Terms in this set (142)
Known as the circadian rhythm pacemaker
(SCN) Suprachiasmatic nuclei
Complaints of morning headaches with severe sleep apnea is a result of _____?
Severe O2 desat and hypercapnia
Term linked with patients experiencing evening and nocturnal hallucinations associated with dementia.
Jactatio Capitis Noctuna
Three potential sources of stray electrical current
The number of "waves" (pen deflections) recorded in one second
Refers to the response time of the polygraph pens in relation to high and low frequency filter settings during a calibration procedure.
Reduction in size or amplitude of a signal
Undesirable variations in baseline during a recording, usually caused by sweat or movement
Voltages originating from living tissues
Signals obtained by comparing voltages from two exploring electrodes
An amplifier component used for storing an electrical charge
A ground connection shared by more than one instrument or appliance
Any material capable of transmitting an electrical current
Flow of electrical force along a conductor
Signal obtained from a pair of electrode sensors
Time required for a pen to descend to 37% of signal amplitude when a DC calibration signal is applied to an amplifier
Fall Time Constant
Electronic device designed to reduce or eliminate unwanted frequencies from passing through the amplifier
Undesirable electrical pathway between two separate ground connections, resulting in a possible hazard to the patient.
Method of measuring changes in body (or body parts) circumference
Stray current generated by the proximity of electrical power cords to adjoining cables or the polygraph chassis
Ratio of output voltage to input voltage, amplifier sensitivity
An instrument used for measuring electrical resistance
Signal obtained by comparing voltages from an exploring electrode to a relatively inactive location
Opposition to an electrical current
Device used to limit the passage of electrical current
Time required for a pen to reach 63% of signal amplitude when a DC calibration signal is applied to an amplifier
Rise Time Constant
Device containing two dissimilar metals, which generate an electrical signal in response to temperature variations
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
Sharp negative waves, usually within the Theta frequency range - typically appearing during the latter part of Stage 1
Sharp negative wave, followed by a slower positive component - seen primarily in Stage 2
Short rhythmic waveform clusters of 12-14 Hz, often showing a waxing and waning appearance - a characteristic feature of Stage 2
Relatively low amplitude waves, with a notched, sawtooth appearance - a common feature of REM sleep
REM is classified into what two categories?
Tonic and Phasic
Artifact caused by electrodes which momentarily lift away from the skin
A transient appearance of alpha activity during sleep
A cessation of airflow detected at the nose and mouth occurring for 10 sec or longer
An interruption of sleep continuity, identified by an abrupt shift in EEG frequency
Cessation of breathing, characterized by an absence of both airflow and respiratory effort
A single page of a PSG, typically representing 30 sec of data
Rapid deep breathing, resulting in reduced levels of CO2 in the blood
Insufficient breathing volumes, resulting in increased levels of CO2 in the blood
Abnormally low blood O2 saturation level
Lower portion of the temporal bone behind the ear
Cessation of breathing caused by upper airway obstruction
Progression and distribution of the various sleep stages and their quantitative relationship to each other
Period of NREM sleep followed by a subsequent REM period
Sleep Cycle (Sleep Patterns; Sleep Stages; Cyclic, Alternating Patterns of)
Device used to convert non-electrical physiological activity into electrical signals
Maximum amount of air the lungs can contain
(TLC) Total Lung Capacity
Arrangement of electrode derivations
Voltage (E) is equal to current (I) flowing in the circuit multiplied by resistance (R) in the circuit.
E = I x R
Three grounds found in electronic equipment
Earth (building or power outlet) ground
Common connection ground
Shock that involves large and quite perceptible currents passing from one external surface area to another
How is the voltage (uV) of an EEG waveform calculated?
