Beta-blockers are known to affect the polysomnogram by

Increasing sleep onset latency and awakenings

Artifacts detected during the biologic calibration:

Should be corrected prior to starting the study

Common Mode Rejection Ratio (CMRR) refers to:

The ability of an amplifier to eliminate unwanted signals.

In portable sleep apnea monitoring, a minimum of four channels are recorded. These channels include

Chest effort, airflow, oxygen saturation, electrocardiography

Which of the following constitutes good sleep hygiene?

getting up to do something relaxing after 20 mins in bed w/o falling asleep

Which of the following is a valid reason for decreasing CPAP pressure?

The patient cannot tolerate the higher pressure

The technologist performs physiological calibrations in order to

verify electrode response to commands

An epoch is considered stage R sleep unless

arousal with increased chin EMG occurs

How long is the normal REM latency?

90 minutes to 2 hours after sleep onset

If the thermister becomes removed during a study causing a flat line in the airflow channel, the best solution is to:

Enter the patient's room quietly and re-adjust the thermister

When traveling, PAP therapy settings may not be adequate if the patient

Travels to elevations over 5,000 ft.

Auto-titrating positive airway pressure (APAP) therapy is indicated for all of the following except:

Patients with obstructive sleep apnea and COPD

Ectopic beats that originate below the bundle of His and occur earlier than normal are called

Premature ventricular contractions

Hypopnea is defined as:

a partial obstruction of the airway.

The time RECOMMENDATION for beginning the initial MSLT nap opportunity is

Within 1.5-3 hours of waking up

Central Apneas are scored when

a decrease in the thermister w/ associated absence of respiratory effort

The first step in artifact isolation is:

determining if common signals exist in multiple channels

Which of the following actions by the sleep technician violates the priniciples of proper body mechanics?

bending at the waist to reach items

ECG artifact in the EEG channels is BEST confirmed by comparing the:

alignment of the QRS complex to the artifact.

The mallampati scale is used to rate:

Size of the airway at the back of the throat

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PSGT 2661 Final Review

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Questions 99

Answers

1
The Berlin questionnaire asks about which of the following?
hypertension
all of the above
daytime tiredness or fatigure
snoring:presence, frequency, impact on bed partner and apneic episodes
2
Which of the following is a quality indicator?
Apnea/hypopnea index
Date of interpretation
Inter-scorer reliability
Video sampling rate
3
Bright light therapy affects which anatomic structure?
Suprachiasmatic nucleus
Hypothalamus
Thalamus
Reticular activating system
4
Beta-blockers are known to affect the polysomnogram by
Increasing sleep onset latency and awakenings
Decreasing slow wave sleep and nightmares
Increasing slow wave sleep and nightmares
Decreasing sleep onset latency and awakenings
5
Artifacts detected during the biologic calibration:
Should be corrected when the patient awakens
Usually do not affect the integrity of the study
Typically resolve on their own and no action is needed
Should be corrected prior to starting the study
6
According to the RECOMMENDED guidelines, unattended portable monitoring devices must include
Blood oxygenation
ECG
Actigraphy
One channel EEG
7
Scoring arousals in children is:
Based on changes in heart rate
not required
same as in adults
Based on behavior and movement
8
Which of the following is needed to calculate the apnea/hypopnea index?
Oxygen desaturation index
total sleep time
total number of limb movements
Number of heart beats per hour of sleep
9
In most sleep systems, which of these devices is the patient head box directly plugged into?
AC amplifier
Polysomnograph
Wall outlet
DC amplifier
10
A stress loop can be most helpful when applying which electrodes?
Leg EMGs
EEGs
Chin EMGs
EKGs
11
What is the RECOMMENDED minimum starting pressure for CPAP titration?
3 cmH20
5 cmH20
4 cmH20
6 cmH20
12
Common Mode Rejection Ratio (CMRR) refers to:
The ratio of protons to electrons in a neuron.
The ability of an electrode to conduct electricity
The ability of an amplifier to eliminate unwanted signals.
The ratio of current to resistance
13
Kleine-Levin syndrome is most likely to affect:
adolescent females
adolescent males.
adult males.
adult females.
14
A pt undergoing polysomnography has a hx of COPD. Which of the following is MOST likely to occur during the sleep study?
Atrial fibrillation
Abnormal baseline SpO2
Increase in stage R sleep
Epileptiform activity
15
In portable sleep apnea monitoring, a minimum of four channels are recorded. These channels include
Oxygen saturation, heart rate, airflow, snoring
Chest effort, airflow, oxygen saturation, electrocardiography
Chest effort, abdominal effort, airflow, electrocardiography
Chest effort, heart rate, oxygen saturation, snoring
16
Which of the following must be accurately marked in order to calculate sleep onset?
onset of video recording
lights out
first epoch of wake
“Eyes open” physiological calibration
17
Which of the following constitutes good sleep hygiene?
watching TV in bed right before trying to go to sleep
getting up to do something relaxing after 20 mins in bed w/o falling asleep
taking naps during the day
drinking alcohol before going to bed
18
The circadian pacemaker is in the:
VLPO
thalamus
SCN
reticular formation.
19
Which of the following is a valid reason for decreasing CPAP pressure?
Paradoxical effort is seen in the chest and abdominal channels
The pt is doing well, and the tech simply wants to try another CPAP setting
The patient is snoring loudly
The patient cannot tolerate the higher pressure
20
The technologist performs physiological calibrations in order to
verify the polarity of the electrocardiogram (ECG)
verify electrode response to commands
assess the function of the computer keyboard
assess the function of the electrical bed.
21
It is acceptable to wear PPE in:
hallways.
the patient room
the elevators
the tech room.
22
How much slow wave sleep is normal for an adult
50%
30%
20%
40%
23
RDI is useful for sleep study interpretation. RDI is an acronym for:
REM duration and indices.
respiratory disturbance index
respiratory duration and indication.
REM duration and indication
24
Which of the following is NOT a therapeutic intervention for narcolepsy?
selective serotonin reuptake inhibitors (SSRIs)
Methylphenidate
tricyclic antidepressants (TCAs)
diet and exercise
25
An epoch is considered stage R sleep unless
arousal with increased chin EMG occurs
alpha rhythm is present
LAMF activity with increased chin EMG occurs
rapid eye movements are absent
26
How long is the normal REM latency?
2 hours after sleep onset
1 to 2 hours after sleep onset
1 hour after sleep onset
90 minutes to 2 hours after sleep onset
27
An EEG pattern seen at sleep onset in infants and children but rarely seen after age 12 is:
Frontal slow-wave activity
Hypnagogic hypersynchrony
Three per second spike and wave activity
Sleep spindles
28
If the thermister becomes removed during a study causing a flat line in the airflow channel, the best solution is to:
re-referencing the airflow channel to one of the respiratory effort channel
Turn off the channel
Continue increasing the amplifier sensitivity until a signal response seen
Enter the patient's room quietly and re-adjust the thermister
29
The C3 to C4 distance is what percentage of the total right pre-auricular to left pre-auricular measurement?
20%
50%
35%
40%
30
During a PAP titration supplemental O2 should be connected to the
PAP mask
Headgear
PAP device outlet
Nasal cannula
31
An elderly pt who functions normally during the day but becomes confused and agitated at night may be suffering from:
sundowning
twilight zone
paradoxical insomnia
Wernicke encephalopathy
32
When traveling, PAP therapy settings may not be adequate if the patient
Is traveling overseas
Uses a humidifier at home
Is traveling to warmer climates
Travels to elevations over 5,000 ft.
33
