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72 Cards in this Set
- Front
- Back
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CENTERAL SLEEP APNEA (CSA)
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PRIMARY CENTRAL SLEEP APNEA
CHEYNE-STOKES BREATHING PATTERN |
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MOST COMMON TYPE OF CSA
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PTS WITH CHF
HIGH ALTITUDE PERIODIC BREATHING CENTRAL SLEEP APNEA DUE TO DRUG OR SUBSTANCE |
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IN ALL TYPES OF CSA, RESPIRATORY EFFORT DECREASES OR STOPS RESULTING IN DROP OR ABSENT OF A/F
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RESPIRATORY EVENTS LEAD TO SLEEP FRAGMENTATION AND HYPOXEMIA
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MSLT FOLLOW A SLEEP STUDY WITH @ LEAST 6 HOURS OF SLEEP
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1.) FIVE MAPS AT TWO HOUR INTERVALS STARTING @ 1.-3 HRS AFTER AWAKENING
2.) SHORTER FOUR HR NAP (NOT RELIABLE FOR DIAGNOSIS OF NARCOLEPSYUNLESS TWO REM ONSETS HAVE OCCURED) 3.) NAPS LAST 15-35 MIN. 4.) LEOG,REOG,CHIN EMG,EEG,( C3-M2,C4-M1,O2-M1,O1-M2) AND ECF ARE RECORDED |
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STANDARD MSLT INSTRUCTIONS
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LIE QUITELY, COMFORTABLE POSITION, KEEP EYES CLOSED AND TRY TO FALL ASLEEP
(THIS IS FOR EACH NAP) LIGHTS TURNED OFF AND TEST STARTS IMMEDITATELY |
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TERMINATION OF NAPS ON MSLT
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1.)NO SLEEP TERMINATE AFTER 20 MINS. TIMING STARTS FROM LIGHTS OUT.
2.) SLEEP OCCURE TES IS CONTINUED FOR 15 MINS. FROM 1ST EPOCH OF SLEEP 3.)AFTER NAP PT OUT OF BED AND PREVENT FROM SLEEPING PRIOR TO THE NEXT NA[ OPPORTUNITY |
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TERMINATION OF NAPS ON MSLT
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1.)NO SLEEP TERMINATE AFTER 20 MINS. TIMING STARTS FROM LIGHTS OUT.
2.) SLEEP OCCURE TES IS CONTINUED FOR 15 MINS. FROM 1ST EPOCH OF SLEEP 3.)AFTER NAP PT OUT OF BED AND PREVENT FROM SLEEPING PRIOR TO THE NEXT NA[ OPPORTUNITY |
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DIAGNOSIS OF NARCOLEPSY
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1.) 4 NAPS FOR THE DIAGNOSIS IF TWO ARE SOREMPS IN THE FIRST FOUR
2.) FIVE NAPS ARE REQUIRED IF ONLY ONE SOREMP IN THE FIRST FOUR. |
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EVALUATION OF DAYTIME SLEEPINES
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1.) 4 NAPS IN NORMAL SUBJECTS SHOW HIGH TEST-RETEST RELIABILITY
2.) 4 OR 5 NAPS MAY BE DONE 3.)COMPARING MSLT DATAT IN SAME PT THE # OF MAPS (4-5 NAPS) MUST BE RECORDED FOR BOTH SETS OF DATA 4.) # OF NAPS AFFECTS SLEEP LATENCY AND RELIABILITY |
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RUNNING MSLT
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1.) DLEEP ONSET THE 1ST EPOCH SCORED ANY STAGE OF SLEEP (MORE THEN 15) OF A 30 SEC EPOCH
2.) NAP CONTINUES FOR 15 MINS. IF PT SLEEP OR NOT. 3.)NO SLEEP NAP ENDS AFTER 20 MINS. |
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SCORE MSLT
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1.) SLEEP LATENCY (TIME FROM START OF NAP TO SLEEP ONSET) FOR EACH NAP
2.) NO SLEEP OCCURS SLEEP LATENCE IS 20 MINS. 3.) CALCULATE MEAN SLEEP LATENCY (MSL) OF THE 4 OR 5 NAPS 4.) DETERMIN WHICH OF THE NAPS CONTAINS AT LEAST ONE EPOCH OF REM SLEEP |
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DECTING SOREMPS
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1.) ANY EPOCH OF REM WITHIN 15 MINS OF SLEEP ONSET CONSIDERED A SLEEP ONSET REM PERIOD ( SOREMP)
