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Sleep -PSGT > PSG T. Prep > Flashcards

PSG T. Prep Flashcards

1
Q

What is the maximal value for electrode impedances for EEG?

A

5000 Ohms

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2
Q

What is the minimum digital resolution?

A

12 bits per sample

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3
Q

What are the minimal and desirable sampling rates for EEG, EOG, EMG and ECG?

A

Minimal 200 Hz and Desirable 500 Hz

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4
Q

What are the LFF and HFF for EEG channels?

A

0.3 Hz and 35 Hz

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5
Q

What are the LFF and HFF for EOG channels?

A

0.3 Hz and 35 Hz

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6
Q

What are the LFF and HFF for EMG channels?

A

10 Hz and 100 Hz

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7
Q

What are the LFF and HFF for ECG channels?

A

0.3 Hz and 70 Hz

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8
Q

What are the LFF and HFF oronasal thermal flow and thoracoabdominal belt signals?

A

0.1 Hz and 15 Hz

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9
Q

What are the LFF and HFF nasal pressure channels?

A

0.03 Hz and 100 Hz

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10
Q

What are the LFF and HFF for snoring channels?

A

10 Hz and 100 Hz

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11
Q

For EEG, _____ Hz sampling rate and HFF settings may be increased.

A

500

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12
Q

Higher sampling rates on channels for EOG, EMG, ECG _________ define waveforms.

A

better

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13
Q

Which channel is exempt from the digital resolution standard?

A

Body position

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14
Q

Which channel can have a lower sampling rate?

A

Snoring channel

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15
Q

Which channel(s) can have impedances of 10 kOhms?

A

Limb EMG

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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

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17
Q

Each channel must have its own ________ ____ ________.

A

50/60 Hz filter

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18
Q

Recommended montage derivation for EEG is:

A

F4-M1, C4-M1, O2-M1 with F3, C3, O1 and M2 as backups.

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19
Q

Standard electrode positions used are part of the _________ system.

A

10-20

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20
Q

M1 and M2 refer to which electrode placements?

A

left and right mastoid processes

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21
Q

__ - __ is NOT appropriate for measuring the amplitude of frontal activity for determination of slow wave activity.

A

FZ-CZ

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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.

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23
Q

Conjugate eye movements result in ____ __ _____ deflections.

A

Out of phase

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24
Q

Acceptable derivations for EOG channels allow for detection of ______ eye movements.

A

Directional

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25
Q

How many electrodes are required for chin EMG?

A

3

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26
Q

The preferred abbreviations for sleep stages are:

A

W, N1, N2, N3 and R

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27
Q

Epochs are described as sleep if they contain: ____ seconds of sleep sequentially OR at least ______ of the epoch is ________.

A

30, half, sleep

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28
Q

Slow waves in sleep are defined as:

A

0.5-2.0 Hz AND minimum amplitude of 75 uV in Frontal channels

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29
Q

Define the four main frequencies of waveforms on EEG: delta, theta, alpha, beta

A

Delta 0-3.99 Hz, Theta 4-7.99 Hz, Alpha 8-13 Hz, Beta faster than 14 Hz

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30
Q

Wakefulness on EEG channels is defined as:

A

alpha rhythm posterior dominant in the occipital region with eye closure and attenuation to eye opening

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31
Q

Wakefulness is demonstrated in EOG, as: (include description of 4 types of eye movements)

A

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

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32
Q

Wakefulness is scored when the following conditions are met:

A

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

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33
Q

Time away from equipment is scored as ______.

A

wake

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34
Q

Stage N1 sleep is defined as:

A

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)

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35
Q

LAMF is

A

Low amplitude mixed frequency activity on EEG found during N1

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36
Q

Describe the 7 characteristics of scoring N1 sleep.

A

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

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37
Q

What EEG feature is acceptable but NOT required for N1?

A

V waves

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38
Q

What EOG feature is acceptable but NOT required for N1?

A

SEM

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39
Q

Which comes first: SEM or attenuation of alpha?