A sigh or hyperventilation can cause a brief fall in PCO2 level resulting in:
Central Apnea
Dead space
Complex sleep apnea
Pneumothorax
34
Auto-titrating positive airway pressure (APAP) therapy is indicated for all of the following except:
patients requiring changes in pressure
To determine a fixed pressure
Titration during attended studies
Patients with obstructive sleep apnea and COPD
35
Ectopic beats that originate below the bundle of His and occur earlier than normal are called
Premature atrial contractions
Nodal escape beats
Junctional escape beats
Premature ventricular contractions
36
Which of the following is required for sleep study completion?
Interface selection
Interpretation of data
Scheduling of PAP study
Date of follow-up
37
Hypopnea is defined as:
a partial obstruction of the airway.
a complete obstruction of the airway.
another word to describe snoring.
being associated with central sleep apnea.
38
What is the minimal recommended samlping rate for EEG?
200 Hz
10 Hz
50 HZ
5 Hz
39
The time RECOMMENDATION for beginning the initial MSLT nap opportunity is
30 minutes after breakfast
Within 1.5-3 hours of waking up
Immediately after 7.5-8 hours of nocturnal sleep
No later than 7:30 am
40
Diagnosis of RLS:
Is based on 15 or more periodic limb movements per hour of sleep
based on 15 or more periodic limb movements per hour of sleep with arousals
Does not require sleep testing
Is based on 5 or more periodic limb movements per hour of sleep
41
CO2 monitoring, using either end-tidal or transcutaneous sensors, is mandatory in children for the scoring of:
Hypoventilation
Central events
Hypopnea
Apnea
42
K complexes must be at least how many seconds in duration?
3 seconds
0.5 seconds
1 second
2 seconds
43
Central Apneas are scored when
There is a 30% decrease in the thermister
a decrease in the thermister and effort followed by effort with no airflow
There is a decrease in the thermister only
a decrease in the thermister w/ associated absence of respiratory effort
44
The first step in artifact isolation is:
determining if common signals exist in multiple channels
identifying the source of the data responsible for artifact
changing recorder time base to count signal frequency
correcting the problem by changing channel derivations
45
Artifact correction is necessary in order to:
rule out insomnia
provide a diagnosis.
.rate the technologist’s skills.
assess amplifier function.
46
The tech decides to switch to BPAP. What should the initial BPAP settings be if the current CPAP setting is 8 cm H2O?
IPAP 8 cm H2O, EPAP 4 cm H2O
IPAP 10 cm H2O, EPAP 6 cm H2O
IPAP 14 cm H2O, EPAP 10 cm H2O
IPAP 12 cm H2O, EPAP 8 cm H20
47
From which derivation might one expect to see the highest amplitude for slow-wave activity?
Frontal derivations
EOG derivations
Occipital derivations
Central derivations
48
Which of the following actions by the sleep technician violates the priniciples of proper body mechanics?
avoiding twisting to lift
bending at the waist to reach items
using a step stool to reach items
avoiding pushing with the arms
49
ECG artifact in the EEG channels is BEST confirmed by comparing the:
alignment of the QRS complex to the artifact.
patient’s pulse rate to that recorded on the EEG.
affected EEG channel(s) with an unaffected channel.
abnormalities on the ECG recording with the artifact.
50
The mallampati scale is used to rate:
Risk of stroke in patients with severe OSA
Size of the airway at the back of the throat
Risk of suicide in patients with major depressive disorder
Severity of oxygen desaturation
51
A pH probe helps diagnose which of the following?
Esophogeal reflux
Severe obstructive sleep apnea
Primary snoring
Central sleep apnea
52
A pt exhibits a-fib on the sleep study. The patient history is negative for cardiovascular disease. The tech should:
discontinue the study and reschedule.
document and contact the physician.
initiate the emergency response system.
order a 12-lead ECG.
53
A true compliance meter on a CPAP device
measures how long the machine has been running
measures the time the patient breathes on the machine
measures patient sleep time
is not really necessary
54
As compared with their AC counterparts, DC amplifiers:
use voltage from a direct current power source.
are not part of the base data acquisition system
emit a direct current voltage that can burn the skin.
are utilized for constant or slow moving variables
55
Sleep efficiency is defined as
the ratio of the percentage of time spent sleeping to the time spent in bed
total sleep in minutes for all stages of sleep
total mins spent awake after falling asleep& until the final awakening time
the amount of time needed to go from an awake state to a sleep state
56
Sawtooth waves are indicative of which stage of sleep?
N2
REM
N3
N1
57
Deep sleep occurs in which sleep stage?
REM
N2
N1
N3
58
Adjusting the sensitivity from 5uV/mm to 10uV/mm will:
Reduce the pen deflection by one half
Double the pen deflection
Increase the pen deflection by 5 times
Reduce the pen deflection by 5 times
59
After a standard sleep study procedure, high level disinfection should be used for which of the following devices
EMG snap electrodes
respiratory effort belts
pulse oximeter probe
oronasal thermocouple
60
During physiologic calibrations, you notice 60Hz artifact in the leg EMGs. What is the best method of correcting this?
Apply the line filter
Reapply or replace the recording electrodes for this channel
Decrease the HFF to 35Hz for this channel
Change the LFF setting for this channel
61
Caffeine consumption changes sleep architecture by increasing which of the following?
REM sleep
Sleep latency
REM latency
REM sleep
62
The gold standard for monitoring respiratory effort is
nasal pressure
respiratory inductance plethysmography
esophageal pressure/manometry
thermistor
63
Electrical interference can best be prevented if which of the following actions are taken?
The high-frequency filter is set at 15Hz
The impedance of input electrodes are similar
The 60Hz filter is applied
