a. activity in the range of 4-7hz, slowing of background frequency by > or equal to 1-2hz b. SEM c. Vertex Sharp Waves d. Hypnagogic Hypersynchrony e. High amplitude, rhythmic 3-5hz activity
Pediatric Stage N2
Same as Adults
Pediactric Stage N3
Same as Adults
Pediatric Stage REM
Same as Adults
Infant Stage Transitional (Stage T)
When two or more Sleep stage characteristics contradict each other the epoch is scored as Stage T
Infant Stage W: Bahavioral Characteristics
Reduced movement (relative to wake), eyes closed, periodic sucking, occasional startle
Infant Stage W: Respiration Characteristics
Irregular, rapid, shallow
Infant Stage W: EEG Characteristics
Low voltage irregular(LVI), Mixed (M)
Infant Stage W: EOG characteristics
Blinking, REM, Scanning movements, brief evey closures (longer than blink)
Infant Stage W: EMG
Present, Movement artifacts
Infant Stage N: Behavioral characteristics
Reduced movement (relative to wake), eyes closed, periodic sucking, occasional startle.
Infant Stage N: Respiration
Infant Stage N: EEG
Trace Alternate (TA), High Voltage Slow(HVS), Sleep spindles or Mixed (M)
Infant Stage N: EOG
Eyes closed, no movements
Infant Stage N: EMG
Present or Low (relative to wake)
Infant Stage R: Behavioral
Eyes closed, small movements
Infant Stage R: Respiratory
Infant Stage R: EEG
Low voltage irregular (LVI) or Mixed (M)
infant Stage R: EOG
REMS or No eye movements (only after Definite REM)
Infant Stage R: EMG
low, Transient Muscle activity(TMA) may occur
Infant EEG Characteristics: Trace Alternate (TA)
At least 3 alternating runs of bilateral Symmetrical synchronous High voltage, 1-3hz delta activity that last 5-6sec, ALTERNATING WITH lower amplitude 4-7hz theta activity lasting 4-12 secs
Infant EEG Characteristics: Low Voltage irregular (LVI)
Continuous LAMF WITH Delta and Predominately Theta activity.
Infant EEG Characteristics: High Voltage Slow (HVS)
Continuous Symmetrical High voltage 1-3hz delta activity
Infant EEG Characteristics: Mixed (M)
Both high voltage and low voltage happening non-periodically, Lower voltage than HVS
Infant EEG Characteristics: Sleep Spindles
12-14hz activity prominently in the central region, ONLY in Stage N sleep.
Hormone that causes drowsiness especially in the first trimester of pregnancy
Pregnancy effect on sleep
Total Sleep time decreases, Shortness of breath, Insomnia, Sleep apnea.
The amount of blood that is pumped through the ventricles in one minute
Amount of blood EJECTED by the ventricle in one contraction
The amount of resistance that must be overcome to push blood through the circulatory system
The flow of Oxygenated blood away from the heart and Deoxygenated blood back to the heart.
Systemic Vascular Resistance
The amount of resistance in systemic circulation
The flow of Deoxygenated blood away from the heart To the lungs and oxygenated blood back to the heart.
Pulmonary vascular resistance
The amount of resistance in the pulmonary circulation
A measure of Cardiac performance in relation to the size of the individual.
measures in L/min/squared meter
Excessive Fragmentary myoclonus
at least 5 twitching movements that occur every minute for 20 mins during NREM sleep
Hypnagogic foot tremor
HFT: A minimum of 4 HFT burst are needed to make a train. frequency of the burst range from .3hz- 4.0hz
Rhythmic movement disorder
Involuntary, repetitive movements that range between .5hz-2.0hz. 4 movements are required to mark a single cluster of movements.
Periodic Leg Movements in Sleep: Single event
PLMS: Duration range from .5-10 seconds, increase of z8uv, the end begins when there is at least .5 seconds of EMG tone that is no more than 2uv higher than resting EMG amplitude.
at least 4 LM events are needed to become a series, LM events with in the SAME series can be 5-90 seconds apart. LM events on different legs that happen within 5seconds of each other count as a SINGLE movement
PLMS and Arousals
Arousals and LMs that occur in a PLM series should be considered associated with each other if both happen simultaneously, overlap, or is there is <.5secs between the two events.
