CPSGT Practice Test 2

Which of the following medications is used to treat narcolepsy? a. Ambien. b. Mirapex. c. Dextroamphetamine. d. Aspirin

C: Dextroamphetamine

What is the most common side effect of proper CPAP use? a. Eye dryness and pain. b. Dizziness. c. Nasal congestion. d. Tinnitus

C: Nasal congestion

For Americans the most common sleep disorder is a. insomnia. b. obstructive sleep apnea. c. central sleep apnea. d. narcolepsy.

A : insomnia

In an EKG the P wave represents a. atrial depolarization. b. atrial contraction. c. ventricular depolarization. d. ventricular contraction

B: atrial contraction.

After 3 years of CPAP use, a patient returns to the sleep lab complaining of excessive daytime sleepiness. Which of the following is a possible cause for the CPAP no longer providing the patient with optimal sleep? a. Excessive alcohol use. b. Patient no longer has sleep apnea. c. Damaged equipment. d. Both A and C.

C: Damaged equipment.

In an EKG the QRS complex represents a. atrial contraction. . ventricular repolarization. c. ventricular contraction. d. atrial depolarization

C: In an electrocardiogram (ECG or EKG) the QRS complex represents ventricular contraction, which is when the ventricles pump blood out of the heart. Each QRS complex lasts from 0.04 to 0.10 seconds. The period after a QRS complex (the ST segment) is when the ventricles begin to repolarize

Muscle artifact can be corrected by a. decreasing the HFF. b. decreasing the LFF. c. moving the electrode that the artifact is appearing on. d. either decreasing the HFF or moving the electrode that the artifact is appearing on.

D: Either decreasing the HFF or moving the electrode that the artifact is appearing on

People with obstructive sleep apnea have a higher risk of a. stroke. b. COPD. c. hypotension. d. depression

A: Stroke

In which study does a patient try to stay awake in a darkened room? a. MSLT. b. MWT. c. NPSG. d. REM behavior disorder study

B: MWT

Alcohol can suppress which stage(s) of sleep? a. Stage 2. b. Stage 3. c. NREM. d. Stage 1.

B: Stage 3 (and REM)

Sleep spindles are a. associated with stage 3 sleep. b. 12-14 Hz. c. have specific amplitude requirements. d. associated with stage 1 sleep

12-14 Hz

What is the standard length of time of each epoch during the scoring of stages in a PSG? a. 30 seconds. b. 45 seconds. c. 3 minutes. d. 10 minutes.

A: According to guidelines of the American Academy of Sleep Medicine entitled, "The Visual Scoring of Sleep in Adults," scoring by 30-second epochs was retained from the Rechtshaffen and Kales process of scoring sleep studies. The reason for the either 20- or 30-second view of the EEG is the ability to see the vertex spike waves, complexes, and spindles clearly enough to confirm sleep staging

What is the minimum time required before increasing the PAP pressure during a titration study? a. 5 minutes. b. 10 minutes. c. 15 minutes. d. 20 minutes.

A: According to the American Academy of Sleep Medicine, CPAP should be increased by at least 1 cm with an interval no shorter than 5 minutes. Increases in PAP do not have an immediate effect on splinting the patient's airway, so time is necessary to observe how effective the increase really was. Aside from the necessity to verify efficacy of PAP increases, if a technician raises the pressure too quickly the patient may respond with complex sleep apnea. Complex sleep apnea is a result of the patient's body rejecting the PAP pressure and refusing to initiate breaths.

Criteria necessary to score an arousal in NREM sleep include all of the following EXCEPT a. a concurrent increase in chin EMG. b. 10 seconds of sleep prior to the arousal. c. the arousal must last at least 3 seconds. d. frequencies greater than 16 Hz, which are not spindles, must occur.

A: An increase in chin EMG amplitude is only required in stage REM sleep. While most arousals will have an increase in muscle tone, the scoring guidelines of the American Academy of Sleep Medicine do not require it for NREM sleep stages. In REM, all of the same requirements apply in addition to the associated increase in the chin EMG

Where is the tape measure placed when measuring the circumference of the head? a. At all 10% up-markings on the head starting and ending at FPz. b. At the inion and nasion. c. Where the tape measure naturally lies with the patient's head shape. d. Right above the ears

A: At all 10% up-markings on the head starting and ending at FPz.

