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168 Cards in this Set
- Front
- Back
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What do the initials "MSLT" stand for? |
Multiple Sleep Latency Test |
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How many naps are usually performed during the MSLT? |
5 naps throughout the day. |
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Following an overnight polysomnogram, when should the 1st nap of a MSLT begin? |
1.5 to 3 hours after the overnight polysomnogram. |
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During the MSLT, when is the nap terminated following the sleep onset? |
15 minutes from the 1st epoch of sleep. |
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On a MSLT, if there is no sleep noted when is the nap terminated? |
20 minutes from the time of "Lights Out". |
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Define sleep latency |
The amount of time elapsed from "Lights Out" to the 1st epoch of sleep. |
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Define REM latency |
The amount of time elapsed from the 1st epoch of sleep to the 1st epoch of REM. |
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What is the purpose of performing the "MSLT"? |
To assess & diagnose diseases of excessive somnolence and to evaluate daytime sleepiness. |
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To support a diagnosis of narcolepsy what is the required TST on the prior night's sleep necessary before performing the MSLT? |
6 hours |
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How long before a MSLT nap should the patient cease smoking? |
30 minutes. |
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What epoch duration is recommended for recording the "MSLT"? |
30 second epochs. |
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What does a mean sleep latency of <5 minutes on a "MSLT" indicate? |
Pathological Sleepiness. |
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What is the range for normal mean sleep latency on a MSLT? |
10-20 minutes. |
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How many naps must have unequivocal REM to support a diagnosis of narcolepsy? |
2 naps |
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What is the tetrad of narcolepsy? |
Excessive Daytime Sleepiness Hypnogognic Hallucinations Sleep Paralysis Cataplexy
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What montage is generally used for recording the "MSLT"? |
The core channels:
2 EOG, 4 EEG, Chin EMG, EKG. |
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How is the mean sleep latency calculated? |
Sum of all the sleep latencies for each nap; divided by the total number of naps performed.
(N1+N2+N3+N4+N5) /# Naps completed |
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On the MWT, what mean sleep latency is considered abnormal? |
Less then 8 minutes |
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How is the mean REM latency calculated? |
Sum of all REM latencies; divided by the # of REM periods that occured.
2+3+2=7/3=2.3 2.3 minutes=Mean REM latency |
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During the MSLT, at what interval are the naps scheduled? |
Every 2 hours. |
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Define The Multiple Sleep Latency Test (MSLT) |
The sleep test used in the assessment and diagnosis of disorders of excessive somnolence and to evaluate daytime sleepiness in relation to various therapeutic or experimental manipulations. |
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How many minutes after lights-out is the standard MSLT terminated if there is no sleep onset noted? |
20 minutes |
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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 |
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On the MWT, when is the test opportunity ended? |
After 40 minutes of after unequivocal sleep onset latency defined as 3 consecutive epochs of Stage N1 or one epoch of any other sleep stage. |
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Define Normal Sinus Rhythm |
Heart Rate- 60-100 beats per minute Rhythm is regular PR interval-0.12 to 0.20 sec. QRS interval- 0.04-0.11 sec. P to QRS ratio: 1:1 |
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Define Sinus Tachycardia. |
EKG channel shows regular rhythm, rate >100 bpm (seldom>150 bpm); P waves present and upright before each QRS complex. Time interval is same for all beats. |
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What is the EKG pattern with no P waves, no QRS complex, chaotic rhythm and no measurable rate. |
Ventricular Fibrillation |
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The EKG channel shows more 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. What is occurring? |
3rd degree AV block or complete heart block |
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What begins the cardiac cycle? |
Discharge of the SA node which causes the atria to depolarize. |
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The left and right bundles send the impulse through which system to the ventricular myocardium? |
Purkinje System |
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Respiratory Disturbance Index (RDI) is a measurement of what? |
The number of apneas, hypopneas and RERAs per hour of total sleep time as determined by all-night polysomnography. |
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Infant breathing pattern that alternates regular breathing with 5-10 seconds of apnea. |
Periodic Breathing |
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Define Apnea |
Cessation of airflow at the nostrils and mouth lasting at least 10 seconds. |
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Define apnea/hypopnea index. |
The number of apneas (obstructive, central, mixed) plus hypopneas per hour of total sleep time as determined by all-night polysomnography. |
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A complaint of morning headaches may be associated with severe sleep apnea as a result of what? |
Severe oxygen desaturation and hypercapnia |
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What initial effect does administering supplement oxygen have on the patient with obstructive sleep apnea syndrome? |
A significant increase in apnea duration with associated hypercapnia and respiratory acidosis. |