2.) REM EPOCH CONISITS OF > 15 SECS. OF REM SLEEP IN A 60 SEC EPOCH 3.) # OF NAPS CONTAINING REM 4.) REM LATENCY IS TIME FROM SLEEP ONSET TO THE FIRST EPOCH OF REM SLEEP |
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MWT
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1.)4-40MIN TRIALS AT 2 HRS INTERVALS TO BEGIN 1.5-3 HRS AFTER AWAKING
2.) LEOG,REOC, CHIN EMG,EEG (C3A2,C4 A1, O2A1,O1A2 AND ECG ARE RECORDED 3.) PRECEDING PSG IS OPTIONAL |
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MWT TEST CONDITIONS
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1.) RM QUIETWITH NIGHT LIGHT ABOUT 3 FT OFF FLOOR. (7.5 WATT)
2.) PT SEATED IN BED WITH BACK AND HEAD SUPPORTED 3.) TEMP AT PT CONFORT 4.) MEDICATIONS, TOBACCO AND CAFFEIN DETERMINED BY CLINICIAN 5.) OPT DRUG SCREEN 6.) LIGHT BREAFAST ONE HR BEFORE 1ST NAP 7.) LIGHT LUNCH IMMEDIATELY AFTER 2SEC NAP |
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PT CALIBRATION INSTRUCTIONS FOR MWT
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1.) SIT QUITELY WITH EYES OPEN FOR 30 SEC.
2.) WITH OUT MOVING HEAD LOOK (R )THE( L),(R) THEN (L) 3.) BLINK EYES SLOWLY 5 TIMES 4.) CLENCH OR GRIT TEETH TOGETHER |
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MWT INSTRUCTIONS
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1.) SIT STILL AND REMAIN AWAKE AS LONG AS POSSIBLE, LOOK AHEAD AND DO NOT LOOK DIRECTLY AT THE LIGHT
2.) PT NOT ALLOWED TO USE EXTRAORDINARY MEASURES TO STAY AWAKE SUCH AT SLAPPING FACE OR SINGING 3.) SAME INSTRUCTIONS SHOULD BE GIVEN PRIOR TO EVERY TEST |
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DETERMINATION OF SLEEP ONSET FOR MWT
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1.) 1ST EPOCH OF ANY STAGE INCLUDING (N1)
2.) 1ST EPOCH OF DLEEP DEFINED AS MORE THAN 15 SEC. OF ACCCUMULATED SLEEP IN 30 SEC EPOCH |
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TERMINATION OF MWT TRIALS
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1.) NO SLEEP OCCURS EACH TRIAL IS TERMINATED AFTER 40 MIN. TIMING STARTS FROM OVERHEAD LIGHTS OUT.
2.) SLEEP OCCURS THE TEST IS CONTINUED FOR 3 EPOCHS OF STAGE N1 OR THE FIRST EPOCH OF ANY STAGE 3.) AFTER TERMINATION OF TRIAL PT SHOULD GET OUT OF DED AND PREVENTED FROM SLEEPING PRIOR TOE THE NEXT TRIAL |
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PATH OF SIGNALS FROM PT TO TRACING
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BRAIN-ELECTRODE-HEADBOX-AMPLIFIER-COMPUTER-DISPLAY
(SKIN TO SCREEN) |
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ELECTRODES
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1.) RECORDED SIGNAL DETERMINED BY ELECTRODE LOCATION AND LOCATION
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EXPLORING ELECTRODE
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USED TO OBTAIN A SIGNAL FROM A SPECIFIC AREA
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REFERENCE ELECTRODE
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PLACED IN AN INACTIVE AREA AND USED TO COMPARE WITH THE EXPLORING ELECTRODE
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PAIRING ELECTRODES
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ALLOWS YOU TO IDENTIFY THE SOURCE OF ELECTRIACAL ACTIVITY
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REFERNTIAL DERIVATION
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COMBINING EXPLORING ELECTRODE WITH REFERENCE ELECTRODE
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BIPOLAR DERIVATION
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COMBINING TWO ELECTRODES TO EACH OTHER
EXAMPLE : ECG & EMG |