Two ground leads are used
64
A 90% drop in airflow from baseline breathing with continued respiratory effort describes what kind of respiratory event
mixed apnea
obstructive apnea
central apnea
hypopnea
65
Electrode popping artifact MOST often occurs because of:
excessive patient sweating
abrupt changes in impedance
alternating current noise.
use of a cellular telephone
66
In infants, episodes of >3 central apneas lasting >3seconds and separated by less than 20 seconds of normal breathing
Periodic breathing
Ataxic breathing
Central breathing
Klein-Levin breathing
67
evaluation of suspected idiopathic hypersomnia of central nervous system origin. This sleep disorder is characterized by
sleep paralysis and REM onset sleep
poor sleep hygiene with nocturnal eating
hypnagogic hallucinations and cataplexy
Excessive daytime sleepiness without REM onset sleep
68
Cycles per second is synonymous with
volts
amplitude
capacitance
hertz
69
A DC amplifier
facilitates recording of slep frequenices
facilitates recording of fast frequenices
attenuates slow frequenices
has a short time constant
70
What is the MOST likely consequence of the over-titration of PAP?
Increased blood pressure
decreased blood pressure
Barotrauma
increased arousals
71
An apnea episode is scored as obstructive when:
continued or increased inspiratory effort exists
no inspiratory effort is detected.
the first 10 seconds of the event has no effort
the event is at least 10 seconds in duration.
72
Standard precautions are intended to be used:
only when the technologist has a cold.
in the home
only when the patient is known to be infected.
in all healthcare settings
73
Oral appliances may be used to treat:
Mild-to-moderate OSA
Idiopathic central sleep apnea
Severe OSA
Cheyne- Stokes breathing pattern
74
A sensation experienced by some people with epilepsy before a seizure is:
An aura
Ictal activity
Clonic activity
Generalized epilepsy
75
It is advisable to place babies and infants in this sleep position in order to reduce the risk of SIDS
prone
upright
side
supine
76
The most commonly used type of oral appliance is a:
Tongue-retaining device
Palate expanding device
Maxillomandibular advancement device
Mandibular advancement device
77
A slow wave must have the following criteria
0-5-2 Hz
None of the above
75uV
Both 0.5-2 Hz and 75uV
78
The filter typically used to remove power line electrical noise is a:
line filter
notch (50-60 hz) filter
High-frequency filter
low-frequency filter
79
Which of the following is FALSE with regard to orofacial masks?
nasal pillows must fit snugly into each nostril when using this mask
the masks are often less comfortable for the patient than nasal masks
there is a greater chance of leakage than with nasal masks
they cover both the nose and the mouth
80
A repeating pattern of “crescendo-decrescendo” respiratory effort is indicative of:
Cheyne-Stokes respiration (CSR).
Biot breathing pattern.
hypopnea.
obstructive apnea.
81
The electrical cycle of the heart begin in the
bundle of his
SA node
AV node
purkinjie fibers
82
Ventricular tachycardia is defined as at least:
a 6-second run of PVCs
a 30-second run of PVCs
four PVCs in a row
three premature ventricular contractions (PVCs) in a row
83
Repetitive teeth grinding during sleep is called?
none of these
EOG
EMG
Bruxism
84
The T wave in ECG represents
Atrial repolarization
Ventricular depolarization
Atril depolarization
Ventricular repolarization
85
On the ECG, the “QRS wave” represents the electrical activity for:
atrial repolarization.
ventricular repolarization.
atrial depolarization.
ventricular depolarization.
86
Arousal index is calculated by
Dividing arousal by total sleep time in hours
Dividing total number of apnea by total sleep time
Dividing total number of respiratory events by total sleep time in hours
Dividing total sleep time by number of arousals
87
In adults, which sleep stage occurs most frequently?
N1
N2
REM
N3
88
During amplifier calibrations, the polysomnograph displays signals of:
100uV and -100uV
5uV and -5uV
50uV and -50uV
0uV and 100uV
89
Ohm law tells us that when voltage is constant, increasing electrode resistance:
Reduces current
Increases radiant heat
Blocks the flow of ions in neurons
Is futile
90
The first line of treatment for a 6-year-old patient with OSA is:
adenotonsillectomy
bilevel
CPAP
uvulopalatopharyngoplasty
91
A common complaint of a patient with gastroesophageal reflux disorder during sleep is:
nightmares
dreaming about a particularly spicy meal
restless leg symptoms
awakenings associated with coughing
92
Bi-level should be switched to the timed mode with a backup respiratory rate when
Central apneas are absent but mixed apneas predominate
Obstructive events persist at higher pressures
Patient is not tolerating pressure increases
Central apneas occur before obstructive events are eliminated
93
When two or more sawtooth-like waves precede each QRS complex, the rhythm is:
atrial flutter
junctional tachycardia.
atrial tachycardia.
v-fib
94
During adult bilevel titration, the technologist should increase IPAP pressure after
More than 3 awakenings in a 2-minute period
Three RERAs
Loud snoring for at least 3 minutes
Two obstructive apneas
95
The montage is selected in order to:
calibrate the oximeter
record physiological parameters
verify amplifier function
assess the patient’s mental state
96
At what frequency does the alpha rhythm oscillate?
8-13 Hz
0.5 to 4 Hz
3-7 Hz
0.5-2 Hz
97
Vertex sharp waves are most frequent in which stage of sleep?
N1
N2
N3
REM
98
For home treatment with positive airway pressure, proper humidifer care includes
washing the reservoir wth bleach
using only tap water for humidification
emptying the water reservoir once per week
rinsing and air-drying the reservoir
99
If no sleep occurs during a multiple sleep latency test (MSLT) nap trial, the sleep latency test is reported as:
The average for the patient
Twenty minutes
Zero minutes
Forty minutes

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