A 43-year-old male who is 5'8" tall and weighs 275 pounds, with no history of smoking or alcohol abuse, complains of trouble falling asleep, headaches, and daytime fatigue. His wife complains that his legs are kicking her while she is asleep. He most likely has..... a. obstructive sleep apnea. b. central sleep apnea. c. Cheyne-Stokes breathing pattern. d. PLMS.

A: Due to his weight, this patient most likely has obstructive sleep apnea. His headaches and daytime sleepiness are probably due to the oxygen deprivation during sleep. His insomnia may result from waking from stage 1 sleep early in the evening due to apnea events. The limb movements that his wife is reporting may be resulting from frequent arousals due to obstructive apnea. A polysomnogram should be scheduled to confirm this diagnosis.

The goals of PAP therapy include all of the following EXCEPT to a.improve diminished lung capacity. b. eliminate flow limitations in the upper airway. c. eliminate excessive daytime somnolence. d. eliminate snoring.

A: Improve diminished lung capacity. The CPAP and BiPAP used in the sleep lab are non-invasive respiratory therapies that do not have effects on patient's lung capacity or tidal volumes. The focus of the PAP devices is to maintain the structural integrity of the airway, especially the upper airway, to prevent collapses that result in obstructive apneas and snoring.

Nicotine may cause a. insomnia. b. sleep apnea. c. REM behavior disorder. d. daytime sleepiness.

A: Insomnia. Nicotine, not necessarily just from smoking but also from the nicotine patch and nicotine gum, is a stimulant that may cause insomnia. Smoking may result in a worsening of apnea as the damage done to the lungs and airways may result in upper airway resistance and low blood oxygen saturation.

What physiological effects does CPAP have on the body? a. b. Improves pulmonary function. c. Increases blood-gas exchange efficacy. d. Controls respiratory rate.

A: Splints the airway to allow breaths to pass through without occlusion. The CPAP will not increase pulmonary function in patients, and it will not improve the rate at which oxygen is transferred into the heart. However, CPAP supports the structural integrity of the airway when patients fail to hold the airway open with their own muscles. By preventing a collapse of the airway, an apneic patient will never have to struggle to reopen their airway while asleep.

What is the minimum AHI to be diagnosed with OSA? a. >5/hr. b. >3/hr. c. >10/hr. d. >15/hr.

A: The minimum AHI (apnea-hypopnea index) to be diagnosed with OSA (obstructive sleep apnea) and qualify for CPAP is 5/hr. An AHI below 5/hr may lead to a diagnosis of upper airway resistance syndrome or no diagnosis at all, but most insurance companies will not authorize an overnight CPAP study, much less a CPAP machine, with an AHI of less than 5/hr.

Lights off: 23:30 Lights on: 05:30 Sleep onset: 00:30 Total NREM sleep time (min): 230 Total REM sleep time (min): 45 What is the total sleep time (TST), in minutes? a. 275. b. 360. c. 300. d. 230.

A: The total sleep time (TST) is determined by adding the NREM sleep time to the REM sleep time. In this case, it was 275 minutes, or a little over 4.5 hours. The total sleep time is valuable for determining the sleep efficiency, or the percentage of time the patient was asleep during a recording period, and also for determining the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) of the patient during the study.

Required criteria for scoring an apneic event for an adult include all of the following EXCEPT: a. the event lasts no longer than 30 seconds. A: There is no maximum time limit for how long an obstructive apneic event can be. There are guidelines for resuming normal breath or resaturations of 2% or more defining the end of an event, but there is no hard cap on how long those events can be to qualify for scoring criteria. b. there is a 90% or more drop from baseline in the thermal sensor channel. c. the duration of the event lasts at least 10 seconds. d. at least 90% of the event must meet the 90% drop from baseline criteria

A: There is no maximum time limit for how long an obstructive apneic event can be. There are guidelines for resuming normal breath or resaturations of 2% or more defining the end of an event, but there is no hard cap on how long those events can be to qualify for scoring criteria.There is no maximum time limit for how long an obstructive apneic event can be. There are guidelines for resuming normal breath or resaturations of 2% or more defining the end of an event, but there is no hard cap on how long those events can be to qualify for scoring criteria.