A

SEM

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40
Q

N2 is defined by:

A

1) K complexes
2) sleep spindles

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41
Q

Well delineated, negative sharp wave followed by a positive wave, lasting >0.5 sec, maximal frontal region

A

K complex

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42
Q

train of distinct sinusoidal waves of 11-16 Hz, lasting >0.5 Hz, seen maximally in the central or vertex region

A

Sleep Spindles

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43
Q

Stage N2 is differentiated from N1 by:

A

K complexes with spindles; or K complexes with arousals; IF K complex without spindles

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44
Q

Where else can spindles be found?

A

Frontal region

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45
Q

When staging sleep, if a K complex occurs in first half of epoch- entire epoch is

A

N2

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46
Q

When staging sleep, if a K complex happens in the second half of epoch, entire epoch is

A

N1

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47
Q

If a delay exists between arousal and K complex, epoch is

A

N1

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48
Q

Stage N2 is scored when the following criteria are met:

A

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

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49
Q

N2 scoring stops when:

A

a) transition to W, N3 or R
b) arousal with LAMF
c) Major body movement followed by SEM & LAMF

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50
Q

N3 sleep is defined by:

A

slow wave activity (0.5-2 Hz)
>75 uV
Frontal region

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51
Q

N3 sleep is scored when:

A

> 20% of epoch consists of slow wave activity regardless of age

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52
Q

Stage N4 sleep is defined by

A

Trick question- no longer defined separately. N4 is replaced with N3.

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53
Q

T/F K complex can be considered a slow wave.

A

True -if it meets slow wave activity criteria, of 0.5-2 hz, > 75 uV and frontal

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54
Q

T/F N3 sleep does NOT have spindles.

A

False- spindles may be present in N3 sleep.

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55
Q

REM sleep is defined by the following criteria:

A

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

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56
Q

REM is scored when the following criteria are met:

A

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

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57
Q

Scoring for REM ends when:

A

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

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58
Q

Majority of epoch rule applies to which stages?

A

N2 and REM

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59
Q

First half and last half of epoch rule apply to which stages?

A

N2 and REM

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60
Q

T/F Alpha can increase in REM for some people.

A

True, but it is slower in REM than during wakefulness, just more abundant.

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61
Q

If SEM occur during REM, they must be accompanied by __ _________ to change the scoring to N1.

A

an arousal

62
Q

REM, low chin EMG and sleep spindles and/or K complexes typically occur during the ______ ____ ______ of the night.

A

first REM period

63
Q

Major body movements are defined as

A

movement or muscle artifact obscuring the EEG for MORE than half of an epoch

64
Q

If major body movement and <15 second of alpha is present, score is

A

wake

65
Q

Epoch 1 - W, Epoch 3 is N2, epoch 2 has a major body movement with no discernable alpha, what is epoch 2 scored as?

A

Wake

66
Q

Epoch 1 - N2, Epoch 3 - N2, epoch 2 has a major body movement with no discernable alpha, what is the score for epoch 2?

A

N2

67
Q

Arousals are defined by:

A

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
Q

T/F An arousal cannot be scored if the 10 seconds of stable sleep occurred during an epoch marked wake.

A

False - as long as the 10 seconds of stable sleep occurred immediately prior to the arousal, an arousal can be scored.

69
Q

Arousals are scored from what derivations?

A

central and occipital

70
Q

Which channel must be included to score arousals?

A

EEG

71
Q

A simple description for placement of cardiac leads in sleep is

A

passenger seatbelt

72
Q

Artifact is minimized in cardiac leads by using what application?

A

standard ECG electrode application

73
Q

Sinus Tachycardia

A

sustained >90 beats/minute in adults

74
Q

Bradycardia

A

sustained <40 beats/minute for ages 6+

75
Q

Asystole

A

No beat for more than 3 seconds for ages 6+

76
Q

V-Tach

A

Also known as wide complex tachycardia - 3 consecutive beats >100 beats/minute, QRS duration of >120 msec

77
Q

SVT

A

Superventricular tachycardia, narrow complex tachycardia - 3 consecutive beats >100 beats/minute, QRS of <120 msec

78
Q

Atrial Fibrillation

A

irregularly irregular ventricular rhythm WITH consistent P waves, rapid oscillation, variable sizing, shapes and timing

79
Q

Sinus rates are _____ in children than in adults

A

Faster

80
Q

Sustained sinus bradycardia or tachycardia must have ___ seconds of stable rhythm.

