RPSGT flashcards
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- EEG electrode impedance limit
- Before polysomnography, each EEG electrode impedance should be at or below 5 kΩ; higher impedance increases noise and artifact.
- C4-M1 derivation
- The C4-M1 EEG channel is the primary central derivation recommended by AASM, with C3-M2 as its backup for sleep staging.
- EOG electrode placement
- E1 is placed 1 cm below and 1 cm lateral to the left outer canthus; E2 is 1 cm above and 1 cm lateral to the right outer canthus.
- Chin EMG placement
- Three chin electrodes are used: one midline 1 cm above the inferior mandible edge and two 2 cm below and 2 cm lateral to midline.
- Leg EMG placement
- Surface electrodes over the anterior tibialis muscles are placed 2-3 cm apart, with bilateral recording recommended to detect periodic limb movements.
- Bio-calibration maneuvers
- Bio-calibration documents eye movements, blinks, jaw clench, sniffs, leg movements, and breathing before lights out to verify signal integrity.
- End-tidal CO2 normal
- End-tidal carbon dioxide monitoring normally reads 35-45 mmHg; values outside this range may indicate hypoventilation or hyperventilation.
- Modified ECG lead
- A single modified ECG lead is placed on the chest to optimize R-wave detection and identify arrhythmias during polysomnography.
- EEG filter settings
- Standard EEG filters for polysomnography are a low-frequency filter of 0.3 Hz and a high-frequency filter of 35 Hz.
- EMG filter settings
- Chin EMG is typically recorded with a low-frequency filter of 10 Hz and a high-frequency filter of 100 Hz.
- Arousal scoring rule
- An arousal is an abrupt EEG frequency shift lasting at least 3 seconds; during REM it also requires a simultaneous chin EMG increase lasting at least 1 second.
- Apnea definition
- An apnea is a drop in airflow of at least 90% from baseline lasting at least 10 seconds, scored as obstructive, central, or mixed.
- Hypopnea definition
- A hypopnea is at least a 30% airflow reduction lasting 10 seconds or more with a 3% oxygen desaturation or an arousal.
- Periodic limb movement rule
- PLMS are scored when at least four consecutive leg movements last 0.5-10 seconds and are separated by 5-90 seconds.
- N3 slow-wave threshold
- Stage N3 requires slow waves of 0.5-2 Hz and greater than 75 µV peak-to-peak occupying at least 20% of the epoch.
- REM chin EMG
- REM sleep requires low chin EMG tone, low-amplitude mixed-frequency EEG, and rapid eye movements, with transient muscle twitches allowed.
- Epoch length
- Sleep is scored in 30-second epochs, and each epoch is assigned a single stage based on the majority pattern or specific transition rules.
- Sleep onset definition
- Sleep onset is the first epoch scored as any sleep stage, typically N1, N2, or REM, after lights out.
- Stage W alpha rule
- Stage W is scored when alpha rhythm occupies more than 50% of the epoch in an individual with occipital alpha.
- N2 continuation rule
- N2 continues until an arousal, transition to W, N3, or REM, or a major body movement followed by slow eye movements.
- AHI severity categories
- An apnea-hypopnea index of 5-15 is mild, 15-30 is moderate, and greater than 30 is severe obstructive sleep apnea.
- Desaturation threshold
- A respiratory desaturation is scored when SpO2 falls at least 3% from the preceding baseline value.
- SOREMP definition
- A sleep-onset REM period is REM sleep occurring within 15 minutes of sleep onset, often seen in narcolepsy and sleep deprivation.
- PLM index formula
- The periodic limb movement index equals the number of PLMS divided by hours of sleep, typically reported separately for adults and children.
- CPAP titration goal
- CPAP pressure is titrated to eliminate obstructive apneas, hypopneas, snoring, and desaturations during supine and REM sleep.
- PAP adherence criterion
- Common adherence criteria require CPAP use of at least 4 hours per night on at least 70% of nights.
- ASV indication
- Adaptive servo-ventilation is used for central sleep apnea, particularly Cheyne-Stokes respiration, by adjusting pressure support to stabilize ventilation.
- Positional therapy
- Positional therapy limits supine sleep using devices or alarms and is considered when apnea is substantially worse in the supine position.
- Fall precautions
- Patients at risk for falls require bed rails, assistance with ambulation, and prompt response to alarms during overnight polysomnography.
- Hand hygiene standard
- Hand hygiene before and after patient contact and between electrode applications reduces transmission of pathogens in the sleep laboratory.
- HIPAA privacy rule
- The HIPAA Privacy Rule protects individually identifiable health information and limits its use and disclosure without patient authorization.
- Informed consent
- Informed consent requires explaining the procedure, risks, benefits, alternatives, and the patient's right to withdraw before testing.