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HEADBOX
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INTERMEDIATE CONNECTION CONDUCTING ELECTRIACAL SIGNAL FRON ELECTRODE TO AMPLIFIER BY
1.) INPROVES CONDUCTION BY REDUCING LENGTH OF HIGH RESISTANCE ELECTRODE WIRE 2.) INCREASE PT MOBILITY BY PORTABLE LINK AOR ALL SENSORS THAT EASILY DISCONNECTED FROM RECORDING SYSTEM CONNECTS TO THE AMPLIFIER VIA SINGLE LOW RESISTANCE WIRE ( SOME ARE COMBINED IN SAME UNIT) |
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AMPLIFIER
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1.)STRENGTH OF THE SIGNAL IS INCREASED WHICH IS DONE BY AMPLIFIER
2.)AMPLIFIER ARE DIFFERENTIAL AMPLIFIERS BECAUSE THEY AMPLIFY THE DIFFERENCE BETWEEN TWO POINTS 3.) THEY CANCEL OUT ANY SIGNALS COMMON TO BOTH INPUTS AND AMPLIFIES ALL OTHERS SIGNALS 4.)THIS GIVES AMPLIFIER ABILITY TO REJECT UNWANTED ELECTRIACAL INTERFERENCE SUCH AS 60HZ INTERFERENCE |
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AMPLIFIER / COMMON MODE REJECTION
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1.)PROCESS OF ELIMINATIONG SINGAL COMMON TO BOTH ELECTRODED
2. |
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COMMON MODE SIGNAL
(AMPLIFIER) |
SIGNAL SHARED BY BOTH INPUTS
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DIFFERENTIAL SIGNAL
(AMPLIFIER) |
SIGNAL NOT SHARED BY BOTH INPUTS
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COMMON MODE REJECTION RATIO (CMRR)
(AMPLIFIER) |
EFFECTIVENESS OF THE DIFFERENTIAL AMPLIFIER
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CMRR
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COMMON MODE SIGNAL : DIFFERENTIAL SIGNAL
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REJECTIONG INTERFERENCE
(AMPLIFIER) |
HIGHER THE RATIO BETTER THE AMPLIFIER
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AMPLIFIERS PROCESS ELECTRIACAL CURRENT IN TWO WAYS
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A/C = ALTERNATING CURRENT
DC = DIRECT CURRENT |
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AMPLIFIER TYPE USED DEPENDS ON CHARACTERISTICS OF RECORDED SIGNAL
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AMPLIFIER BOXES TYPICALLY HAVE MULTIPLE AMPLIFIERS BUILT IN THEM
EACH CHANNEL HAS A SINGLE TYPE OF AMPLIFIER |
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AC AMPLIFIER
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FREQUENTLY FROM + TO -
EXAMPLE EEG, EMG, EOG, VOLTAGE ID UP AND DOWN TIME IS ACROSS THE PAPER |
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DC AMPLIFIER
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SIGNALS THAT ALWAY FLOW SAME DIRECTION BUT CAN INCREASE OR DECREASE
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AC/DC AMPLIFIERS
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1.) ALTERNATION CURRENT FLOW CHANGES DIRECTION CONTINUOUSLY
EX: EEG,EMG,EOG 2.) DIRECT CURRENT CURRENT FLOWS IN ONE DIRECTION EX: CPCP, OXUNETER, PRESSURE TRANSDUCER SIGNALS |
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DISPLAY FEATURES
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GAIN, SENSITIVITY, FILTERS, SAMPLING RATE, MONTAGE, MONITOR SETTINGS
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GAIN
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INCREASING GAIN=LARGER DEFLECTIONS
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SENSITIVITY
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SENSITIVITY =VOLTAGE/DEFLECTION
LOW SENSITIVITY SETTING =LARGER DEFLECTION EXP: SEN INPUT = 5 50UV = DEF 10MM 10 50UV = DEF 5MM 25 50UV = DEF 2MM HIGHER SENSITIVITY =SMALLER WAVE(DEF) SENSITIVITY AFFECTS HOW WAVE IS DISPLAYED NOT CHANGE ACTUAL VOLTAGE |