Multiplying the amplitude (mm) of the waveform by the sensitivity (uV/mm)
V = A x S
What considerations 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 long time constant
Suggested solution to soak contaminated electrodes
5% Hypochlorite solution (household bleach)
Distinct EEG activity appearing to be composed of one dominant frequency
EEG activity with a frequency faster than 13 Hz
Morphologically and topographically distinct EEG activity seen in the central areas, frequency is about 9 Hz
Breathing pattern characterized by rhythmic waxing and waning of the depth of respiration, with regularly recurring periods of apneas
EKG channel shows regular rhythm, rate 60-100 bpm; P-waves present and upright before each QRS complex. Time interval is same for all beats
Normal Sinus Rhythm
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
EKG channel shows regular rhythm, rate < 60 bpm; P-waves present and upright before each QRS complex. Time interval is same for all beats
EKG channel shows more P-waves than QRS complexes with no association between the two. The P-R interval is variable and the QRS complexes are the same and regular
3rd degree AV block (complete heart block)
Normal arterial pCO2 value
Normal arterial pO2 value
When does sleep onset occur when scoring an MSLT?
The time from Lights Out to the 1st epoch scored as sleep
A patient with "Ondine's Curse" would be expected to have what type of respiratory impairment?
Central Alveolar Hypoventilation
Which class of drugs is known to aggravate Periodic Limb Movements of sleep?
What is the effect of chronic alcoholism on REM?
Name the components of the narcoleptic tetrad
The ratio of total sleep time to total time in bed
In 1953 Aserinsky and Kleitman associated what with dreaming during sleep?
Rapid Eye Movements
REM sleep is associated with what changes in the autonomic nervous system?
Variable heart rate
decrease in tonic muscle activity
Reticular activating system is essential for what part of the sleep/wake cycle?
Initiation and maintenance of wakefulness
Ultradian rhythm refers to a period of what time?
Less than 24 hrs
Increased resistance of the upper airways secondary to blockage of one nasal orifice restricts ventilation more severely in REM or NREM?
Paradoxical breathing is noted in neonates or infants?
Periodic breathing in the normal infant most commonly occurs in Active or Quiet sleep?
Ultradian rhythm of alternating sleep cycles has a period of how many minutes during infancy?
Minimum of 3 Central events lasting < 4 sec within 20 sec of each other
A person's maximum breathing ability
Content of air remaining in lungs at end of normal expiration
Functional Residual Capacity (FRC)
Leg muscle used to monitor/record myoclonic movements
Which type of montage is recommended in order to maximize the voltages recorded during a PSG?
Referential montage using contralateral ear references
Multiple Sleep Latency Test
How many naps are usually performed during the MSLT?
When does the 1st nap begin once the MSLT has started?
1.5 - 3 hrs after the nocturnal recording
After sleep onset occurs, when is the nap terminated?
15 mins from 1st epoch of sleep
If no sleep is noted, when is nap terminated?
20 mins from "Lights Out"
Amount of time elapsed from "Lights Out" to 1st epoch of sleep
Amount of time elapsed from 1st epoch of sleep to 1st epoch of REM
Purpose of MSLT?
Assess and diagnose diseases of excessive somnolence and to evaluate daytime sleepiness
Do naps occur Q2 hrs from the time the previous nap ended or Q2 hrs on the hour or half-hour?
Q2 hrs on the hour or half-hour
How long before a nap begins should the subject cease smoking?
What epoch size is best for recording MSLT?
30 sec epochs
A mean sleep latency of < 5 mins during the MSLT indicates what?
Normal mean sleep latency is how many mins?
How many naps must have unequivocal periods of REM to arrive at a diagnosis of narcolepsy?
Excessive Daytime Sleepiness
What montage is generally used for recording the MSLT?
The core channels:
How is 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
How is median sleep latency calculated?
Align all sleep latencies in numeric order.
5 naps; select the 3rd number:
1, 5, (10), 15, 17 ==> Median latency is 10 mins
4 naps; add 2nd and 3rd #s and divide by 2:
1, (5), (10), 15 ==> (5+10=15/2=7.5)
Median latency is 7.5 mins
How is the mean REM latency calculated?
