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Sleep medicine > Scoring and Staging > Flashcards

Scoring and Staging Flashcards

1
Q

What are the EEG leads to detect eye movements?

A

E1 and E2

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2
Q

What lead are E1 and E2 (Left and Right eye outer canthus) referenced to?

A

M2 (Right mastoid)

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3
Q

Definition of slow waves

A

Peak to peak amplitude greater than 75 microvolts

Frequency 0.5 to 2 Hz

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4
Q

The EEG background for REM sleep is low voltage mixed frequency but what will frequently appear and is not an arousal?

A

Alpha bursts

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5
Q

Is a K complex or sleep spindles necessary to score an epoch as N2?

A

No. Once N2 has been determined (by a K complex or sleep spindle) then all subsequent epochs of low amplitude-mixed frequency will also be N2

  • Unless there is an arousal
  • Unless criteria met for N3 or REM
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6
Q

Describe a K complex

A
  • Negative sharp wave followed immediately by a positive component (per convention a negative wave goes up)
  • Stands out from the background
  • 0.5 seconds or longer
  • Amplitude is not a criterion
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7
Q

Rule for K complex associated arousal

A

Must commence no more than 1 second after the end of the K complex

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8
Q

EEG criteria for vertex waves

A
  • Sharply contoured negative deflection (upward on EEG)
  • Most often in central leads
  • Usually seen in N1 sleep
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9
Q

EEG criteria for a slow wave

A
  • At least 75 microVolt peak to peak amplitude
  • 0.5 to 2 Hz (subset of delta: 1 - 4 Hz)
  • Defining characteristic of N3 sleep
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10
Q

What are the sensors needed to detect:

  • Apnea
  • Hypopnea
A

Apnea = Oronasal thermal sensor (thermistor or thermocouple)

Hypopnea = Nasal pressure transducer (more sensitive than a thermal sensor)

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11
Q

What are the AASM criteria for scoring an apnea?

A
  • Drop in the peak signal excursion by >/= 90% of present baseline using an oronasal thermal sensor, PAP device flow or an alternate apnea sensor
  • Duration of drop is >/= 10 seconds
  • Drop in Sa02 is not a criteria
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12
Q

What are the AASM rules for scoring a hypopnea? Rules 1A and 1B

A

Both

  • 30% or > drop in peak signal excursion from baseline
  • 10 or > seconds

1A

  • 3% drop in SaO2 or associated with an arousal

1B

  • 4% drop in SaO2 and no arousal

You can use one or the other in scoring a study but not both

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13
Q

What is normal REM latency?

A

90 - 120 minutes

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14
Q

What has to happen to end N2 sleep?

A
  • Arousal
  • Wakefulness
  • Transition to N3
  • Transition to REM
  • Major body movement
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15
Q

What are the rules for scoring REM sleep?

A

All of the following

  • Low amplitude mixed frequency without K complexes or sleep spindles
  • Low chin EMG for the majority of the epoch with concurrent REM
  • REMs at any position within the epoch
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16
Q

What are the rules for scoring REM sleep in the proceeding and following segments without Rapid Eye Movements?

A

All of the following

  • LAMF without K complexes or sleep spindles
  • Low chin EMG tone
  • No intervening arousal
  • Slow eye movements following an arousal or stage wake are absent
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17
Q

Are sleep spindles seen in N3 sleep?

A

Yes. They can continue into N3 sleep.

18
Q

Are eye movements seen in N3 sleep?

A

Usually, no

19
Q

Criteria for N3 sleep

A

> 20% delta

20
Q

What can be used to detect hypoventilation during a PSG?

A
  • PcO2 in ABG
  • PcO2 via end-tidal CO2 sensor
  • PcO2 via transcutaneous CO2 sensor
21
Q

What are the definitions of sinus tachycardia and sinus bradycardia in sleep?

