activity on EEG found during N1
36
Describe the 7 characteristics of scoring N1 sleep.
1) PDR (Alpha) attenuated by 50% of LAMF
2) LAMF, V waves, SEM
3) Majority of epoch meets 1 and/or 2 AND absence of ANY other stage
4) Continue N1 until identifies another stage
5) When arousal in N2 - SCORE N1 if LAMF, - K/spindles or any other stage sleep
6) When arousal in REM- score N1 if LAMF, - alpha, + SEM, +chin at REM level
7) N1 until another stage identified
37
What EEG feature is acceptable but NOT required for N1?
V waves
38
What EOG feature is acceptable but NOT required for N1?
SEM
39
Which comes first: SEM or attenuation of alpha?
SEM
40
N2 is defined by:
1) K complexes
2) sleep spindles
41
Well delineated, negative sharp wave followed by a positive wave, lasting >0.5 sec, maximal frontal region
K complex
42
train of distinct sinusoidal waves of 11-16 Hz, lasting >0.5 Hz, seen maximally in the central or vertex region
Sleep Spindles
43
Stage N2 is differentiated from N1 by:
K complexes with spindles; or K complexes with arousals; IF K complex without spindles
44
Where else can spindles be found?
Frontal region
45
When staging sleep, if a K complex occurs in first half of epoch- entire epoch is
N2
46
When staging sleep, if a K complex happens in the second half of epoch, entire epoch is
N1
47
If a delay exists between arousal and K complex, epoch is
N1
48
Stage N2 is scored when the following criteria are met:
a) does not meet N3
b) if last half of previous epoch OR first half of current epoch has >/= 1 k complex or spindle
c) majority of epoch meets N2
d) same/next epoch has arousal - epoch BEFORE arousal is N2
e) epochs with k complex/spindles followed by LAMF & NO arousal - N2
f) Epoch following N3 - NOT N3, W, or R is N2
49
N2 scoring stops when:
a) transition to W, N3 or R
b) arousal with LAMF
c) Major body movement followed by SEM & LAMF
50
N3 sleep is defined by:
slow wave activity (0.5-2 Hz)
>75 uV
Frontal region
51
N3 sleep is scored when:
>20% of epoch consists of slow wave activity regardless of age
52
Stage N4 sleep is defined by
Trick question- no longer defined separately. N4 is replaced with N3.
53
T/F K complex can be considered a slow wave.
True -if it meets slow wave activity criteria, of 0.5-2 hz, > 75 uV and frontal
54
T/F N3 sleep does NOT have spindles.
False- spindles may be present in N3 sleep.
55
REM sleep is defined by the following criteria:
a) REM - rapid eye movements, irregular, <500 msec
b) LOW chin EMG - lowest of entire recording
c) Sawtooth waves maximal central region
d) Transient, brief, irregular EMG <0.25 seconds
56
REM is scored when the following criteria are met:
1) LAMF EEG activity
2) LOW chin EMG majority of epoch
3) Absence of K complexes and/or spindles
4) REMs
5) NO arousals
6) Continue R if MAJORITY of epoch contains segment meeting R
57
Scoring for REM ends when:
1) Transition to another stage W, N2, N3
2) Increase in CHIN EMG
3) Arousal w/ LAMF & SEM
4) Major body movement with LAMF/SEM, decrease in CHIN EMG
5) Arousal associated K complexes/spindles in FIRST half & NO REMs
58
Majority of epoch rule applies to which stages?
N2 and REM
59
First half and last half of epoch rule apply to which stages?
N2 and REM
60
T/F Alpha can increase in REM for some people.
True, but it is slower in REM than during wakefulness, just more abundant.
61
If SEM occur during REM, they must be accompanied by __ _________ to change the scoring to N1.
an arousal
62
REM, low chin EMG and sleep spindles and/or K complexes typically occur during the ______ ____ ______ of the night.
first REM period
63
Major body movements are defined as
movement or muscle artifact obscuring the EEG for MORE than half of an epoch
64
If major body movement and <15 second of alpha is present, score is
wake
65
Epoch 1 - W, Epoch 3 is N2, epoch 2 has a major body movement with no discernable alpha, what is epoch 2 scored as?
Wake
66
Epoch 1 - N2, Epoch 3 - N2, epoch 2 has a major body movement with no discernable alpha, what is the score for epoch 2?
N2
67
Arousals are defined by:
1) sudden shift in EEG frequency (anything above delta)
2) must be >3 seconds
3) must follow >10 seconds of stable sleep
4) If during REM - chin EMG must increase simultaneously for >1 second
68
T/F An arousal cannot be scored if the 10 seconds of stable sleep occurred during an epoch marked wake.