Sum of all REM latencies divided by # of REMs that occurred
2+3+2=7/3=2.3 ==> Mean REM latency is 2.3 mins
How frequent are the naps scheduled during MSLT?
Respiratory Disturbance Index (RDI) measures what?
The number of apneas and hypopneas per hr of total sleep time as determined by all-night PSG
Reflux is identified in the distal esophagus by a drop in the pH below what?
A patient can become the pathway of least resistance, and therefore susceptible to shock when what occurs?
When not all the equipment attached to the patient is connected to a common ground
What are the effects of chronic alcoholism on sleep?
Reduced NREM delta sleep and REM sleep
A 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.
During REM sleep, inhibition of thermoregulartory mechanisms leads to a state of what?
What equation best expresses time constant?
TC = C x R
TC = Time Constant
C = Capacitance
R = Resistance
Impedances > 10,000 ohms allows for greater potential of electrode imbalance and the appearance of what in the recorded signal?
60 Hz interference
If the circumference measurement of the head is 60cm, what is the distance of T4 from Fp2?
What is the minimum paper speed recommended to allow clear visual resolution of alpha and sleep spindles?
What sleep stage?:
Low voltage, mixed frequency EEG with a prominence of activity in the 2-7 Hz range, slow eye movements, tends to be relatively short, ranging from 1-7 mins.
The amplitude of this waveform is occasionally as high as 200 uV
Vertex Sharp Wave
Total duration of this waveform should exceed 0.5 sec with a well-delineated negative sharp wave followed by a positive component
What sleep stage requires at least 20%, but not more than 50% of the epoch to consist of waves of 2 Hz or slower with amplitudes > 75uV from peak to peak?
Alpha activity in REM sleep is how many Hz slower that during wakefulness?
1-2 Hz slower
How are eye movements recorded?
There's a small electropotential difference between the cornea (+) and the retina (-).
An electrode closest to the cornea will register a (+) deflection; electrode closet to retina will register a (-) deflection.
List the 4 skull landmarks used in the 10-20 system of electrode placement
Nasion - Inion
Right Preauricular - Left Preauricular
The degree to which an amplifier will reject a common mode signal is expressed as what?
Common Mode Rejection Ratio
This sleep test is used in the assessment and diagnosis of disorders of excessive somnolence and to evaluate daytime sleepiness in relation to various therapeutic or experimental manipulations
How many minutes after Light-Out (if no sleep is seen) is the standard MSLT terminated?
In order to assess the occurrence of REM sleep during MSLT, the test should continue for how long after the 1st epoch of sleep?
How many sleep-onset REM episodes in a series of 5 naps are diagnostic for narcolepsy?
NREM in an infant is known as?
REM in the infant is known as?
Other than the EEG recording, what else is used to differentiate the sleep stages in an infant?
Observed behaviors and movement patterns
At what age do sleep spindles appear in the infant?
They appear at 4 wks of age, develop rapidly through 8 wks of age, and clearly characterize NREM sleep by 3 months of age
An epoch that does not meet the criteria for Active sleep or Quiet sleep is called what?
Trace' Alternant pattern is associated with what stage of sleep in the infant?
Infant breathing pattern that alternates regular breathing with 5-10 sec of apnea
REM occupies what percentage of sleep in the neonate at term?
Term used for a brief superimposition of EEG alpha activity on sleep activities during stage of sleep.
TRUE or FALSE?:
Thermoregulartory responses such as sweating and panting are noted in REM, but are absent in NREM.
Sweating and panting is seen in NREM, but are absent in REM
Cessation of airflow at the nostrils and mouth lasting at least 10 sec
A function that expresses the frequency of eye movements per unit time during REM
The number of apneas (Obstructive, Central, Mixed) + hypopneas per hour of total sleep time as determined by all-night PSG
(RDI) Respiratory Disturbance Index
What initial effect does administering supplemental O2 have on the OSA patient?
A significant increase in apnea duration with associated hypercapnia and respiratory acidosis
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