RPSGT cheat sheet

AASM EEG montage: F4-M1, C4-M1, O2-M1 as primary; F3-M2, C3-M2, O1-M2 as backups; EOG E1-M2 and E2-M2; chin EMG with three electrodes.

Electrode impedance target is ≤5 kΩ; impedance checks are documented before recording and after any electrode repair.

E1 sits 1 cm below and 1 cm lateral to the left outer canthus; E2 sits 1 cm above and 1 cm lateral to the right outer canthus.

Chin EMG: one midline electrode 1 cm above the inferior edge of the mandible; two electrodes 2 cm below and 2 cm lateral to midline.

Leg EMG: surface electrodes 2-3 cm apart over the anterior tibialis; bilateral recording is recommended for PLM detection.

Bio-calibration includes eyes open, eyes closed, left/right gaze, blinks, jaw clench, sniff, leg movements, and breathing.

End-tidal CO2 normal range is 35-45 mmHg; transcutaneous CO2 is an alternative for pediatric or ventilation monitoring.

A single modified ECG lead on the chest is used to maximize R-wave detection and identify cardiac arrhythmias.

Oximetry sampling should provide a stable SpO2 waveform; signal averaging time affects detection of brief desaturations.

EEG filter settings: low-frequency 0.3 Hz, high-frequency 35 Hz; EOG 0.3-35 Hz; chin EMG 10-100 Hz.

AASM recommends at least 200 Hz sampling for EEG, EOG, EMG, and ECG; airflow and oximetry can be sampled at lower rates.

Arousal: abrupt EEG frequency shift ≥3 seconds; in REM, a concurrent chin EMG increase ≥1 second is required.

Apnea: ≥90% airflow reduction for ≥10 seconds; obstructive if effort persists, central if effort is absent, mixed if both patterns occur.

Hypopnea: ≥30% airflow reduction for ≥10 seconds with ≥3% desaturation or an arousal.

PLMS: ≥4 consecutive leg movements, each 0.5-10 seconds, separated by 5-90 seconds.

Stage N3: slow waves 0.5-2 Hz and >75 µV occupying ≥20% of the epoch.

REM: low-amplitude mixed-frequency EEG, low chin EMG tone, and rapid eye movements; transient muscle activity may persist.

MSLT: four or five naps at 2-hour intervals; mean sleep latency ≤8 minutes is abnormal; SOREMP is REM within 15 minutes.

Scoring uses 30-second epochs; each epoch receives one stage based on the predominant pattern and transition rules.

Sleep onset is the first epoch of any sleep stage after lights out.

Stage W: alpha rhythm >50% of the epoch in patients with occipital alpha; without alpha, use eye blinks, reading eye movements, or high chin EMG.

N1: low-amplitude mixed-frequency EEG, slow eye movements, and vertex sharp waves; no sleep spindles or K-complexes.

N2 begins with a K-complex unassociated with arousal or a sleep spindle in the first half of the epoch or last half of the preceding epoch.

N3: ≥20% of the epoch occupied by slow waves of 0.5-2 Hz and >75 µV.

REM: low-amplitude mixed-frequency EEG, low chin EMG, and rapid eye movements; chin EMG may show brief twitches.

AHI = apneas plus hypopneas per hour of sleep; 5-15 is mild, 15-30 is moderate, and >30 is severe.

Report includes study indication, technical quality, sleep architecture, respiratory events, PLM index, ECG findings, and diagnostic impression.

CPAP titration endpoint: elimination of obstructive apneas, hypopneas, snoring, and desaturations in supine REM sleep.

PAP adherence is commonly defined as ≥4 hours per night on ≥70% of nights; Medicare uses a 30-day compliance window.

BiPAP is used when high CPAP pressure is poorly tolerated or ventilation is inadequate; ASV targets central sleep apnea and Cheyne-Stokes respiration.

Oxygen therapy is added when SpO2 remains <90% despite adequate PAP pressure.

Positional therapy is indicated when the AHI is at least twice as high in the supine position as in the nonsupine position.

Fall precautions include bed rails, call-light access, assisted ambulation, and alarm response.

Infection control: hand hygiene before and after contact and between patients; disinfect reusable electrodes per manufacturer instructions.

Professional standards include informed consent, HIPAA confidentiality, accurate documentation, and adherence to the BRPT code of ethics.

Emergencies: maintain suction, oxygen, bag-valve-mask, and AED access; activate EMS for chest pain, severe dyspnea, or unresponsiveness.