False - as long as the 10 seconds of stable sleep occurred immediately prior to the arousal, an arousal can be scored.
69
Arousals are scored from what derivations?
central and occipital
70
Which channel must be included to score arousals?
EEG
71
A simple description for placement of cardiac leads in sleep is
passenger seatbelt
72
Artifact is minimized in cardiac leads by using what application?
standard ECG electrode application
73
Sinus Tachycardia
sustained >90 beats/minute in adults
74
Bradycardia
sustained <40 beats/minute for ages 6+
75
Asystole
No beat for more than 3 seconds for ages 6+
76
V-Tach
Also known as wide complex tachycardia - 3 consecutive beats >100 beats/minute, QRS duration of >120 msec
77
SVT
Superventricular tachycardia, narrow complex tachycardia - 3 consecutive beats >100 beats/minute, QRS of <120 msec
78
Atrial Fibrillation
irregularly irregular ventricular rhythm WITH consistent P waves, rapid oscillation, variable sizing, shapes and timing
79
Sinus rates are _____ in children than in adults
Faster
80
Sustained sinus bradycardia or tachycardia must have ___ seconds of stable rhythm.
30
81
Report significant arrhythmias if:
ECG is quality recording
82
Report ectopic beats if:
clinically significant
83
Leg movement monitors are placed
1) longitudinally
2) symmetrically
3) middle of anterior tibialis
4) bilaterally
84
T/F Impedances for leg movement monitors can be <25 kOhms.
False, should be <10 kOhms, but <5 is ideal.
85
T/F Notch filter should be avoided on leg movement monitors.
True
86
Leg movements are not scored if:
occurring within a 0.5 second window before or after any respiratory event
87
What is the cutoff time frame for an associated arousal and limb movement?
within 0.5 seconds
88
How many arousals are scored when multiple PLMs (periodic limb movements) and associated 3 sec arousals occur within 10 seconds?
Only the first arousal is scored.
89
Which muscles are monitored in the upper extremities for PLMS?
Flexor Digitorum Superficialis
Extensor Digitorum Communis
90
What condition is monitored with leads on the masseter muscle?
Bruxism
91
What additional monitoring is essential for the diagnosis of RMD (rhythmic movement disorder)?
Video PSG
92
What action should the patient perform to calibrate leads on the anterior tibialis?
point toes toward head
93
What action should the patient perform to calibrate leads on the flexor digitorum superficialis?
bend at base of fingers
94
What action should the patient perform to calibrate the leads on the extensor digitorum communis?
extend fingers back without moving the wrist
95
What action should the patient perform to calibrate the leads on the masseter muscle?
bite down
96
Define a significant leg movement event.
Duration 0.5-10 sec
Amplitude: Increase of 8 uV ABOVE resting EMG
Timing: EITHER a) point where 8 uV increase happened OR b) point of amplitude drop to 2 uV, after 0.5 sec duration
97
PLMS are scored based on: number ____ and period ___ _____ ____ -onset to onset.
4 Limb movements
5-90 seconds apart
98
Leg movements on 2 different legs, within 5 seconds are counted as ___ ____
1 limb movement
99
ALMA (define term)
Alternating Leg Muscle Activation
4 alternating LM
Frequency 0.5-30 Hz
Alternating between legs
duration of 100-500 msec
benign
100
HFT (define term)
Hypnagogic Foot Tremor
4 bursts
0.5-4.0 Hz
duration 250-1000 msec
benign movement
101
EFM (define term)
Excessive Fragmentary Myoclonus
duration 150 msec
20 min of NREM sleep
5 EMG potentials/min
benign movement
102
Bruxism (define term)
brief OR sustained elevations of chin EMG
BRIEF: 0.25-2 seconds & episodes sequentially
Sustained: duration of >2 seconds
>2x background chin EMG
separated by >3 sec stable background
103
RBD (define term)
REM Sleep Behavior disorder
1) Tonic sustained activity in >50% of epoch
2) Phasic excessive transient muscle activity in >50% of 10-"3 second mini epochs"
3) Either or BOTH - sustained EMG in chin and/or excessive transient EMG chin/limb during REM
104
T/F Transient EMG and occasional visible twitching of small muscle groups are normal in REM.
True
105
RBD is a loss of ______ during REM sleep.
atonia
106
RMD (define term)
Rhythmic Movement Disorder
1) Freq: 0.5-2.0 Hz
2) >/= 4 mvmts
3) 2x background EMG activity
107
What tool is used to measure apneas?
