Aasm Scoring Rules V2.2 - Iv: Sleep Staging Rules: Part 1: Rules For Adults

Front 1

What are the recommended EEG derivations?

Back 1

a. F4-M1

b. C4-M1

c. O2-M1

Backup electrodes should be placed at F3, C3, O1 and M2 to allow display of F3-M2, C3-M2 and O1-M2 if electrodes malfunction during the study.

Front 2

What are the acceptable EEG derivations?

Back 2

a. Fz-Cz

b. Cz-Oz

c. C4-M1

Backup electrodes should be placed at Fpz, C3, O1, and M2 to allow substitution of Fpz for Fz, C3 for Cz or C4, O1 for Oz and M2 for M1 if electrodes malfunction during the study.

Front 3

At minimum, how many derivations are required to stage sleep?

Back 3

At a minimum, frontal, central, and occipital derivations (3 EEG channels) are required to stage sleep.

Front 4

What are the recommended EOG derivations?

Back 4

E1 - M2

E2 - M2

When using the recommended EOG derivations, if the the M2 reference electrode fails, E1 and E2 should be referenced to M1.

Front 5

What are the recommended EOG electrode positions?

Back 5

E1 is placed 1 cm below the left outer canthus

and

E2 is placed 1 cm above the right outer canthus

Front 6

When using the recommended electrode derivations, conjugate eye movements result in

Back 6

Out-of-phase deflections

Front 7

When using the recommended electrode derivations, vertical movements result in

Back 7

in-phase deflections

Front 8

When using the recommended electrode derivations, horizontal eye movements result in

Back 8

out-of-phase eye movements

Front 9

How many electrodes should be placed to record chin EMG?

Back 9

Three:

a.One in the midline 1 cm above the inferior edge of the mandible

b. One 2 cm below the inferior edge of the mandible and 2 cm to the right of the midline

c. One 2 cm below the inferior edge of the mandible and 2 cm to the left of the midline

Front 10

If two or more stages coexist during a single epoch of sleep, how should you score the epoch?

Back 10

assign the stage comprising the greatest portion of the epoch

Front 11

Slow wave activity:

Back 11

frequency of 0.5-2.0 Hz and minimum amplitude of 75 μV peak to peak in frontal derivations

Waves of frequency 0.5 Hz-2 Hz and peak-to-peak amplitude >75 μV, measured over the frontal regions referenced to the contralateral ear or mastoid (F4-M1, F3-M2).

Front 12

Delta waves are...

Back 12

0-3.99 Hz

Front 13

Theta waves are...

Back 13

4-7.99 Hz

Front 14

Alpha waves are...

Back 14

8-13 Hz

Trains of sinusoidal 8-13 Hz activity recorded over the occipital region with eye closure, attenuating with eye opening.

Front 15

Beta waves are...

Back 15

greater than 13 Hz

Front 16

Eye blinks:

Back 16

Conjugate vertical eye movements at a frequency of 0.5-2 Hz present in wakefulness with the eyes open or closed.

Front 17

Reading eye movements:

Back 17

Trains of conjugate eye movements consisting of a slow phase followed by a rapid phase in the opposite direction as the individual reads.

Front 18

Rapid eye movements (REM):

Back 18

Conjugate, irregular, sharply peaked eye movements with an initial deflection usually lasting <500 msec. While rapid eye movements are characteristic of stage R sleep, they may also be seen in wakefulness with eyes open when individuals scan the environment.

Front 19

Slow eye movements (SEM):

Back 19

Conjugate, reasonably regular, sinusoidal eye movements with an initial deflection usually lasting >500 msec

Front 20

Score epochs as stage W when more than 50% of the epoch contains EITHER

Back 20

a. Alpha rhythm (posterior dominant rhythm) over the occipital region (individuals generating alpha rhythm with eye closure)

b. Other findings consistent with stage W (all individuals)

i. Eye blinks (0.5 to 2 Hz)

ii. Rapid eye movements associated with normal or high chin muscle tone

iii. Reading eye movements

Front 21

In stage W, the majority of individuals with eyes closed will demonstrate...

Back 21

alpha rhythm (posterior dominant rhythm

Front 22

The earliest sign of drowsiness is...

Back 22

absence of eye blinks

Front 23

The chin EMG during stage W is...

Back 23

variable amplitude but is usually higher than during sleep stages.

Front 24

Time with the patient disconnected from the recording equipment (i.e. restroom break) should be scored as...

Back 24

stage W

Front 25

Low-amplitude, mixed-frequency EEG activity:

Back 25

Low-amplitude, predominantly 4-7 Hz activity

Front 26

Vertex sharp waves (V waves):

Back 26

Sharply contoured waves with duration <0.5 seconds maximal over the central region and distinguishable from the background activity.

