SLEEP TEST Flashcards
WHAT DOES “MSLT” REFER TO?
Multiple Sleep Latency Test.
HOW MANY NAPS ARE USUALLY PERFORMED DURING AN MSLT?
4-5 Naps throughout the day.
When does the 1st nap begin once an MSLT has started?
1.5 – 3 hours after lights on.
After sleep onset occurs, when is the nap terminated?
15 minutes from the 1st epoch of sleep.
If there is no sleep noted, when is the nap terminated?
20 minutes from the time of lights out.
SLEEP LATENCY IS DEFINED AS;
The amount of time elapsed from lights out to the 1st epoch of sleep.
REM LATENCY IS DEFINED AS;
The amount of time elapsed from the 1st epoch of sleep to the 1st epoch of REM.
WHAT IS THE PURPOSE OF PERFORMING THE “MSLT”?
To assess & diagnose diseases of excessive somnolence to evaluate daytime sleepiness.
DO THE NAPS OCCUR EVERY 2 HOURS FROM THE TIME THE PREVIOUS NAP ENDED OR EVERY 2 HOURS ON THE HOU R OR HALF-HOUR?
Every 2 hours on the hour or half hour.
HOW LONG BEFORE A NAP BEGINS SHOULD THE SUBJECT CEASE SMOKING?
30 minutes.
WHAT EPOCH SIZE IS BEST FOR RECORDING THE “MSLT”?
30 seconds.
A MEAN SLEEP LATENCY OF INDICATES WHAT?
Pathological sleepiness.
A normal mean sleep latency is how many minutes?
10 – 20 minutes
How many naps must have unequivocal periods of REM to arrive at a Diagnosis of Narcolepsy?
2 naps.
What is the Narcoleptic Tetrad?
Excessive daytime sleepiness, hypnogognic hallucinations, sleep paralysis, cataplexy.
What montage is generally used for the recording the “MSLT”?
4 EEG, 2EOG, EMG (chin), EKG.
How is the mean sleep latency calculated?
Sum of all latencies, divided by total# of naps.
How is the median latency calculated?
For 5 naps. Align in numerical order, select 3rd.
For 4 naps. Align in order, average 2nd and 3rd.
How is the mean REM latency calculated?
Sum of all REM latencies, divided by # of REMs.
How frequent are the naps scheduled during the MSLT?
Every 2 hours.
Respiratory Disturbance Index (RDI) is measurement of what?
The # of apneas, hypopneas and all reap. disturbances (snore arousals, UARS..) per hour of total sleep time.
Reflux is identified in the distal esophagus by a drop in pH below what?
4.0
A pt. can become the pathway of least resistance, and therefore susceptible to shock when what occurs?
When not all the equipment attached to the pt. is connected to a common ground.
What are the effects of chronic alcoholism on sleep?
Reduction of NREM delta sleep and REM sleep.
A sleep disturbance that last one to several nights in an isolated period and is most often caused by an acute situational stress or travel across multiple time zones.
Transient Insomnia.
During REM, inhibition of thermoregulartory mechanisms lead to what state?
Poikilothermia.
What equation best expresses time constant?
TC= C x R TC=Time Constant
C= Capacitance
R= Resistance
Impedances greater than 10,000 ohms, allows for greater potential of electrode imbalance and the appearance of what in the recorded signal?
60 Hz interference.
If the circumference measurement of the head is 60 cm, what is the distance of the T4 from the Fp2?
12 cm.
What is the minimum paper speed recommended to allow clear visual resolution of alpha and sleep spindles?
10 mm / second.
What sleep stage: low voltage mixed frequency EEG, with a prominence of activity in the 2 - 7 cps range, slow eye movements, tends to be relatively short, ranging from 1 -7 minutes.
Stage 1.
The amplitude of this waveform is occasionally as high as 200 uV?
Vertex Sharp Wave.
The total duration of this waveform should exceed. 5 sec with a well-delineated negative sharp wave followed by a positive component.
K-Complex.
What sleep stage requires at least 20% but no more than 50% of the epoch to consist of wave of 2 cps or slower w/amplitudes greater than 75 uV.
Stage 3.
Alpha activity in stage REM sleep is how many cps slower than wakefulness?
1 - 2 cps.
How are eye movements recorded?
There is a small electropotential difference between the cornea (+) and the retina (-). An electrode closest to the cornea will register a (+) deflection and close to the retina will register a (-) deflection.
List the 4 skull landmarks used in the 10 - 20 system.
Nasion, Inion, Right and Left Preauricular.
The degree to which an amplifier will reject a common mode signal is expressed as what?
