Sleep Scoring

Question 1

In an adult, to differentiate sustained sinus tachycardia from transient responses to arousals and respiratory events, the stable tachycardia must be present for how long of what minimum time duration?

Answer 1

30 seconds

Question 2

In a 5-year-old child, what respiratory event should be scored if there is a 15-second long, 95% drop in the peak signal excursion, absent inspiratory effort through the entire duration of the event, 2% desaturation, and no arousal?

Answer 2

No event

Question 3

What is the proper placement of the electro-oculogram electrodes?

Answer 3

1 cm lateral and 1 cm above the right eye

Question 4

What is the minimum percentage of slow wave activity that is required to score Stage N3?

Answer 4

20%

Question 5

What is the maximum duration of a significant leg movement event?

Answer 5

10 sec

Question 6

To score an arousal during any sleep stage, the abrupt shift of EEG must occur for how long?

Answer 6

3 sec

Question 7

For children 6 and older when do you score bradycardia

Answer 7

When there is a sustained heart rate below 40 beats per minute

Question 8

What is the best way to distinguish between K complexes and vertex waves?

Answer 8

K complexes are predominately frontal

Question 9

When polysomnography is performed to detect transient muscle activity in the upper limbs in REM sleep for suspected REM behavior disorder, which muscles in the arms are monitored?

Answer 9

Flexor digitorum superficialis

Question 10

At what age can sleep be scored as stage N1, N2 or N3?

Answer 10

5-6 months

Question 11

What percentage of the population does not generate alpha rhythm when drowsy with eyes closed?

Answer 11

10%

Question 12

When should hypoventilation be scored in a 17-year old girl?

Answer 12

If there is 26% total sleep time with end-tidal CO2 >50mmHg

Question 13

Which of the following is true with respect to eye movements and the electrooculogram?

Answer 13

The cornea is positive relative to the retina

Question 14

What if a PSG channel goes out

Answer 14

We’re encouraged to use of all available signals when staging and scoring respiratory events if recommended signals (A) have temporarily been lost. Based on the AASM scoring manual technical specifications for identification of a hypopnea, it is recommended that the nasal pressure transducer be used to monitor airflow. However, when the nasal pressure transducer in not functioning or the signal is unreliable, alternative hypopnea sensors may be used. These include one of the following: an oral thermal airflow; Respiratory Inductance Plethysmography sum (RIPsum); RIPflow, or dual thoracoabdominal RIP belts. Since the other signals are intact, it is reasonable to score these events as obstructive hypopneas based on the RIP belt signals. These events should not be marked as RERAs or MT.

Question 15

How are leg electrodes placed

Answer 15

Electrodes should be placed on the middle of
the anterior tibialis muscle, 2 to 3 cm apart
along the length of the leg
• Leg electrodes should be placed on both legs

Question 16

What are acceptable Respiratory Effort Monitors

Answer 16

• Recommended = Esophageal
manometry or RIP belts (calibrated
or uncalibrated)
• Esophageal manometry measures
pressure in the chest using a probe
that is placed through the nose into
the esophagus
• RIP belts measure the volume of the
lungs using elastic belts around the
chest and abdomen
• Calibration is difficult and alters with
movement. Most centers use
uncalibrated RIP
• PVDF belts approved (acceptable)
• Piezo belts are not acceptable

Question 17

What are pulse oximeter standards

Answer 17

A pulse oximeter uses
changes in the
wavelength of blood in
the capillary bed to
estimate oxygen
saturation
• Maximum acceptable
signal averaging time of
≤3 seconds at HR 80 bpm

Question 18

What is acceptable Digital resolution

Answer 18

– Digital resolution – the precision of the amplitude
measurement (Y axis)
• The AASM Manual requires a minimum 12 bit per
sample resolution

Question 19

what is the appropriate display

Answer 19

The display for scoring and review of sleep study data must meet or exceed the following criteria: 15 inch screen size, 1600 pixels horizontal and 1050 pixels vertical

Question 20

What is the sampling rate and filter for EOG and EEG

Answer 20

EEG 200 - 500 0.3 35

EOG 200 - 500 0.3 35

Question 21

What is the sampling rate and filter for EMG

Answer 21

EMG 200 - 500 10 100

Question 22

What is the sampling rate and filter for ECG

Answer 22

ECG 200 500 0.3 70

Question 23

What is the sampling rate and filter for airflow

Answer 23

Airflow 25 100 0.1 15