Scoring and Sleep Stages F (D-37 - D-40)

Question 1

What is the minimum and maximum duration of an LM (limb movement) event?

Answer 1

0.5-10 seconds

Question 2

What is the minimum amplitude of an LM (limb movement) event?

Answer 2

8 uV increase in voltage above resting EMG

Question 3

What is the timing of an onset of an LM (limb movement) event?

Answer 3

The point at which there’s an 8 uV increase in EMG voltage above resting EMG

Question 4

What is the timing of an ending of an LM (limb movement) event?

Answer 4

The start of a period lasting at least 0.5 sec during which the EMG does not exceed 2 uV above resting EMG.

Question 5

To define a PLM series, the minimum amount of consecutive LM events is ___.

Answer 5

4 LM.

Question 6

To define a PLM series, the minimum period length between LM to include them as part of a PLM series is ___ seconds. The maximum period length is ___.

Answer 6

Minimum: 5 seconds
Maximum: 90 seconds

Question 7

Leg movements on 2 different legs separated by less than 5 seconds between movement onsets are counted as ___.

Answer 7

They’re counted as a single leg movement.

Question 8

When should an arousal and limb movement occurring in the same PLM movement be considered associated with each other?

Answer 8

When they occur simultaneously
When they overlap
Less than 0.5 sec between the end of one event and the onset of the other event.

Question 9

When should a limb movement NOT be scored?

Answer 9

If it occurs during the period from 0.5 seconds preceding an apnea or hypoxia to 2.5 seconds following the respiratory event.

Question 10

How do you define sustain muscle activity (tonic activity) in REM sleep?

Answer 10

REM sleep with at least 50% of the epoch having a loud chin EMG.

Question 11

How do you define excessive transient muscle activity (Phasic activity)?

Answer 11

In a 30 second epoch of REM sleep divided into 10 sequential 3-second mini-epochs, at least 50% (5) of the mini-epochs contain bursts of transient muscle activity.

Question 12

What is RBD? How do you define excessive transient muscle activity (Phasic activity) in RBD?

Answer 12

RBD: Rapid Eye Movement Sleep Behavior Disorder
Excessive transient muscle activity bursts are 0.1-5 seconds in duration and at least 4 times as high in amplitude as the background EMG activity.

Question 13

There are two kinds of bruxism. What are they?

Answer 13

Sustained and phasic bruxism

Question 14

How long does bruxism have to last to score it?

Answer 14

3 seconds

Question 15

Bruxism is usually scored by chin EMG. When can you score it by audio?

Answer 15

If there are 2 audible cases in one night.

Question 16

If you want to score PSG features of a rhythmic movement disorder, what are the minimum & maximum frequencies?

Answer 16

0.5 Hz to 2 Hz.

Question 17

What are the minimum number of individual movements required to make a cluster of rhythmic movements?

Answer 17

4

Question 18

Bruxism: Chin EMG activity must be between __ and __ seconds long and at least # must occur in regular sequence.

Answer 18

0.25 to 2 seconds.

At least 3 must occur.

Question 19

How do you score an apnea or hypopnea duration?

Answer 19

Measure from the nadir preceding the first breath that is clearly reduced to the beginning to the first breath that approximates the baseline breathing amplitude.

Question 20

What is the top of a waveform called?

What is the bottom of the waveform called?

Answer 20

Zenith and nadir

Question 21

What sensor should you use to determine apnea duration? (There are two sensors you can use.)

Answer 21

The oronasal thermal sensor or PAP device flow signal.

Question 22

What sensor should you use to determine hypopnea duration? (There are two sensors you can use.)

Answer 22

The nasal pressure signal or PAP device flow signal.

Question 23

When should you score an event as an apnea event?

Answer 23

A drop in the peak signal excursion (by greater than 90%) and the duration of the 90% drop lasts at least 10 seconds.

Question 24

When should you score an apnea event as obstructive?

Answer 24

Apnea criteria is met and associated with continued inspiratory effort.

Question 25

When should you score an apnea event as central?

Answer 25

Apnea criteria is met and associated with absent inspiratory effort.

Question 26

When should you score an apnea event as mixed?

Answer 26

Apnea criteria is met and no airflow or effort is seen followed by a period of no airflow with respiratory effort.