A

Sinus tachycardia: > 90 bpm

Sinus bradycardia: < 40 bpm

(Note: This is different than during wake: 100 and 60)

22
Q

What are the 2 different sensors on PSG for hypopnea and apnea respectively?

A

Pressure or PTAF = Pressure transducer for hypopnea

Flow or Airflow = Thermistor for apnea

23
Q

What is the rule for a Major Body Movement with alpha?

A

If alpha is present for any part of an epoch with a MBM then it is scored as state Wake

24
Q

What is the rule for an epoch with a Major Body Movement without alpha?

A

The epoch is scored the same stage as the epoch that follows it

25
Q

What is used to measure chest and abdominal movements?

A

Inductance plethysmography (not piezoelectric belts)

26
Q

Where on the EEG are slow waves and K complexes typically seen?

A

Frontal leads

27
Q

Where on the EEG are sleep spindles typically seen?

A

Central leads

28
Q

Where on the EEG are theta waves typically seen?

A

Central and temporal leads. Usually seen in N1 and REM

29
Q

Where on the EEG are vertex waves typically seen?

A

Central leads

30
Q

Where on the EEG are sleep spindles typically seen?

A

Central

31
Q

What is the frequency range for sleep spindles?

A

11 - 16 Hz

32
Q

EEG criteria for arousals

A
  • Abrupt shift in EEG frequency for at least 3 seconds
  • At least 10 seconds of stable sleep preceding
  • If during REM must have at least 1 second of increased chin EMG during episode
33
Q

What is the Respiratory Disturbance Index (RDI)?

A

RERA + AHI

34
Q

Criteria for RERA

A

All of the following

  • >/= 10 seconds
  • Increased respiratory effort or flattening of inspiratory portion of nasal pressure (diagnostic) or PAP device flow waveform
  • Arousal from sleep
  • Not an apnea/hypopnea
35
Q

Criteria for hypoventilation

A

Either of the following:

  • PcO2 increases > 55 mm Hg for 10 or more minutes
  • An increase >/= 10 mm Hg PcO2 during sleep (compared to awake supine) to a value > 50 mm Hg for 10 or more minutes
36
Q

Respiratory rules in children (< 13 y/o)

Obstructive Apnea

A
  • Event lasts for at least 2 missed breaths
  • 90% fall in signal amplitude for 90% of the respiratory cycle compared to baseline
  • Continued respiratory effort occurs throughout the period of decreased airflow
37
Q

Respiratory rules in children (< 13 y/o)

Hypopnea

A
  • At least 30% fall in nasal pressure signal
  • At least 2 missed breaths
  • Fall in nasal pressure lasts at least 90% of hypopnea duration
  • Associated with arousal or at least 3% desaturation
38
Q

Respiratory rules in children (< 13 y/o)

Hypoventilation

A

PcO2 > 50 mm Hg for > 25% of the sleep time

39
Q

Respiratory rules in children (< 13 y/o)

Central apnea

A
  • Drop in thermal signal by >/= 90% in amplitude and duration
  • Plus one of the following
    • Event lasts >/= 20 seconds
    • Events last duration of what would be 2 pre-event breaths and is associated with an arousal or a >/= 3% O2 desat
    • Events last duration of what would be 2 pre-event breaths and is associated with a decrease in HR to less than 50 bpm for at least 5 seconds or less than 60 bpm for 15 seconds (infants under 1 year of age only)
40
Q

Respiratory rules in children (< 13 years old)

Mixed apnea

A
  • Drop in thermal signal by >/= 90% in amplitude and duration
  • Event lasts for 2 breaths (pre-event baseline)

and

  • Absent respiratory effort during one portion of the event

and

  • Presence of inspiratory effor during another portion of the event (does not matter which comes first)
41
Q

Respiratory rules in children

Scoring of hypoventilation

A

> 25% of the total sleep time, arterial (or surrogate) PCO2 > 50 mmHg

Sleep medicine (21 decks)

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