What is the most important aspect of fielding a patient's questions in the morning following the sleep study? a. To be positive and avoid alarming the patient. b. To give the patient as many details about their results as possible. c. To be vague and avoid giving any straight answers. d. To defer all questions the patient has to the physician

A: To be positive and avoid alarming the patient. While the technician should avoid giving results and diagnoses to the patient in the morning, there are certain things the technician can and should share with the patient. The only real universal guideline is to avoid using phrases that may alarm or terrify the patient. Even though technicians understand what it means to "stop breathing" during apneic events, a patient may hear those words and become terrified to sleep. Considering it may be weeks before they are treated with CPAP therapy, it would be very inconvenient for them to fear sleep in the meantime.

BiPAP S/T stands for a. bilevel positive airway pressure spontaneous/timed. b. bilevel positive air pressure spontaneous/timed. c. bilevel positive airway pressure synchronized/timed. d. bilevel positive air pressure synchronized/timed

A: bilevel positive airway pressure spontaneous/timed.

Sweat artifact looks like a. slow-wave sleep. b. a solid, fuzzy bar in the electrode channel. c. a random, sudden "popping" in the electrode channel. d. an arousal.

A: slow delta waves / slow wave sleep

In polysomnography, sensitivity is generally measured in.... a. uV/mm. b. uV/cm. c. uV/in. d. Hz/mm

A: uV/mm. Sensitivity is measured in microvolts per millimeter, or uV/mm. What this means is that for each microvolt of a wave, the display will measure it in one mm. This also means that the larger the number of microvolts per millimeter, the smaller the wave will be displayed, because it will take more voltage to change the signal

The best way to eliminate artifact is by a. adjusting the filters. b. going to the problem source and replacing and reapplying the affected leads. c. doing nothing, as they tend to resolve on their own. d. stopping the study and reapplying all the leads.

B : going to the problem source and replacing and reapplying the affected leads.

To ensure REM sleep has a chance to occur during a multiple sleep latency test nap, how long should that nap continue? a. 25 minutes following "lights out." b. 15 minutes following sleep onset. c. 15 minutes following "lights out." d. 20 minutes following sleep onset

B: 15 minutes following sleep onset. According to the guidelines of the American Academy of Sleep Medicine for the operation of a multiple sleep latency test (MSLT), a MSLT nap continues for 15 minutes following sleep onset. The first thing for which the MSLT is looking is to see if the patient is capable of falling asleep in a 20- minute space of time. If a patient does not fall asleep within 20 minutes, the nap is ended. If the patient falls asleep during the 20-minute window, the nap continues for 15 more minutes from that time to see if REM can be reached shortly after sleep onset.

A mixed apnea is characterized by which of the following? a. A combination of hypopnea and obstructive characteristics. b. A lack of respiratory effort at the start of the event where respiratory effort returns before the event ends. c. Respiratory effort present at the start of the event where the effort ceases in the second half of the event. d. Intermittent respiratory effort throughout an obstructive event

B: A mixed apnea is a respiratory event that begins with the qualities of a central sleep apneic event. As long as any respiratory effort begins before normal breath and recovery happens, it is scored as a mixed apnea. It cannot be the opposite, and a mixed apnea in no way indicates a combination of any other respiratory events besides the above description.

What is the maximum recommended CPAP for patients under the age of 12 years? a. 10 cm. b. 15 cm. c. 20 cm. d. 25 cm.

B: According to the Clinical Guidelines for the Manual Titration of Positive Airway Pressure in Patients with Obstructive Sleep Apnea, pediatric patients under the age of 12 years should not have their PAP pressures raised above 15 cm. This consensus is based on physical tolerance and patient compliance studies. As far as compliance goes, if a patient will not use the CPAP at uncomfortable pressures, then it will not help them

REM behavior disorder is usually treated with a. CPAP. b. medications such as benzodiazepines, Sinemet, and clonidine. c. medications such as Ambien, Lunesta, or Sonata. d. medications such as Provigil, Ritalin, or Dexedrine.