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Define Central Apnea. |
A cessation of breathing, characterized by an absence of both airflow and respiratory effort. |
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Define hyperventilation. |
Rapid deep breathing, resulting in reduced levels of CO2 in the blood. |
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Define hypoventilation. |
Insufficient breathing volumes resulting in increased levels of CO2 in the blood. |
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What is an abnormally low blood oxygen saturation level? |
Hypoxemia |
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Define Obstructive Apnea |
A cessation of breathing caused by upper airway obstruction. |
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The maximum amount of air the lungs can contain |
Total Lung Capacity |
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What is a breathing pattern characterized by rhythmic waxing and waning of the depth of respiration, with regularly recurring periods of apneas? |
Cheyne-Stokes Respiration |
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What is the normal arterial pCO2 value in adults? |
35-45 mmHg |
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Normal arterial pO2 |
80-100 mmHg |
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What is the major cause of hypoventilation and reduced ventilatory response to chemical response during sleep? |
Increased airway resistance |
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Define paradoxical breathing |
The thorax and abdomen move in opposite direction. |
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What is an imaging study that allows for the observation of anatomic changes in the upper airway during ventilation? |
Video fluoroscopy of the pharynx. |
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Describe Sleep Related Hypoventilation/Hypoxemic Syndrome |
Episodes of shallow breathing of 10 seconds or longer with decreases in oxygen saturation and associated EEG arousal and increased carbon dioxide levels associated with a reduced response to hypercapnia or hypoxia during wake and sleep. |
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Describe what occurs in the lungs during expiration. |
The blood delivers carbon dioxide to the lungs for removal from the body |
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Describe the 4 parts of the pharynx. |
Nasopharynx, oropharynx, velopharynx, and hypopharynx |
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A patient an become the pathway of least resistance, and therefore susceptible to shock when what occurs? |
When all the equipment attached to the patient is not connected to a common ground. |
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What equation best expresses time constant? |
TC=CXR TC=Time Constant C=Capacitance R= Resistance |
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An impedance's greater than 10,000 ohms, allows for greater potential of electrode imbalance and the appearance of what in the recorded signal? |
60 Hz Interference |
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If the circumference measurement of the head is 60 cm, what is the distance of T4 electrode from the Fp2 electrode? |
12 cm |
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What is the minimum time base recommended to allow clear visual resolution of alpha and sleep spindles? |
10 mm/sec |
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Define Stage N1 |
Low voltage, mixed frequency EEG with a prominence of activity in the 2-7 Hz range, slow rolling eye movements. |
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Name the waveform that is sharply contoured, <.5 seconds in duration stands out from background activity and is maximal over the central region. |
Vertex Sharp Wave (V waves) |
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Define K Complex |
The waveform that has a total duration greater than 0.5 sec with a well-delineated negative sharp wave followed by a positive component. |
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What sleep stage requires at least 20% of the epoch to consist of waves of 2 Hz or slower with amplitudes greater then 75 uV from peak to peak? |
Stage N3 |
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Define rapid eye movements |
Conjugate, irregular, sharply peaked eye movements with an initial deflection usually lasting <500 msec. |
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How are eye movements recorded? |
There is small electropotential difference between the cornea (+) and the retina (-). An electrode closest to the cornea will register a (+) deflection; electrode closest to the retina will register a (-) deflection. |
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List the 4 skull landmarks used in 10-20 System of electrode Placement. |
Nasion, Inion, Right Preauricular, and Left Preauricular |
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Define Common Mode Rejection Ratio |
The degree to which an amplifier will reject a common signal |
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Define quiet sleep. |
EEG pattern with high voltage slow waves, Trace Alternant or mixed waveforms, no REMs present and the chin EMG is higher in tone, breathing pattern is regular and cyclical. |
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Define active-REM sleep. |
EEG channels have theta waves of low voltage irregular mixed pattern, REMS are present with other facial movements (smiles, frowns, and sucking) and the chin EMG is reduced, respiration's are irregular with short central pauses with periods of short, rapid breathing, body movements are often present. |
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What is the age at which K complexes are present? |
4-6 months post term or older |
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At what age do sleep spindles appear in the infant? |
2-3 months post term or older |
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An epoch that does not meet the criteria for Active Sleep or Quiet Sleep is called what? |
Indeterminate Sleep |
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Trace Alternant pattern is associated with what stage of sleep in the infant? |
Quiet Sleep |
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REM occupies what percentage of sleep in the neonate at term? |
50% |