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SENSITIVITY ( PART 2)
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SENSITIVITY =VOLTAGE/DEFLECTION
DEFLECTION=VOLTAGE/SENSITIVITY SENSITIVITY IS INVERSELY PROPORTIONAL TO DEFLECTION AND GIVES A LARGER DEFLECTION |
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CALCATIONS ON SENSITIVITY
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S=7 D=10 V=? V=7X10=70
D=5 V=50 S=? S=50/5=10 V=100 S=5 D=? D=100/5=20 |
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FILTERS
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FOCUS ON SIGNAL FREQUENCIES WE WANT TO SEE
ATTENUATE UNWANTED SIGNALS EACH CHANNEL CAN BE OPTIMIZED BY USING FILTERS AND ALLOW ONLY SIGNALS IN THE DESIRED FREQUENCY RANGE |
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LOW FREQUENCY FILTER
(LFF) |
ASLO KNOWN AS (HIGH PASS FILTERS)
LFF ALLOWS HIGHER FREQUENCIES TO PASS UNCHANGED WHILE LOWER FREQUENCIES ARE ATTENUATED HIGHER FILTER VALUE MORE LOWER FREQUENCY WAVES ATTENUATED REMOVES RESPIRATORY AND SWEAT SWAY ARTIFACT CAUTION FILTER ALSO ATTENUATE DESIRED FREQUESNCIES SUCH AS SLOW WAVE SLEEP |
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LFF
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EMG =0.3HZ
EOG =0.3HZ EMG =10HZ (CHIN,LEG, INTERCOSTAL) ECG =0.3 HZ |
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HIGH FREQUENCY FILTERS (HFF)
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ALSO KNOW AS (LOW PASS) FILTERS
LETS SLOWER WABES THROUGH AND ATTENUATES HIGH FREQUENCIES USED TO SET HIGH FREQUENCY RECORDING LIMITS ALLOW RECORDING OF ONLY SLOWER SIGNALS EX: ELIMINATES MUSCLE ARTIFACT OR EXTERNAL ELECTRICAL ARTIFACT IN EEG CHANNELS CAN ATTENUATE DESIRED HIGH FREQUENCIES SUCH AS AROUSALS |
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HIGHT FREQUENCY FILTERS ( HFF)
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DETTINGS BY DERIVATION
EEG=35HZ EOG=35HZ EMG=100HZ ECG=70HZ |
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TIME CONSTANTS
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1.) FALL TIME IN SEC. FOR SQ WAVE TO DECAY TO 37%OF MAX AMPLITUDE
LFF DETERMINES FALL TIME CONSTANT INCREASE LFF DECREASE TIME CONSTANT 2.) RISE CONSTANT SEC. FOR SQ WAVE TO REACH 63% OF MAX AMPLITUDE HFF DETERMINES RISE TIME CONSTANT |
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60HZ / NOTCH FILTER
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HIGH FREQUENCY ARTIFACT CAUSED BY
1.) HIGH SIGNAL IMPEDANCE 2.) INTERFERENCE FROM ELECTRICAL EQUIPMENT 3.) POOR APPLICATION OF ELECTRODES CAUTION: IT CAN ATTENUATE EPILEPTIFORM SPIKES AND MUSCLE ACTIVITY |
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SAMPLE RATE
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ELECTRICAL SIGNALS PRODUCE CONTINUOUS OUTPUT. DIGITAL PSG CONVERT CONTINUOUS WAVE FORM INTO NUMERIC VALUES
MEASURE OF HOW FREQUENTLY SIGNAL IS CONVERTED AND IS EXPRESSED IN CYCLES PER SECOND (HZ) SHAPE OF WAVE IS DETERMINED BY FREQUENTLY THE SIGNAL IS SAMPLED HIGHER SAMPLING RATE MORE FREQUENTLY SIGNAL SAMPLED MORE FREQUENT SAMPLING MORE ACCURATE THE SHAPE MINIMUM ACCEPTABLE SAMPLING RATE IS 2.5 TIMES > THAN HIGHEST HFF |
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DERIVATION
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DIFFERENTIAL AMPLIFIER MEASURES DIFFERENCES IN VOLTAGE BETWEEN TWO INCOMING SIGNALS
G1= EXPLORING G2= REFERENCE OR ANOTHER EXPLORING ELECTRODE |
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MONTAGE
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GROUP OF DEVIVATION USED FOR AND PT .