B: REM behavior disorder is often treated with benzodiazepines, clonidine, or Sinemet to prevent muscle activity during REM. Sleeping aids such as Ambien, Sonata, or Lunesta could potentially make the disorder worse as they are powerful narcoleptics. Medications such as Provigil, Ritalin, or Dexedrine are stimulants that are often used to treat narcolepsy

A patient who had no central apneas during her initial polysomnogram begins presenting with central apneas at 15 cwp on CPAP. What is the most likely cause? a. The CPAP pressure is too low. b. The CPAP pressure is too high. c. There is a mask leak. d. This is natural and isn't a concern

B: The CPAP pressure is too high.

Which filter would be used to adjust the rise time of a signal? a. The LFF. b. The HFF. c. The gain. d. The sensitivity.

B: The HFF.

Lights off: 23:30 Lights on: 05:30 Sleep onset: 00:30 Total NREM sleep time (min): 230 Total REM sleep time (min): 45 What is the percentage of REM sleep (rounded to the nearest percentage)? a. 20%. b. 16%. c. 15%. d. 84%.

B: The percentage of REM sleep is found by dividing the amount of time of REM sleep by the total sleep time: 45/275 = ~16%. The percentage of REM sleep is useful in determining if a patient's sleep architecture is fractured and is also useful in calculating the patient's REM apnea-hypopnea index (AHI) or respiratory disturbance index (RDI).

Lights off: 23:30 Lights on: 05:30 Sleep onset: 00:30 Total NREM sleep time (min): 230 Total REM sleep time (min): 45 What is the total recording time (TRT), in minutes? a. 275. b. 360. c. 300. d. 230.

B: The total recording time is measured from "lights off" to "lights on." In this case, the TRT was 6 hours. To get that in minutes, you would multiply 6 by 60 and get 360 minutes. The total recording time is valuable for determining the sleep efficiency, or the percentage of time the patient was asleep during the recording period

An alternating EEG pattern seen during quiet sleep in a newborn infant, consisting of both highand low-voltage activity is termed a. active sleep. b. trace alternant. c. sawtooth waves. d. slow-wave sleep

B: Trace alternant is the NREM sleep for infants that diminishes and becomes nonexistent between 3-6 weeks of age in healthy infants. This pattern is found in an infant's slow-wave sleep and after the first month of life; it is gradually replaced with sleep spindles.

Before a technician begins cardiopulmonary resuscitation on a patient, basic life support procedures require the technician to do which of the following? a. Contact a nurse for assistance. b. Verify the patient's unresponsiveness. c. Check the patient's pulse. d. Listen for the patient's breath

B: Verify the patient's unresponsiveness. According to "Basic Life Support Procedures" from the American Heart Association, health care providers should not initiate cardiopulmonary resuscitation (CPR) on conscious and responsive patients. That is not to say that a patient must be unresponsive for it to be an emergency situation; however, CPR does require the patient to be unconscious

The technician's duties include all of the following EXCEPT a. providing a safe environment for the patient. b. giving an interpretation of the study to the patient. c. making sure the study is accurate. d. changing CPAP pressure

B: giving an interpretation of the study to the patient.

K-complexes are often seen a. in stage 1 sleep. b. in stage 2 sleep. c. in stage 3 sleep. d. in REM

B: in stage 2 sleep

Electrical safety requires all of the following actions from a technician EXCEPT a. checking the conditions of wires to assure none are frayed or damaged. b. the application of a ground placed with the pulse oximetry probe. c. the application of a ground lead wire placed on the head for the PSG. d. keeping liquid away from all electrical components

B: the application of a ground placed with the pulse oximetry probe. Pulse oximetry devices are very low-voltage, passive electrical devices that do not require a ground to avoid patient electrocution. Pulse oximetry is a direct current electrical device. Frayed and exposed wires, improperly grounded surface electrodes, as well as wet equipment can electrocute a patient.

In an ECG the T wave represents a. ventricular contraction. b. ventricular repolarization. c. atrial repolarization. d. atrial contraction.