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Term used for brief superimposition of EEG alpha activity on sleep activities during a stage of sleep. |
Alpha Intrusion |
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What impact does sleep have on thermoregulatory responses? |
Sweating or shivering do not occur in stage R sleep; changes in body posture at different temperatures occurs in NREM sleep but not during stage R sleep; all autonomic thermoregulatory responses are impaired in stage R sleep. |
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A function that expresses the frequency of eye movements per unit time during sleep stage REM. |
REM Density |
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What is the recommended procedure for electrode application to record eye movements? |
One electrode is 1 cm above and slightly lateral to the outer canthus, while the other electrode is 1 cm below and slightly lateral to the outer canthus of the eye. |
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What are 3 potential sources of stray electrical current? |
Short Circuit, Leakage Current, Ground Loop |
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Define signal frequency |
The number of waves recorded in one second, described as cycles per seconds (cps) or Hertz (Hz) |
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Define signal amplitude |
The vertical height of the wave representing the electrical force of voltage of the wave. |
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Define time constant. |
The response time to the selected high and low frequency filter settings during the calibration procedure. |
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Describe signal attenuation. |
Reduction in size or amplitude of a signal. |
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Describe slow frequency artifact. |
Undesirable variations during a recording, usually caused by sweat referred to as "sweaty sway" or can by caused by pressing against the electrode, "electrode artifact popping". |
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What are voltages originating from living tissues? |
Bio-electrical Potentials |
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What are signals obtained by comparing voltages from two exploring electrodes? |
Bipolar Derivation |
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What is the amplifier component used for storing an electrical charge? |
Capacitor |
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A ground connection shared by more than one instrument or appliance. |
Common Ground |
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List 3 sources of the physiological signals in polysomnography |
1. Bioelectrical potentials 2. Transduced signals from sensors attached to the patient 3. Signals derived from ancillary equipment |
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Define current. |
Flow of electrical force along a conductor which is a material capable of transmitting an electrical current. |
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What is signal derivation? |
Signal obtained from a pair of electrodes or sensors. |
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What is the recommended sampling rate the EEG, EOG, EMG, and ECG during digital polysomnography? |
The desirable sampling rate is 500 Hz with a minimum sampling rate of 200 Hz. |
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What is fall time constant interval? |
The time interval during which the calibrated signal wave falls to 37% of the signal amplitude when a DC calibration signal is applied to an amplifier. |
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Define digital filter. |
Filters are designed to reduce or eliminate unwanted frequencies from passing through as amplifier. Digital filters use software algorithms to delete selected frequencies after the amplified signals have been converted to digital form. |
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What is a system referencing? |
Used in digital polysomnography systems for selecting and changing signal input derivations. It relies on a common reference electrode and the signals form each electrode are initially referenced to the common "system" electrode (Cz). The common reference is digitally subtracted from any pair of input signals-C3/M2 the Cz reference is subtracted from both the C3 and M2. |
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What is Inductive Plethsymography? |
A method of measuring changes in body (or body parts) circumference. |
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Name the stray current that is generated by the proximity of electrical power cords to adjoining cables or the polygraph chassis. |
Leakage Current |
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The ratio of output voltage to input voltage or amplifier sensitivity is also known as what? |
Gain |
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Define action potential |
Electrical signals that originate at the junction between axon and cell body and travel down the axon at speeds of 0.1 to 100 m/sec. |
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What derivation is used to obtain a signal by comparing voltages from an exploring electrode to a relatively inactive electrode? |
Referential Derivation |
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What is created when there is an opposition to electrical current? |
Resistance |
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Describe how synchronized neuronal activity is recorded. |
Surface EEG electrodes are large and record from the signal form millions of neurons and the voltage changes recorded in the EEG reflect the summed electrical activity of the entire region under the electrode. |
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What is 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 |
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What is recommended method to detect hypopneas? |
Nasal air pressure transducer |
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What is the sequence of tests used to verify and document appropriate amplifier and pen responses to various maneuvers performed by the patient prior to a sleep study? |
Bio-Calibrations |
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Typically appearing during the latter part of N1 sleep. Name the sharp negative wave, usually within the theta frequency range. |