1.) CONSTRUCTED BY ADDING MULTIPLE DERIVATIONS 2.) ON ANALOG SYSTEMS MONTAGE HAS TO BE CONSTRUCTED FOR EACH PT 3.) DIGITAL SYSTEM MONTAGE CAN BE SET IN ADVANCE AND SAVED |
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SIGNAL POLARITY
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(-) OUTPUT VOLTAGE RECORDED WITH (G1) = UPWARD DEFLECTION
(+) OUTPUT VOLTAGE RECORDED (G1)=DOWNWARD DEFLECTION UPWARD DEFLECTION=(-) DOWNWARD DEF=(+) |
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AMPLITUDE
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AMOUNT OF FLUCTUATION OF THE SIGNAL (IN MICROVOLTS/MILLIMETER
-UV/MM MEASURED FROM PEAK TO TROUGH EX: PEAK -50 TROUGH -40 = 40UV -85--20=65 WITH WAVE GOING UP SO IT IS (+) POLARITY |
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EOG & EYE MOVEMENTS
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EYES TO (R)
EYES LOOKING UP= MEAT IN MIDDLE DEFLECTION EYES STRAIGHT =STRAIGHT DEFLECTION EYES (L) EYES DOWN = OUTWARD DEFLECTION |
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ELECTROMYOGRAM
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3 ELECTRODES USED TO RECORD CHIN
1.) MIDLINE 1 CM ABOVE INFERIOR EDGE OF MANDIBLE 2.) 2CM BELOW INFERIOR EDGE OF MANDIBLE AND 2CM TO THE (R) OF MIDLINE ) PME CM BELOW INFERIOR EDGE OF MANDIBLE & CM TO LEFT OF MIDLINE |
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LEG (EMG)
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BELLY OF ANTERIOR TIBIALIS SPACED 2-4CM APART AWAY FROM BONE AND IN A STRAIGHT LINE
PREP SITES SEPARATE TO AVOID FORMING SALT BRIDGE (FLOW OF ELECTRICAL CURRENT BETWEEN TWO ELCTRODES ) OCCURS WHEN TWO ELECTRODES OCCUPY SAME PREP SITE |
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SNORING SENSORS
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TWO TYPES
1.) ACOUSTIC=MICROPHONE 2. PIEZO= VIBRATIONS DURING SNORING |
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FLOW SENSORS
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MONITOR NASAL AND/OR
ORAL A/F |
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PNEUMOTACHOMETER
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GOLD STANDARD FOR ASSESSMENT A/F
1.) ACCURATE MEASURE OF TV 2.) LIMITED BY REQUIREMENT FOR TIGHT FITTING FACE MASK |
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NASAL PRESSURE
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FLUCTUATION IN NASAL PRESSURE DURING (I) AND (E)
CHANGES IN PRESSURE CHANGE FLOW PRESSURE CHANGE DETECTED BY NASAL CANNULA CHANGED TO FLOW SIGNAL BY TRANSDUCER FAIRLY ACCURATE OF A/F USES A DC AMPLIFIER NOTE: APNEA & HYPOPNEA CAN NOT BE DIFFERENTIATED BY NASAL PRESSURE FLAT LINE SIGNAL MAY REPRESENT APNEA OR MOUTH BREATHING |
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THERMISTOR/THERMOCOUP
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DO NOT DIRECTLY MEASURE A/F
DETECT CHANGE IN AIR TEMPERATURE BETWEEN (I) & (E) QUALITATIVE RATHER THAN QUANTITATIVE SIGNAL |
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THERMISTORS
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MADE FROM MATERIAL WHOSE RESISTANCE TO ELECTRIACL CURRENT VARIES WITH CHANGES IN TEMPERATURE
DEGREE OF CHANGE IN RESISTANCE USED TO REFLECT CHANGE IN A/F HOWEVER CHANGE IN A/F IS NOT DIRECTLY PROPORTIONAL TO CHANGE IN RESISTANCE SENSOR REQUIRES USE OF POWER SOURCE CAN NOT TOUCH SKIN OR WILL NOT VARY WITH TEMP. ONLY |