B: ventricular repolarization. The T wave represents ventricular repolarization in an EKG. When the ventricles repolarize it concludes the heartbeat and sets the stage for the next heartbeat. In all, it takes less than a second for the heart to go through the contraction-relaxation cycle and produce a heartbeat. A normal adult's heart beats at 60-100 beats per minute. A slower heart rate is referred to as bradycardia and a faster heart rate is tachycardia

What is the most likely sensitivity setting for the EEG in a polysomnogram? a. 3 uV/mm. b. 15 uV/mm. c. 7 uV/mm. d. 1 uV/mm.

C: 7 uV/mm. Generally the sensitivity is set between 5 uV/mm and 9 uV/mm. Of those choices 7 uV/mm would be the best answer. Normally, 1 uV/mm or 3 uV/mm would be far too high of a sensitivity setting (the lower the number of microvolts the less it will take to increase the wave size) and 15 uV/mm would be too low of a sensitivity setting (the higher the number of microvolts the more it will take to increase the wave size).

Which of the following does the American Academy of Sleep Medicine recommend all patients should receive before a titration begins? a. Informational packet and calming therapy. b. A course on how to use CPAP and a hands-on demonstration. c. Adequate PAP education, hands-on demonstration, careful mask fitting, and acclimatization. d. Careful mask fitting and calming therapy

C: Adequate PAP education, hands-on demonstration, careful mask fitting, and acclimatization. The recommendation of the American Academy of Sleep Medicine applies to patients in the sleep lab for a PAP study and those in the lab for a split-night study. Any time the technician suspects a patient might qualify for a split night, these processes should be resolved before beginning the study

All of the following statements are true about the changes seen from stage N2 to N3 EXCEPT a. sleep spindles may persist into stage N3 sleep. b. eye movements are not typically seen. c. EMG chin activity is often higher than in stage N2. d. delta activity reaches 20% or more in the epoch.

C: All of the statements listed in the question are true except for C. The chin EMG is actually often lower than it was seen in stage N2 when N3 sets in. The reason for this is stage N3 is a deeper stage of sleep, and the muscles relax even more than they had in stage N2 or N1 that preceded it.

Which sensors need to be cleaned and disinfected? a. Any sensors that come into contact with the patient's bodily fluids. b. Only sensors in the patient's nose. c. Any sensors that come in direct contact with the patient in any location. d. Only sensors placed in abraded locations

C: Any sensors that come in direct contact with the patient in any location. All sensors that touch the patient's skin anywhere on the body are to be cleaned and disinfected. Sensors used in the nose and mouth require a higher level of disinfection than other sensors, which may only come into coincidental contact with the skin. The technician should always follow lab protocol for specific disinfection requirements on a case-by-case basis.

Which sensors need to be cleaned and disinfected? a. Any sensors that come into contact with the patient's bodily fluids. b. Only sensors in the patient's nose. c. Any sensors that come in direct contact with the patient in any location. d. Only sensors placed in abraded locations.

C: Any sensors that come in direct contact with the patient in any location. All sensors that touch the patient's skin anywhere on the body are to be cleaned and disinfected. Sensors used in the nose and mouth require a higher level of disinfection than other sensors, which may only come into coincidental contact with the skin. The technician should always follow lab protocol for specific disinfection requirements on a case-by-case basis.

The technician should log which patient information into the computer before the study? a. Medical history. b. Time of last nicotine intake. c. Study identification number. d. Time of arrival.

C: Different labs have different policies and systems for patient acquisition, but in general the patient's name, date of birth, gender, referring doctor, and the study identification number are all logged in before the beginning of the study. Other things that may also be included are the patient's height and weight, his insurance, his social security number, his medication, and the study type.

Excessive transient muscle activity found in REM sleep indicates which of the following sleep disorders? a. Rhythmic movement disorder. b. Amyotrophic lateral sclerosis. c. REM behavior disorder. d. Obstructive sleep apnea disorder

C: During REM, the body paralyzes the control of muscles to protect people from hurting themselves during active dreams. The chemical that is released during REM can usually be attributed to sleep paralysis when sleep is suddenly disrupted. Patients who are capable of moving and who have muscle tone during REM suffer from REM behavior disorder.