Vertex Waves |
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Primarily seen in stage N2 sleep; what waveform appears as a sharp negative deflection, followed by slower positive deflection? |
K- Complex |
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Characteristic of stage N2 sleep; What is the short rhythmic clusters of 12-14 Hz, often showing a waxing and waning appearance? |
Sleep Spindles |
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Define sawtooth waves. |
A common feature of REM sleep; the relatively low amplitude waveform, with a notched appearance. |
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What are the two categories of REM sleep? |
Tonic and Phasic |
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What type of artifact is caused by electrodes that momentarily lift away from the skin? |
Electrode Popping |
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What type of airflow sensor is less responsive to minor changes in airflow and are more susceptible to drift caused by air currents, or contact with the patient's skin? |
Temperature based sensors, such as thermocouple. |
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What respiratory event is defined by a cessation of airflow detected at the nose and mouth occurring for 10 seconds longer? |
Apnea |
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What is the abrupt shift in EEG frequency, that interrupts the continuity of sleep? |
Arousal |
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What is the time segment, usually 30 seconds, used to score sleep stages? |
Epoch |
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What muscle is monitored when testing for bruxism? |
Masseter muscle |
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Name the bony area located behind the ear, used for placement of the reference electrodes M1 and M2. |
Mastoid Process |
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What is the progression and distribution of various sleep stages and the quantitative relationship to each other? |
Sleep Architecture |
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What is the term used to describe a period of NREM sleep followed by a subsequent REM period? |
Sleep Cycle |
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What type of device is used to convert non-electrical physiological activity into electrical signals? |
Transducer |
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What is the term used to describe the arrangement of electrode derivations? |
Montage |
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What physical law is represented by the following equation: Voltage(E) is equal to the current (I) flowing in the circuit multiplied by the resistance (R) in the circuit, E=I x R? |
Ohm's Law |
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What are the 3 types of grounds found in electronic equipment? |
Earth (building or power outlet) ground, chassis ground, common connection ground. |
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What are the 4 sources of artifacts? |
1. Irrelevant physiological signals, ex. EKG 2. Environmental interferences 3. Faulty or improperly applied electrodes 4. Electrical interference |
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What consideration should be given to the choice of electrodes used for recording EEG? |
Choose a material that has minimum drift of electrode potential and a very log time constant. |
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What is the frequency of Alpha? |
8 to 13 cycles per second. |
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What is the EEG activity with a frequency faster than 13 Hz? |
Beta Activity |
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What is the EEG rhythm seen in the central areas with a frequency of 9 Hz and is not responsive to eye opening? |
Mu Rhythm |
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What is WASO? |
Wake After Sleep Onset: Wakefulness that occurs after the defined sleep onset. |
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What changes in the autonomic nervous system occur during REM sleep? |
Variable heart rate, irregular breathing, increase in PaCO2, decrease in tonic muscle activity, increase in blood pressure. |
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What are PGO waves? |
A component of REM sleep, these waves start in the Pons and are transmitted to the thalamic lateral Geniculate nucleus and to the visual Occipital cortex. |
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What type of slow waves are found in the occipital channels in the patients over 2 years old; and occurs during wakefulness with the eyes open? |
Polyphasic slow waves |
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What 2 types of waveform analysis is provided in digital polysomnography? |
Power Spectral Analysis and Period Amplitude Analysis |
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What are categories of proper lifting techniques that will insure proper body mechanics when assisting a patient in the sleep center? |
Bending, reaching, pulling or pushing and lifting. |
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If there is an electrical accident, what level of electric current introduced in the human body will cause ventricular fibrillation? |
1000 to 4300 Milliamperes |
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Reflux is identified in the distal esophagus by a drop in the pH below what? |
4.0 |
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What are the effects of chronic alcoholism on sleep? |
Decreases sleep onset latency, suppresses REM sleep and may increase Stage N3 sleep in the first half of the night, then in the second half of the night, there is increased Stage N1 sleep and more awakenings. |
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Define transient insomnia |
A sleep problem that lasts less than one month. |
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What neuromuscular disorders are most commonly associated with sleep disordered breathing. |
1. Muscular dystrophy 2. Myotonic dystrophy 3.Amyotrophic lateral sclerosis 4.Myasthemia gravis |
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What are the polysomnographic findings that may occur during a sleep study on a patient with the gastro-esophageal reflux? |
1. Increased arousal index 2. Decrease in Stage N3 sleep 3. Poorer sleep related quality of life |