A

30

81
Q

Report significant arrhythmias if:

A

ECG is quality recording

82
Q

Report ectopic beats if:

A

clinically significant

83
Q

Leg movement monitors are placed

A

1) longitudinally
2) symmetrically
3) middle of anterior tibialis
4) bilaterally

84
Q

T/F Impedances for leg movement monitors can be <25 kOhms.

A

False, should be <10 kOhms, but <5 is ideal.

85
Q

T/F Notch filter should be avoided on leg movement monitors.

A

True

86
Q

Leg movements are not scored if:

A

occurring within a 0.5 second window before or after any respiratory event

87
Q

What is the cutoff time frame for an associated arousal and limb movement?

A

within 0.5 seconds

88
Q

How many arousals are scored when multiple PLMs (periodic limb movements) and associated 3 sec arousals occur within 10 seconds?

A

Only the first arousal is scored.

89
Q

Which muscles are monitored in the upper extremities for PLMS?

A

Flexor Digitorum Superficialis
Extensor Digitorum Communis

90
Q

What condition is monitored with leads on the masseter muscle?

A

Bruxism

91
Q

What additional monitoring is essential for the diagnosis of RMD (rhythmic movement disorder)?

A

Video PSG

92
Q

What action should the patient perform to calibrate leads on the anterior tibialis?

A

point toes toward head

93
Q

What action should the patient perform to calibrate leads on the flexor digitorum superficialis?

A

bend at base of fingers

94
Q

What action should the patient perform to calibrate the leads on the extensor digitorum communis?

A

extend fingers back without moving the wrist

95
Q

What action should the patient perform to calibrate the leads on the masseter muscle?

A

bite down

96
Q

Define a significant leg movement event.

A

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
Q

PLMS are scored based on: number ____ and period ___ _____ ____ -onset to onset.

A

4 Limb movements
5-90 seconds apart

98
Q

Leg movements on 2 different legs, within 5 seconds are counted as ___ ____

A

1 limb movement

99
Q

ALMA (define term)

A

Alternating Leg Muscle Activation
4 alternating LM
Frequency 0.5-30 Hz
Alternating between legs
duration of 100-500 msec
benign

100
Q

HFT (define term)

A

Hypnagogic Foot Tremor
4 bursts
0.5-4.0 Hz
duration 250-1000 msec
benign movement

101
Q

EFM (define term)

A

Excessive Fragmentary Myoclonus
duration 150 msec
20 min of NREM sleep
5 EMG potentials/min
benign movement

102
Q

Bruxism (define term)

A

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
Q

RBD (define term)

A

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
Q

T/F Transient EMG and occasional visible twitching of small muscle groups are normal in REM.

A

True

105
Q

RBD is a loss of ______ during REM sleep.

A

atonia

106
Q

RMD (define term)

A

Rhythmic Movement Disorder
1) Freq: 0.5-2.0 Hz
2) >/= 4 mvmts
3) 2x background EMG activity

107
Q

What tool is used to measure apneas?

A

Oronasal thermal airflow sensor

108
Q

What tool is used to measure hypopneas?

A

nasal pressure transducer

109
Q

What tools are used to measure respiratory effort?

A

esophageal manometry, RIP betls and PVDF belts

110
Q

Duration of an apnea or hypopnea is measured by

A

a) nadir preceding first breath clearing reduced
b) to beginning of first breath returned to baseline

111
Q

Apneas are scored when

A

BOTH 90% or greater drop from baseline AND at least 10 seconds

112
Q

Obstructive apneas are scored when

A

continued or increased inspiratory effort throughout event

113
Q

Central apneas are scored when

A

absent inspiratory effort throughout event

114
Q

Mixed apneas are scored when

A

absent of inspiratory effort for first part of event AND/OR followed by resumption of inspiratory effort

115
Q

T/F Apnea has to have a desaturation.

