Scoring and Sleep Stages (D-41 - D-48)

Question 1

When should you score a respiratory event as a hypopnea event?

Answer 1

Peak signal excursions drop by 30% or greater of pre-event baseline using nasal pressure, PAP device flow, or an alternative hypopnea sensor.
Must last for 10 seconds.
O2sat must drop by 3% and an arousal occurs

Question 2

How long does a hypopnea event have to last to score it?

Answer 2

10 seconds

Question 3

To score a hypopnea event, the O2sat must drop by ___% with an arousal or ___% without an arousal.

Answer 3

3% with arousal

4% without an arousal.

Question 4

When should you score a RERA?

Answer 4

Score a Respiratory Effort Related Arousal if
Increasing resp effort
Flattening of the inspiratory portion of the flow waveform.
…And leads to arousal from sleep

Question 5

When should you score consecutive Cheyne-Stokes breathing patterns?
How long does it have to last?

Answer 5

An episode of more than 3 consecutive central apneas or central hypopneas with a crescendo-decrescendo breathing pattern.
Must last for greater than 40 seconds.

Question 6

When should you score non-consecutive Cheyne-Stokes breathing patterns?
How often should these patterns be seen?

Answer 6

There are greater than 5 central apneas or central hypopneas with a crescendo-decrescendo breathing pattern over 2+ hours of monitoring.

Question 7

When you hear the term “Crescendo” and “Decrescendo”, think of this breathing pattern.

Answer 7

Cheyne-Stokes Breathing

Question 8

When doing home sleep apnea testing (HSAT), what has to be reported? (x5)

Answer 8

Type of device
Type of airflow sensor
Type of respiratory effort sensor(s)
O2saturation
Heart rate

Question 9

What does HSAT stand for?

Answer 9

Home Sleep Apnea Testing

Question 10

What TIME data do you have to report in HSAT? (x4)

Answer 10

Recording start time
Recording end time
Total recording time
Monitoring time (Monitoring time is not the same as recording time)

Question 11

What SLEEP DATA do you have to report in HSAT? (x5)

Answer 11

Heart rate average, highest, and lowest
Number of apneas
Number of hypopneas

Question 12

What is an REI? How is it calculated?

Answer 12

Respiratory Event Index

Monitoring time = # resp events x 60 divided by TST in minutes

Question 13

What is an AHI? How is it calculated?

Answer 13

Apnea Hypopnea Index

(# apneas + #hypopneas x 60) divided by TST in minutes.

Question 14

What is an ODI? How is it calculated?

Answer 14

Oxygen Desaturation Index
#O2 desaturations >3-4% x 60) divided by MT in minutes.

Question 15

If you have to report a measure of O2 saturation, you should report one of three parameters. What are they?

Answer 15

ODI
O2sat, mean value, zenith, and nadir
O2sat, % of the time at or below 88%

Question 16

When there is an REI or an AHI, what should you report?

Answer 16

Report the interpretation.

Question 17

If the HSAT study is non-diagnostic, what should you do?

Answer 17

Recommend in-center PSG if clinically indicated.

Question 18

HSAT equipment recording features must include these features: (x7)

Answer 18

FDA approval of device
Unique identifier for each device
Minimum definition of CPT codes
Must record oxymetry
Must record heart rate
Display raw data for review/manual scoring
Calculate REI & MT.

Question 19

HSAT must have at least one of these three sensors:

Answer 19

Oronasal thermal airflow sensor
Nasal pressure transducer
Alternative sensor (RIPsum or RIPflow)

Question 20

What is a PAT?

Answer 20

Peripheral Arterial Tone

Question 21

What general parameters should be recorded on a PAT? (x5)

Answer 21

Type of device
Airflow/Effort Surrogate signals
O2sat (Zenith & Nadir)
Sleep/Wake and REM time estimates
Heart rate

Question 22

When using a PAT, what TIME recording data should be reported? (x4)

Answer 22

Recording start time
Recording stop time
Duration of recording
Estimated sleep time

Question 23

When using a PAT, what PHYSIOLOGICAL data should be reported?

Answer 23

Heart rate
Number of sleep-related respiratory events
ODI

Question 24

What CPT codes govern HSAT equipment?

Answer 24

95800, 95801, and 95806

Question 25

What CPT codes govern PAT devices?

Answer 25

95800 and 95801