All are potential causes of central sleep apnea EXCEPT a. congestive heart failure. b. brain stem injury. c. obesity. d. neurological disease.

C: Obesity. Central sleep apnea is caused by brain damage, congestive heart failure, stroke, or COPD. Obesity is generally a cause of obstructive sleep apnea. Other causes of obstructive sleep apnea can be obstructions in the throat and upper airways such as tonsils or adenoids or excess tissue in the soft palate, deviated septum, or an oversized jaw. Alcohol and smoking increase the severity of obstructive apnea as well.

If the CPAP pressure is set and left below a patient's optimal pressure, what may occur? a. A decrease in patient arousals. b. REM rebound. c. Ongoing hypoventilation or hypoxemia. d. Increased compliance

C: Ongoing hypoventilation or hypoxemia. Patients who are left on suboptimal pressures will continue to under breathe and fail to get sufficient oxygen exchange to the heart. Even if a patient is not having specific or frequent events, CPAP should be used to increase the fullness of the flow wave and proper oxygenation of the blood.

A patient is snoring on CPAP at 11 cwp. What is the best course of action for the technician to take? a. Lower the CPAP to 10 cwp. b. Switch to BiPAP 15/10 cwp. c. Raise the CPAP to 12 cwp. d. Do nothing. Snoring is not treated by CPAP

C: Raising the CPAP pressure is normally the best way to treat primary snoring if there are no mask leaks and no central apneas. Switching to BiPAP is done if the patient starts to develop central apneas. A mask leak might be causing problems with the treatment and preventing the tech from determining if a pressure is at a good therapeutic level.

What should the technician do if the patient awakens and complains that the pressure is too high? a. Switch to the pressures of BiPAP titration. b. Ask the patient to continue trying to return to sleep, and make no changes to the pressure. c. Restart pressure with one that the patient subjectively feels comfortable. d. Reduce pressure to no less than where obstructive apnea was eliminated.

C: Restart pressure with one that the patient subjectively feels comfortable. Often patients will awaken from sleep confused and panicked at this strange new device that they forgot was on their face. The reactions commonly seen are anxiety and fear. The most important goal when facing patients who complain of the pressure being too high is for them to return to sleep. If patients cannot return to sleep, then the titration cannot continue. The technician should do whatever the patients want to instill calm and allow them to return to sleep as far as the PAP pressure is concerned, even if it does not make sense.

Which of the following is an adequate chemical disinfectant used to clean surfaces? a. Oxirane. b. Formaldehyde. c. Sodium hypochlorite. d. Isoflurane.

C: Sodium hypochlorite. Oxirane is a cyclic ether used in high-level sterilization; it is not recommended for casual surface cleaning and is far too powerful for such a task. Formaldehyde is also a very powerful disinfectant and sterilant, which should only be used on critically contaminated surfaces. Isoflurane is an inhaled ether gas used in anesthetics and would not be appropriate for any surface cleaning. Sodium hypochlorite, or bleach, is a safe and appropriate chemical for surface cleaning when used according to directions

Where is the O1 lead located in relation to the T3 lead? a. Left and behind, 25% of the total circumference of the head. b. Right and behind, 25% of the total circumference of the head. c. Left and behind, 20% of the total circumference of the head. d. Right and behind, 20% of the total circumference of the head

C: The O1 lead is on the left side of the head, 20% of the total circumference of the head behind the T3 lead. The O2 lead is on the right side of the head, 20% of the total circumference of the head behind the T4 lead. An easy way to remember which side of the head a lead is on is to remember that odd numbered leads are on the left (e.g., O1, C3, T3) and even numbered leads are on the right (e.g., O2, C4, T4).

Lights off: 23:30 Lights on: 05:30 Sleep onset: 00:30 Total NREM sleep time (min): 230 Total REM sleep time (min): 45 What is the sleep efficiency (rounded to the nearest percentage)? a. 70%. b. 89%. c. 76%. d. 74%.