Common Mode Rejection Ration.
This sleep test is used in the assessment and diagnosis of disorders of Excessive somnolence and to evaluate daytime sleepiness in relation to Various therapeutic or experimental manipulations?
MSLT.
How many minutes after lights out (with no sleep) is the standard MSLT Terminated?
20 minutes.
IN ORDER TO ASSESS THE OCCURRENCE OF REM SLEEP DURING THE MSLT, THE TEST SHOULD CONTINUE FOR HOW LONG AFTER THE FIRST EPOCH OF SLEEP?
15 minutes.
HOW MANY SLEEP-ONSET REM EPISODES IN A SERIES OF 5 NAPS ARE DIAGNOSTIC FOR NARCOLEPSY?
2
NREM SLEEP IN THE INFANT IS KNOW AS?
Quiet Sleep.
REM SLEEP IN THE INFANT IS KNOWN AS?
Active Sleep.
OTHER THAN EEG RECORDING, WHAT ELSE IS USED TO DIFFERENTIATE THE SLEEP STAGES IN THE INFANT?
Observed behaviors and movement patterns.
AT WHAT AGE DO SLEEP SPINDLES APPEAR IN INFANTS?
The appear at 4 weeks of age, develop rapidly through 8 weeks of age, and clearly characterize NREM sleep by 3 months of age.
AN EPOCH THAT DOES NOT MEET THE CRITERIA FOR ACTIVE SLEEP OR QUITE SLEEP IS CALLED WHAT?
Intermediate Sleep.
TRACE ALTERNANT PATTERN IS ASSOCIATED WITH WHAT STAGE OF SLEEP IN THE INFANT?
Quiet Sleep (NREM Sleep).
INFANT BREATHING PATTERNS THAT ALTERNATES REGULAR BREATHING WITH 5-10 SECONDS OF APNEA?
Periodic Breathing.
REM OCCUPIES WHAT PERCENTAGE OF SLEEP IN THE NEONATE AT TERM?
50%.
TERM USED FOR A BRIEF SUPERIMPOSITION OF EEG ALPHA ACTIVITY ON SLEEP ACTIVITIES DURING A STAGE OF SLEEP?
Alpha Intrusion.
THERMOREGULATORY RESPONSES SUCH AS SWEATING AND PANTING ARE NOTED IN REM, BUT ARE ABSENT IN NREM SLEEP. TRUE OR FALSE
False
Sweating and panting are seen in NREM, but absent in REM.
DEFINE APNEA?
Cessation of airflow at the nostrils and mouth lasting at least 10 seconds.
A FUNCTION THAT EXPRESSES THE FREQUENCY OF EYE MOVEMENTS PER UNIT TIME DURING SLEEP STAGE REM?
REM Density.
THE NUMBER OF APNEAS (Obstructive, Central, Mixed) PLUS HYPOPNEAS PER HOUR OF TOTAL SLEEP TIME AS DETERMINED BY ALL-NIGHT POLYSOMNOGRAPHY?
Respiratory Disturbance Index (RDI)
KNOW AS THE PACEMAKER FOR MAMMALIAN CIRCADIAN RHYTHMS?
Suprachiasmatic Nuclei (SCN).
A COMPLAINT OF MORNING HEADACHES ASSOCIATED WITH SEVERE SLEEP APNEA IS A RESULT OF WHAT?
Severe oxygen desaturation and hypercapnia (Elevated levels of carbon dioxide in the blood).
WHAT INITIAL EFFECT DOES ADMINISTERING SUPPLEMENT OXYGEN HAVE ON THE OSA PATIENT?
A significant increase in apnea duration with associated hypercapnia and respiratory acidosis.
WHAT TERM IS LINKED WITH PATIENT EXPERIENCING EVENING AND NOCTURNAL HALLUCINATIONS ASSOCIATED WITH DEMENTIA?
Sundowning.
JACTATION CAPITIS NOCTURNA?
Headbanging.
WHAT IS THE RECOMMENDED PROCEDURE FOR ELECTRODE APPLICATION TO RECORD EYE MOVEMENTS?
On electrode is 1cm above and slightly lateral the outer can thus, while the other electrode is 1cm below and slightly lateral the outer can thus of the eye.
THREE POTENTIAL SOURCES OF STRAY ELECTRICAL CURRENT?
Short circuit, Leakage Current, Ground Loop.
THE NUMBER OF PEN DEFLECTIONS OR “WAVES” RECORDED WITHIN THE SPAN OF ONE SECOND?
Signal Frequency.
MEASUREMENT OF FREQUENCY, NUMBER OF CYCLES PER SECOND?