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What is the Suprachiasmatic nuclei (SCN)? |
Known as the pacemaker for mammalian circadian rhythms. |
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Define the term "sundowning". |
Term used to describe patients whose function deteriorates in the late afternoon and evening causing confusion or agitation. |
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Define rhythmic movement disorders in children. |
Movements that occur during the transition from wake to sleep which includes body rocking, head rolling and head banging which usually resolve by age 4 |
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What is the quantitative definition for insomnia? |
Reported sleep onset latency or wake after sleep onset of greater than 31 minutes occurring at least 3 times per week for at least 6 months. |
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What is the most common cause of heart failure in the adult population? |
Left ventricular myocardial failure |
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Define Restless Legs Syndrome |
Disorder characterized by an irresistible urge to move the legs, accompanied by uncomfortable sensations when resting or inactive often with temporary relief while walking. |
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A patient with "Ondine's Curse" would be expected to have what type of respiratory impairment? |
Central Alveolar Hypoventilation |
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Which class of drugs is known to aggravate Periodic Limb Movements of Sleep? |
Tricyclic Antidepressants |
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Define Rolandic Epilepsy |
Benign childhood Epilepsy with CentroTemporal spikes (BECT) |
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Define REM Behavior Disorder |
Disorder characterized by excessive motor activity during sleep and sleep behaviors that may enact the patient's dreams or nightmares. |
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The reticular activating system is essential for what part of the sleep/wake cycle? |
Initiation and Maintenance of Wakefulness |
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Ultradian is compromised of what 3 behavioral states? |
Quiet wakefulness, NREM, and REM |
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Define Restorative Theory |
Theory based on body tissue being restored in NREM sleep and brain tissue being restored in REM sleep. |
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Define Nightmares |
Disturbing, frightening dreams followed by awakenings which occur during REM sleep |
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What happens to swallowing during sleep? |
It is suppressed to mainly during slow wave sleep |
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What is sleep disturbance that lasts one to several nights in an isolated period and is most often caused by an acute situational stress or travel across multiple time zones? |
Adjustment Insomnia (Acute Insomnia) |
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What is a type of insomnia identified by a sleep study with an increased sleep latency or wake after sleep onset with a reduced sleep efficiency and may also have an increased percentage of Stage N1 sleep and a decrease in Stage N2 sleep? |
Psychophysiological Insomnia |
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What is the disorder which includes severe complaints of insomnia but with no reduction in daytime functioning and there are no objective sleep study results which includes about 5% of patients with insomnia? |
Paradoxical Insomnia |
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What type of insomnia is differentiated by complaints of insomnia from childhood with findings on a sleep study that reveal increased Stage N1 and N2 with decreases in Stage N3 sleep |
Idiopathic Insomnia |
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Define Behavioral Insomnia of Childhood |
The parent reports the child has difficulty falling asleep, staying asleep or both, often associated with lack of bedtime routine and stalling going to bed. |
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What sleep disorder is characterized by prolonged central, mixed or obstructive apneas or hypopneas in the newborn infant? |
Primary Sleep Apnea of Infancy |
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Behaviorally Induced Insufficient Sleep Syndrome |
The person voluntarily reduces sleep time to participate in other types of activities and does not feel alert and well rested during the day. |
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A patient who exhibits confusion during or following arousals from NREM sleep might have what type of sleep disorder? |
Confusional Arousals |
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Define Exploding Head Syndrome |
Patient reports a sudden loud noise of sense of violent explosion in the head while falling asleep or waking during the night. |
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Define Sleep Related Eating Disorder |
Sleep disorder characterized by the patient reporting eating and drinking during sleep, often several times during the night. |
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What is Propriospinal Myoclonus of Sleep Onset? |
Sudden, rapid muscle jerks that occur at sleep onset. |
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A patient who reports painful contractions of the calf muscles during sleep that cause arousals and awakenings might have which sleep disorder? |
Sleep Related Leg Cramps |
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Define a short sleeper |
A person who reports sleeping 5 hours or less |
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What is a disorder noted by pain unrefreshing sleep, fatigue, cognitive difficulties, depression and anxiety associated with alpha intrusion that is often noted during the sleep study? |
Fibromyalgia |
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A patient with Post Traumatic Stress Disorder (PTSD) often complains of what disturbance during sleep? |
Persistent Nightmares |
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What is a patient most likely experiencing who reports the inability to move the legs and arms upon falling asleep, then opens the eyes or tries to take deep breaths? |
Sleep paralysis |