C: The sleep efficiency, or the percentage of the total recording time the patient was asleep, is gained by dividing the total sleep time by the total recording time (TST/TRT = SE). In this case it is roughly 76%. This is useful for comparison to the ideal sleep efficiency and can help determine if the patient's sleep architecture is fractured

Periodic limb movements in sleep (PLMS) are defined as .... a. at least 2 movements, between 5 and 90 seconds apart, and between 0.5 and 5 seconds in duration for each movement. b. at least 4 movements, between 5 and 90 seconds apart, and between 1 and 5 seconds in duration for each movement. c. at least 4 movements, between 5 and 90 seconds apart, and between 0.5 and 5 seconds in duration for each movement. d. at least 4 movements, between 10 and 90 seconds apart, and between 0.5 and 5 seconds in duration for each movement.

C: at least 4 movements, between 5 and 90 seconds apart, and between 0.5 and 5 seconds in duration for each movement.

G1 and G2 represent a. the first signal input and the ground lead, respectively. b. the ground lead and the first signal input, respectively. c. the first signal input and the second signal input, respectively. d. the ground lead and the exploring electrode, respectively

C: the first signal input and the second signal input, respectively.

Cataplexy is a. a sudden jolt or spasm when transitioning from wake to stage 1. b. the loss of muscle tone in REM. c. the loss of muscle tone that accompanies a strong emotion. d. a waxing or waning in respiratory flow and rate.

C: the loss of muscle tone that accompanies a strong emotion.

Which of the following EEG frequencies can be seen during an arousal from sleep? a. Alpha. b. Theta. c. Any frequency over 16, excluding sleep spindles. d. All of the above.

D: All of the above. The guidelines of the American Academy of Sleep Medicine for scoring arousals suggest scoring them during any stage of sleep, if there is an abrupt shift of EEG frequency, including alpha, theta, or frequencies over 16 Hz (not including spindles) that last at least 3 seconds, with at least 10 seconds of stable sleep preceding the change. Arousals may be scored within epochs that are predominantly stage wake as long as there are 10 seconds of sleep before the arousal is present.

Which of the following statements about the removal of paste residue from the patient in the morning is true? a. The paste never needs to be removed. b. Only remove the paste if the patient asks. c. Remove the paste if the patient is physically unable. d. Always remove remnants of paste from the patient's body.

D: Always remove remnants of paste from the patient's body. Although most of the paste used in sleep labs is nontoxic, every single "Safety Data Sheet" for conductive pastes clearly states that the paste should be removed from the patient following use. Even if a patient is going to take a shower immediately, the paste should be wiped clean before the conclusion of the equipment-removal process in the morning.

_________ is measured in Hertz (Hz) and __________ in microvolts (uV). a. Amplitude, frequency b. Amplitude, sensitivity c. Frequency, sensitivity d. Frequency, amplitude

D: Frequency, amplitude

Which of the following is true about CPAP mask leaks? a. There cannot be any clinical leak for a successful titration. b. There may be some leak present, depending on the mask style. c. The acceptable leak value varies from patient to patient. d. Leaks should be within the manufacturer's recommended range and not causing sleep fragmentation

D: Leaks should be within the manufacturer's recommended range and not causing sleep fragmentation

According to scoring guidelines of the American Academy of Sleep Medicine, which piece of equipment is used to identify hypopnea? a. Thermal sensor. b. Nasal air pressure transducer. c. Capnograph. d. None of the above

D: None of the above. A minimum duration of 0.5 seconds and a maximum duration of 10 seconds are in line with scoring guidelines of the American Academy of Sleep Medicine (AASM), as are the criteria for the ending of a leg movement event. However, the opposite is true for leg movements associated with respiratory events. According to the scoring guidelines of the AASM, leg movements associated with respiratory events are not scored because their causality is uncertain.

Antidepressants suppress which stage of sleep? a. Stage 1. b. Stage 2. c. Stage 3. d. REM.

D: REM

What percentage drop in the SpO2 data must be seen to score an obstructive event? a. 3% or more. b. 4% or more. c. 5% or more. d. No required drop in the SpO2 channel.

D: Scoring obstructive apneas only relies on the 90% for 90% of the event with respiratory effort throughout criteria. Unlike hypopneas, apneas do not require an associated drop in blood oxygen saturation to be scored. Obstructive apneas will often have desaturations associated with them, and the validity of the event should be questioned if there is not a change in the SpO2 .