Oronasal thermal airflow sensor
108
What tool is used to measure hypopneas?
nasal pressure transducer
109
What tools are used to measure respiratory effort?
esophageal manometry, RIP betls and PVDF belts
110
Duration of an apnea or hypopnea is measured by
a) nadir preceding first breath clearing reduced
b) to beginning of first breath returned to baseline
111
Apneas are scored when
BOTH 90% or greater drop from baseline AND at least 10 seconds
112
Obstructive apneas are scored when
continued or increased inspiratory effort throughout event
113
Central apneas are scored when
absent inspiratory effort throughout event
114
Mixed apneas are scored when
absent of inspiratory effort for first part of event AND/OR followed by resumption of inspiratory effort
115
T/F Apnea has to have a desaturation.
False - desat is NOT required to score an apnea
116
If event qualifies for hypopnea and apnea
Score apnea
117
1A Hypopnea
>30% drop for >10 sec AND
>3% desat from baseline OR arousal
118
1B Hypopnea
>30% drop for >10 sec AND
>4% desat from baseline
119
Obstructive hypopnea
any snoring, inspiratory flattening or paradox breathing
120
Central hypopnea
NONE snoring, inspiratory flattening, or paradox breathing
121
RERA in adults
sequence of breath >10 seconds
increased respiratory effort
flattening of inspiratory signal leading to arousal
122
Hypoventilation
EITHER:
-increase in PC02 >55 mmHg for >10 min
OR
->10 mmHg increase in PC02 during sleep and exceeds 50 mmHg >10 min
123
What is the conversion factor for hypoventilation scoring?
1 mmHg = 0.133kPa
124
Cheyne Stokes Breathing
BOTH
>3 consecutive CA or CH separated by a crescendo AND decrescendo in amplitude in a cycle for >40 seconds. AND
>5 CA or CH per hour of sleep over 2 hrs of monitoring
125
Define cycle length for Cheyne Stokes Breathing
time from beginning of CA to end of next C/D respiratory phase
126
HSAT Recommended parameters are:
type of device
type of airflow sensors
type of respiratory effort sensor
oxygen saturation
heart rate
127
HSAT options parameters are
body position
sleep/wake/REM time estimates
snoring (acoustic, piezo-electric, or pressure transducer)
128
To ID respiratory events on HSAT use:
At least one of:
oronasal thermal airflow sensor
nasal pressure transducer
RIPsum/RIPflow
PVDFsum
129
To monitoring respiratory effort on HSAT use:
One of the following in either single or dual models:
thoracoabdominal RIP/PVDF/Piezo belts
Pneumatic belts
130
HSAT oxygen saturation use
pulse ox
131
To monitor snoring in HSAT
use ONE of the following
acoustic sensor
piezo electric sensor
nasal pressure transucer
132
HSAT score apnea if:
BOTh - peak signal drop >90% of baseline AND duration of drop is >10 seconds
133
HSAT score obstructive if
meets apnea criteria AND
continued/increased effort throughout absent airflow
134
HSAT score central if
meets apnea criteria AND NO effort throughout absent airflow
135
HSAT score mixed if
meets apnea criteria with initial absent effort followed by effort with no airflow
136
HSAT Hypopnea - is rule 1 or rule 2 scored if NO sleep is recorded?
Rule 1
137
HSAT Hypopnea - is A or B scored if >4% O2 desat?
B
138
T/F HSAT Hypopnea is peak excursion drop of >50% of pre event baseline.
False - >30% drop
139
In HSAT, PAT stands for
Peripheral Arterial Tonometry
140
In HSAT, surrogate AHI is based on
estimated sleep time from actigraphy
141
In HSAT, raw tracings must be available in detail with the
ability to edit events.
142
HSAT requires at least ____ airflow sensor(s).
1
143
Monitoring time (MT) is defined as
total recording time minus periods of artifact and time patient was awake
144
REI is
respiratory event index
145
In HSAT, MT replaces
TRT - total recording time
146
Supplemental oxygen may blunt __________.
desaturations.
147
RIPsum is the sum of signal for
chest and abdomen belts
148
T/F Monitoring snoring and hypoventilation is optional.
True
149
T/F Transient muscle activity and occasional visible twitching of small muscle groups are a normal phenomenon seen in N2 sleep.
False, seen in REM
150
T/F Sinus rates vary by age with adults faster than children.
False, children sinus rates are faster than adults.