Hertz.
REFERS TO THE RESPONSE TIME OF THE POLYGRAPH PENS IN RELATION TO HIGH AND LOW FREQUENCY FILTER SETTINGS DURING A CALIBRATION PROCEDURE?
Time Constant.
REDUCTION IN SIZEOR AMPLITUDE OF A SIGNAL?
Attenuation.
UNDESIRABLE VARIATION IS BASELINE DURING A RECORDING, USUALLY CAUSED BY SWEAT OR MOVEMENT?
Baseline Sway.
Voltage originating from living tissues?
Bio-electrical Potentials.
SIGNALS OBTAINED BY COMPARING VOLTAGES FROM TWO EXPLORING ELECTRODES?
Bipolar Derivation.
AN AMPLIFIER COMPONENT USED FOR STORING ELECTRICAL CHARGE?
CAPACITOR.
A GROUND CONNECTION SHARED BY MORE THAN ONE INSTRUMENT OR APPLIANCE?
Common Ground.
ANY MATERIAL CAPABLE OF TRANSMITTING AND ELECTRICAL CURRENT?
Conductor.
FLOW OF ELECTRICAL FORCE ALONG A CONDUCTOR?
Current.
SIGNAL OBTAINED FROM A PAIR OF ELECTRODES OR SENSORS?
Derivation.
RECORDING OF ELECTRICAL ACTIVITY GENERATED BY THE BRAIN?
ELECTROENCEPHALOGRAM (EEG).
THE TIME REQUIRED FOR A PEN TO DESCEND TO 37% OF SIGNAL AMPLITUDE WHEN A DC CALIBRATION SIGNAL IS APPLIED TO AN AMPLIFIER?
Fall Time Constant.
AN ELECTRONIC DEVICE DESIGNED TO REDUCE OR ELIMINATE UNWANTED FREQUENCIES FROM PASSING THROUGH AN AMPLIFIER?
Filter.
AN UNDESIRABLE ELECTRICAL PATHWAY BETWEEN TWO SEPARATE GROUND CONNECTIONS, RESULTING IN A POSSIBLE HAZARD TO A PATIENT?
Ground Loop.
A METHOD OF MEASURING CHANGES IN BODY (OR BODY PARTS) CIRCUMFERENCE?
Inductance Plethysomography.
Stray current generated by the proximity of electrical power cords to
Adjoining cables or the polygraph chassis.
Leakage Current
Ratio of output voltage to input voltage, amplifier sensitivity.
Gain
An instrument used for measuring electrical resistance.
Ohmmeter
Signal obtained by comparing voltages from an exploring electrode to
A relatively inactive location.
Referential Derivation
Opposition to an electrical current.
Resistance
A device used to limit the passage of electrical current
Resistor
The time required for a pen to reach 63% of signal amplitude when a DC
Calibration signal is applied to an amplifier.
Rise Time Constant
A device containing two dissimilar metals, which generate an electrical
Signal in response to temperature variations.
Thermocouple
A sequence of tests used to verify and document appropriate amplifier and pen
Responses to various maneuvers performed by the patient prior to sleep study.
Bio-Calibrations
Sharp negative waves, usually within the theta frequency range-typically appearing
During the latter part of stage 1 sleep.
Vertex Waves
A sharp negative wave, followed by a slow positive component-seen primarily
In stage 2 sleep.
K-Complex
Short rhythmic waveform clusters of 12-14 Hz, often showing a waxing and waning
Appearance-a characteristic feature of stage 2 sleep.
Sleep Spindles
Relatively low amplitude waves, with a notched, sawtooth appearance-a
Common feature of REM sleep.
Sawtooth Waves
REM sleep is classified into what two categories?
Tonic and Phasic
Artifact caused by electrodes which momentarily lift away from the skin.
Electrode Popping
A transient appearance of alpha activity during sleep.
Alpha Intrusion
A cessation of airflow detection at the nose occurring for 10 seconds or longer.
Apnea
An interruption of sleep continuity, identified by an abrupt shift in EEG frequency.
Arousal
A cessation of breathing, characterized by an absence of both airflow and
Respiratory effort.
Central Apnea
A single page of a polysomnogram, typically representing 30 seconds of data.
Epoch
Rapid deep breathing, resulting in reduced levels of CO2 in the blood.
Hyperventilation
Insufficient breathing volumes resulting in increased levels of CO2 in the blood.
Hypoventilation
Abnormally low blood oxygen saturation levels.
Hypoxemia
Jaw muscle.
Masseter
Lower portion of the temporal bone behind the ear.