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THERMOCOUPLES
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TWO DIFFERENT METALS BROUGHT TOGETHER PRODUCE MEASURABLE ELECTRICAL CURRENT
CHANGE IN TEMP. CHANGES IN ELECTRICAL CURRRENT BETWEEN METALS DEGREE OF CHANGE IN VOLTAGE REFLECT CHANGE IN A/F HOWEVER CHANGE IN A/F IS NOT PROPORTIONAL TO CHANGE IN COLTAGE SENSOR DOES NOT REQUIRE A POWER SOURCE |
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PARADOXIVAL BREATHING
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OUT OF PHASE MOVEMENT OF THORACIC AND ABDOMINAL CAVITIES OCCURS WITH RESPIRATORY MUSCLES DISORDERS OR WITH COMPLETE AND PARTIAL OCCLUSION OF UPPER A/W
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EFFORT SENSORS
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MEASURE EXPANSION AND CONTRACTION OF THORACIC AND ABDOMINAL CAVITIES REFLECTING EFFORT TO BREATH
INTERCOSTAL EMG= ESOPHAGEAL PRESSURE MANOMETERS MEASURE EFFORT AND LUNG VOL. STRAIN GAUGES IMPEDANCE PLETHYSMOGRAPHY INDUCTANCE PLETHYSMOGRAPHY |
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INDUCTANCE PLETHYSMOGRAPH
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MEASURE OF THE OPPOSITION OF A CONDUCTOR TO A CHANGE IN ELECTRICAL CURRENT FLOW
CONDUCTING WIRE IN BELT EFFORT BELTS ON CHEST AND ABDOMEN AND SMALL ELECTRIC CURRENT IS PASSED THROUGH WIRE CHANGE IN INDUCTANCE IS RELATED TO VOLUME CHANGE AND EFFORT IF CALIBRATED THE SUM OF TWO SIGNALS ACCURATE MEASURE OF TV USED WITH CHILDREN PLACED AT NIPPLE SUBAXILLARY |
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INTERCOSTAL EMG
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MEASURE ACTIVITY OF MUSCLES INVOLVED IN BREATHING
ELECTRODES IN SKIN IN THE INTERCOSTAL SPACE AT LOWER RIBS EFFORT ONLY |
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ESOPHAGEAL PRESSURE MANOMETRY
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REFERENCE STANDARD FOR MEASUREMENT OF RESPIRATORY EFFORT
PASSED THROUGH NOSE AND INTO ESOPHAGUS TO MEASURE PRESSURE CHANGES INTRAPLEURAL PRESSURE DECTED BY AIR -FILLED BALLOONS OR FLUID-FILLED CATHETERS THAT ARE ATTACHED TO TRANDUCERS AND SIGNAL AMPLIFIERS RESPIRATORY EFFORT INCREASES AND PRESSURE BECOMES NEGATIVE, RELIABLE ACCURATE QUANTITATIVE MEASURE OF RESPIRATORY EFFORT NOT USED DUE TO PT COMFORT ISSUES |
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ESOPHAGEAL PRESSURE MANOMETRY
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REFERENCE STANDARD FOR MEASUREMENT OF RESPIRATORY EFFORT
PASSED THROUGH NOSE AND INTO ESOPHAGUS TO MEASURE PRESSURE CHANGES INTRAPLEURAL PRESSURE DECTED BY AIR -FILLED BALLOONS OR FLUID-FILLED CATHETERS THAT ARE ATTACHED TO TRANDUCERS AND SIGNAL AMPLIFIERS RESPIRATORY EFFORT INCREASES AND PRESSURE BECOMES NEGATIVE, RELIABLE ACCURATE QUANTITATIVE MEASURE OF RESPIRATORY EFFORT |
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CAPNOGRAPHY
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MEASURES CARBON DIOXIDE BY
1.) END-TIDAL= MEASURING FROM NOSE AND/OR MOUTH,TIGHT FITTING MASK TAKEN AT END OF EXPIRATION NORMAL=35-45mmhg 2.) TRANSCUTANEOUS CO2 MEASUREMENT= PROBE HEATS SKIN AND HAS TO BE MOVED OFTEN VARING WITH SKIN THICKNESS WITH ADULTS SCORE HYPOVENTILATION DURING SLEEP IF >10mmhg INCREASE PaCO2 DURING SLEEP IN CAMPARISON TO AWAKE SUPINE VALUE |