Front 27

Sleep onset:

Back 27

The start of the first epoch scored as any stage other than stage W. (In most subjects this will usually be the first epoch of stage N1.

Front 28

In individuals who generate alpha rhythm, score stage N1 if...

Back 28

alpha rhythm is attenuated and replaced by low-amplitude, mixed-frequency activity for more than 50% of the epoch

Front 29

In individuals who do not generate alpha rhythm, score stage N1 when...

Back 29

Commencing with the earliest of ANY of the following phenomena:

a. EEG activity in range of 4-7 Hz with slowing of background frequencies by ≥1 Hz from those of stage W

b. Vertex sharp waves

c. Slow eye movements

Front 30

Assign a stage to each epoch for example A & B:

Back 30

A: Answers

50 = W

51 = W

52 = W

53 = N1

54 = N2

B: Answers

60 = W

61 = W

62 = N1

63 = N1

64 = N2

Front 31

K complex:

Back 31

A well-delineated, negative, sharp wave immediately followed by a positive component standing out from the background EEG, with total duration ≥0.5 seconds, usually maximal in amplitude when recorded using frontal derivations. For an arousal to be associated with a K complex, the arousal must either be concurrent with the K complex or commence no more than 1 second after termination of the K complex.

Front 32

Sleep spindle:

Back 32

A train of distinct waves with frequency 11-16 Hz (most commonly 12-14 Hz) with a duration ≥0.5 seconds, usually maximal in amplitude in the central derivations.

Front 33

Begin scoring stage N2 (in absence of criteria for N3) if EITHER or BOTH of the following occur during the first half of that epoch or the last half of the previous epoch:

Back 33

a. One or more K complexes unassociated with arousals

b. One or more sleep spindles

Front 34

Assign a stage to each epoch for example A, B, & C:

Back 34

Front 35

When should you continue to score stage N2?

Back 35

Continue to score epochs with low-amplitude, mixed-frequency EEG activity without K complexes or sleep spindles as stage N2 if they are preceded by epochs containing EITHER of the following and there is no intervening arousal:

a. K complexes unassociated with arousals

b. Sleep spindles

Front 36

Assign a stage to epoch 200 and 201:

Back 36

Answers:

200 = N3

201 = N2

Front 37

When should you end scoring stage N2?

Back 37

End scoring stage N2 sleep when ONE of the following events occurs:

a. Transition to stage W

b. An arousal followed by low-amplitude, mixed-frequency EEG (change to stage N1 until a K complex unassociated with an arousal or a sleep spindle occurs.) This assumes that the epoch does not meet criteria for stage R (rule I.3)

c. A major body movement followed by slow eye movements and low-amplitude, mixed-frequency EEG without non-arousal associated K complexes or sleep spindles (score the epoch following the major body movement as stage N1; score the epoch as stage N2 if there are no slow eye movements; the epoch containing the body movement is scored using the major body movement rules under section J

d. Transition to stage N3

e. Transition to stage R

Front 38

Assign a stage to each epoch for example A & B:

Back 38

A: Answers

50 = N2

51 = N2

52 = N2

53 = N2

B: Answers

60 = N2

61 = N1

62 = N1

63 = N2

Front 39

You should score stage N3 when...

Back 39

≥20% of an epoch consists of slow wave activity, irrespective of age.

Front 40

K complexes would be considered slow waves if...

Back 40

they meet the definition of slow wave activity.

Front 41

Can sleep spindles persist in stage N3?

Back 41

Yes

Front 42

Describe the chin EMG during stage N3...

Back 42

In stage N3, the chin EMG is of variable amplitude, often lower than in stage N2 sleep and sometimes as low as in stage R sleep.

Front 43

Sawtooth waves:

Back 43

Trains of sharply contoured or triangular, often serrated, 2-6 Hz waves maximal in amplitude over the central head regions and often, but not always, preceding a burst of rapid eye movements.

Front 44

Transient muscle activity:

Back 44

Short irregular bursts of EMG activity usually with duration <0.25 seconds superimposed on low EMG tone. The activity may be seen in the chin or anterior tibial EMG derivations, as well as in EEG or EOG deviations, the latter indicating activity of cranial nerve innervated muscles (facial muscles and scalp). The activity is maximal in association with rapid eye movements

Front 45

Assign a stage to each epoch for example A, B, & C:

Back 45

Front 46

Assign a stage to each epoch for example A, B, & C:

Back 46

Front 47

Assign a stage to each epoch for example A, B, & C:

Back 47

Front 48

Assign a stage to each epoch for example A & B:

Back 48

Front 49

Assign a stage to each epoch for example A & B:

Back 49

Front 50

Assign a stage to each epoch for example A & B:

Back 50

Front 51

Assign a stage to each epoch for example A & B:

Back 51

Front 52

Assign a stage to each epoch for example A, B, C, & D:

Back 52