Mastoid
A cessation of breathing caused by upper airway obstruction.
Obstructive Apnea
The progression and distribution of the various sleep stages and their
Quantitative relationship to each other.
Sleep Architecture
A period of NREM sleep followed by a subsequent REM period.
Sleep Cycle (also see Sleep Patterns; Sleep Stages; Cyclic, Alternating Patterns of)
A device used to convert non-electrical physiological activity into electrical
Signals.
Transducer
Maximum amount of air the lungs can contain.
Total Lung Capacity
An arrangement of electrode derivations.
Montage
Voltage (E) is equal to Current (I) flowing in the circuit multiplied by
Resistance (R) in the circuit.
E=I x R
Ohm’s Law
Three grounds found in electronic equipment.
Earth (building or power outlet) ground, chassis ground, common connection ground.
What consideration should be given to the choice electrodes used for recording
EEG?
Choose a material that has minimum drift of electrode potential and a very long time constant.
Suggested solution to soak contaminated electrodes.
5% Hypochlorite solution (household bleach)
Shock that involves large and quite perceptible currents passing from one external
Surface area to another.
Macroshock
How is the voltage (uV) of an EEG waveform calculated?
Multiplying the amplitude (mm) of the waveform by the sensitivity (uV/mm). V=A x S.
Distinct EEG activity appearing to be composed of one dominant frequency.
Monomorphic
EEG activity with a frequency faster than 13 Hz.
Beta Activity
Morphologically and topographically distinct EEG activity seen in the central
Areas, frequency is about 9 Hz.
Mu Rhythm
Breathing pattern characterized by rhythmic waxing and waning of depth
Of respiration, with regularly recurring periods of apnea.
Cheyne-Stokes Respiration
EKG channel shows regular rhythm, rate 60-100 bpm; P waves present and
Upright before each QRS complex. Time interval is same for all beats.
Normal Sinus Rhythm
EKG channel shows regular rhythm, rate ≥100 bpm (seldom ≥150 bpm);
P waves present and upright before QRS complex. Time interval is same for all
Beats.
Sinus Tachycardia
EKG channel shows regular rhythm, rate ≤ 60 bpm; P waves present and upright
Before QRS complex. Time interval is same for all beats.
Sinus Bradycardia
EKG channel shows P waves then QRS complexes with no association
Between the two. The P-R interval is variable and the QRS complexes are the
Same and regular.
3rd degree AV block or complete heart block
Normal arterial pCO2 value.
35-45 mmHg
Normal arterial pO2 value.
80-100 mmHg
When does sleep onset occur when scoring an MSLT?
The time from lights out to the first epoch scored as sleep.
A patient with “Ondine’s Curse” would be expected to have what type or
Respiratory impairment?
Central Alveolar Hypoventilation
Which class of drugs is known to aggravate Periodic Limb Movements of Sleep?
Tricyclic Antidepressants
What is the effect of chronic alcoholism on REM?
Decreases REM sleep
What does the narcoleptic tetrad consist of?
EDS, Cataplexy, Sleep Paralysis, Hypnagogic Hallucinations
Define sleep efficiency.
The ratio of total sleep timed to total time in bed.
In 1953 Aserinsky and Kleitman associated what with dreaming during sleep?
Rapid Eye Movements
REM sleep is associated with what changes in the autonomic nervous system?
Variable heart rate, irregular respiration’s, decrease in tonic muscle activity.
The reticular activating system is essential for what part of the sleep/wake cycle?
Initiation and Maintenance of Wakefulness
Ultradian rhythm refers to a period of what time?
Less than 24 hours
Are newborns and infants obligatory “nasal breathers” or “mouth breathers”?
“Nasal Breathers”
Increased resistance of the upper airways secondary to blockage of one nasal
Orifice restricts ventilation more severely in REM or NREM?
REM
Paradoxical breathing is noted in neonates or infants?
Neonates
Periodic breathing in the normal infant most commonly occurs in Active
Or Quiet Sleep?
Active Sleep
The Untradian rhythm of alternating sleep cycles has a period of how many minutes
During infancy?
30-70 minutes
What is the definition of periodic breathing?
Minimum of 3 central events lasting less than 4 seconds within 20 seconds of each other.
A person’s maximum breathing ability.
Vital Capacity
The content of air remaining in the lungs at the end of normal expiration.
Functional Residual Capacity
Leg muscle used to monitor/record myoclonic movements.
Anterior Tibialis
Which type of montage is recommended in order to maximize the voltage
Recorded during a ploysomnogram?
Referential montage using contralateral ear references.