A

False - desat is NOT required to score an apnea

116
Q

If event qualifies for hypopnea and apnea

A

Score apnea

117
Q

1A Hypopnea

A

> 30% drop for >10 sec AND
3% desat from baseline OR arousal

118
Q

1B Hypopnea

A

> 30% drop for >10 sec AND
4% desat from baseline

119
Q

Obstructive hypopnea

A

any snoring, inspiratory flattening or paradox breathing

120
Q

Central hypopnea

A

NONE snoring, inspiratory flattening, or paradox breathing

121
Q

RERA in adults

A

sequence of breath >10 seconds
increased respiratory effort
flattening of inspiratory signal leading to arousal

122
Q

Hypoventilation

A

EITHER:
-increase in PC02 >55 mmHg for >10 min
OR
->10 mmHg increase in PC02 during sleep and exceeds 50 mmHg >10 min

123
Q

What is the conversion factor for hypoventilation scoring?

A

1 mmHg = 0.133kPa

124
Q

Cheyne Stokes Breathing

A

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
Q

Define cycle length for Cheyne Stokes Breathing

A

time from beginning of CA to end of next C/D respiratory phase

126
Q

HSAT Recommended parameters are:

A

type of device
type of airflow sensors
type of respiratory effort sensor
oxygen saturation
heart rate

127
Q

HSAT options parameters are

A

body position
sleep/wake/REM time estimates
snoring (acoustic, piezo-electric, or pressure transducer)

128
Q

To ID respiratory events on HSAT use:

A

At least one of:
oronasal thermal airflow sensor
nasal pressure transducer
RIPsum/RIPflow
PVDFsum

129
Q

To monitoring respiratory effort on HSAT use:

A

One of the following in either single or dual models:
thoracoabdominal RIP/PVDF/Piezo belts
Pneumatic belts

130
Q

HSAT oxygen saturation use

A

pulse ox

131
Q

To monitor snoring in HSAT

A

use ONE of the following
acoustic sensor
piezo electric sensor
nasal pressure transucer

132
Q

HSAT score apnea if:

A

BOTh - peak signal drop >90% of baseline AND duration of drop is >10 seconds

133
Q

HSAT score obstructive if

A

meets apnea criteria AND
continued/increased effort throughout absent airflow

134
Q

HSAT score central if

A

meets apnea criteria AND NO effort throughout absent airflow

135
Q

HSAT score mixed if

A

meets apnea criteria with initial absent effort followed by effort with no airflow

136
Q

HSAT Hypopnea - is rule 1 or rule 2 scored if NO sleep is recorded?

A

Rule 1

137
Q

HSAT Hypopnea - is A or B scored if >4% O2 desat?

A

B

138
Q

T/F HSAT Hypopnea is peak excursion drop of >50% of pre event baseline.

A

False - >30% drop

139
Q

In HSAT, PAT stands for

A

Peripheral Arterial Tonometry

140
Q

In HSAT, surrogate AHI is based on

A

estimated sleep time from actigraphy

141
Q

In HSAT, raw tracings must be available in detail with the

A

ability to edit events.

142
Q

HSAT requires at least ____ airflow sensor(s).

A

1

143
Q

Monitoring time (MT) is defined as

A

total recording time minus periods of artifact and time patient was awake

144
Q

REI is

A

respiratory event index

145
Q

In HSAT, MT replaces

A

TRT - total recording time

146
Q

Supplemental oxygen may blunt __________.

A

desaturations.

147
Q

RIPsum is the sum of signal for

A

chest and abdomen belts

148
Q

T/F Monitoring snoring and hypoventilation is optional.

A

True

149
Q

T/F Transient muscle activity and occasional visible twitching of small muscle groups are a normal phenomenon seen in N2 sleep.

A

False, seen in REM

150
Q

T/F Sinus rates vary by age with adults faster than children.

A

False, children sinus rates are faster than adults.

Sleep -PSGT (1 decks)

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