During a CPAP titration study a patient at a CPAP pressure of 15 cm who is still snoring and having hypopneas complains that the pressure feels too high and she cannot sleep. What should the technician do? a. Leave the CPAP at 15 cm and wait for the patient to fall back to sleep. b. Lower the CPAP pressure to 13 cm and wait for the patient to fall back to sleep before raising it again. c. Raise the CPAP pressure to 17 cm. d. Switch to BiPAP of 15/11 cm and continue the titration.

D: Switching to BiPAP will sometimes help the patient deal with higher pressures. The EPAP should be 4-8 cm lower than the IPAP pressure and should be set at a pressure where the apneas are cleared. The higher IPAP pressure should be set where the snoring and hypopneas have been cleared. The two different pressures will help the patient relax and fall back to sleep but still provide a good point in which to continue the titration

Key things to look for in REM behavior disorder montage are a. muscle movements, increased chin EMG activity, and obstructive apneas in REM. b. muscle movements, increased chin EMG activity, and central apneas in REM. c. muscle movements, decreased chin EMG activity, and obstructive apneas in REM. d. muscle movements and increased chin EMG activity in REM.

D: The key things to look for are increased chin EMG activity, muscle movements and obstructive apneas in REM. This is abnormal and potentially dangerous to the patient or his bed partner. REM behavior disorder montages normally have a full EEG hookup, the standard baseline montage, and extra EMG leads on the arms to look for this activity. There should also be audio and video monitoring to look for any excess movements or activity in REM.

Lights off: 23:30 Lights on: 05:30 Sleep onset: 00:30 Total NREM sleep time (min): 230 Total REM sleep time (min): 45 What is the percentage of NREM sleep (rounded to the nearest percentage)? a. 20%. b. 16%. c. 15%. d. 84%.

D: The percentage of NREM (non-REM) sleep is found by dividing the amount of NREM sleep by the total sleep time: 230/275 = ~84%. The percentage of non-REM sleep is useful in determining if a patient's sleep architecture is fractured and is also useful in determining the patient's non-REM apnea-hypopnea index (AHI) or respiratory disturbance index (RDI).

Lights off: 23:30 Lights on: 05:30 Sleep onset: 00:30 Total NREM sleep time (min): 230 Total REM sleep time (min): 45 What is the total wake time (TWT), in minutes? a. 25. b. 15. c. 100. d. 85.

D: The total wake time is gathered by subtracting the total sleep time from the total recording time (TRT- TST = TWT). In this case the answer is 85. The total wake time is valuable for determining the sleep efficiency, or the percentage of the total sleep time the patient was asleep during the study, and for helping to determine if the patient has insomnia or long awakenings during the night.

Heated humidity can possibly remedy which of the following conditions seen in some patients? a. Patient complains of being cold. b. Patient mouth-breathes because of nasal congestion. c. Patient complains of dry throat or nose. d. Both B and C.

D: When scoring infant sleep studies, the only available options for sleep stage scoring are indeterminate sleep, active REM sleep, and quiet sleep. At around 6 months of age, pediatric scoring rules become more applicable as waveforms, such as sleep spindles, become manifested. An infant's EEG is so unlike the pediatric and adult waveforms that identifying the standard sleep stages would be impossible.

Staging choices for infants include which of the following combinations? a. Active REM sleep and quiet sleep. b. Indeterminate sleep, wake, and quiet sleep. c. Active REM sleep and delta sleep. d. Indeterminate sleep, active REM sleep, and quiet sleep.

D: When scoring infant sleep studies, the only available options for sleep stage scoring are indeterminate sleep, active REM sleep, and quiet sleep. At around 6 months of age, pediatric scoring rules become more applicable as waveforms, such as sleep spindles, become manifested. An infant's EEG is so unlike the pediatric and adult waveforms that identifying the standard sleep stages would be impossible.

What is hypnagogic jerk? a. A muscle spasm during the transition from stage 1 to stage 2 sleep. b. A muscle spasm during the transition from stage 2 to REM sleep. c. A muscle spasm during the transition from sleep to wakefulness. d. A muscle spasm during the transition from wakefulness to sleep.

D:A muscle spasm during the transition from wakefulness to sleep.