Temporal Lobe Epilepsy
Seizures that occur primarily in the temporal lobe
non specific Severe Seizures during childhood usually in PTs younger than 8years old, Mental Retardation, slow (less than 2.5hz) spike wave like pattern on the EEG
Deterioration of the language part of the brain. contains multifocal spikes and spike wave discharges.
Generalized Anxiety Disorder
Increase in Stage 1 Non-REM sleep. Difficulty falling asleep, decreased REM sleep
Responsible for production of hormones that regulate sleep, hunger, thirst, sex drive, and release of other hormones. Creates homeostasis and controls autonomic functions
center for memory, emotion, and autonomic nervous system
Important in Recollective memory
Posterior pituitary gland
produces antidiuretic hormone that promps kidneys to absorb more water from the blood
In the Periods between seizures, EEG shows Irregular and disorganized activity in the EEG. no distinguishable pattern, often seen in Infantile Spams
Measure of the percentage of red blood cells in 100ml of blood
- While intoxicated Decrease sleep latency, PT has increase N3 and reduced REM.
- After being intoxicated Reduced N3 and Increased REM
Insomnia, Disturbed sleep, ^REM, vDelta
Total sleep is reduced, Deep sleep Reduced, increase sleep latency, Increase EMG activity
Increased TST, increase deep sleep, excessive daytime sleepiness (EDS)
PT May only sleep for short, disrupted periods
Sleep is prolonged
Opioids: Acute Vs Chronic
-Acute: Increase in sleepiness with reduced stage R
19 questions about time preferences. determines when PT is most awake
given after a PSG to determine if Varribles of the sleep lab effected sleep performance.
Given to PT's Bed-Partner(roommate). Gives insight to PT's behavior while in sleep that PT may not be aware of.
Pre Sleep Questionnair
Helps determine if the previous 24hrs were normal for the PT prior to PSG. Technologist may ask additonal questions.
Has two components: Evening- mood assesment, Medications taken, time of Lights out. Morning- Approximate sleep onset, #of arousals, 1-5 mood scale
Stanford Sleepiness scale
Assessment for EDS, 1-7 sleepiness scale used to describe different parts of the day. 4-7 correlates with EDS
Epworth Sleepiness Scale
Determines how likely PT will Fall asleep in a given scenario, 0-3 scale. Score of 9or< is high index for sleep.
Sleep-Wake Activity Inventory
Nine Statements that the PT will score with 1-9 scale. (1-always present, 9 never present). score of <50 mean sleepiness
Fatigue Severity Scale
9 descriptions relating to fatigue, PT will score on 1-7. above 35 suggest high Fatigue
Determines risk of OSA or Progress after treament with PAP device. total of 14 questions in three categories: snoring, Fatigue, hypertension. High risk is positive in 2 or more category.
Pittsburgh sleep quality index
19 questions which make up 7 sections that create a global score. This questionnaire help asses the PTs sleep quality after 1 month.
Obstructive Sleep Apnea screening tool. 8 yes or no questions which every "yes" answer is 1 point. less than 3 is low risk for OSA
Generated by the PT's Tissue and motion and recored by surface electrodes
Generated by sensors that convert action into electrical signals.
Standard Time Scale
Waves/cycles per second
Vertical height of the wave Determined by voltage
Standard Voltage setting
50 microvolts/cm (50 microvolts of signal produce a standard waveform that is 1cm high).
Adjust the visual height of the wave without changing the Time constant or Voltage
Used to Isolate Bandwidths and reduce outside interference.
Used to eliminate signals below the normal bandwidth
Used to eliminate signals above Normal bandwidth
60 Hz notch
Used to remove Signals in 50-60hz range without affecting other frequencies
only record signals within a particular range
Sample Rate: EEG
Desirable: 500 hz Minimal: 200 hz
Sample Rate: EOG
Desirable: 500 hz Minimal: 200 hz
Sample Rate: EMG
Desirable: 500 hz Minimal: 200 hz
Sample Rate: ECG
Desirable: 500 hz Minimal: 200 hz
Sample Rate: Airflow
Desirable: 100 hz Minimal: 25hz
Sample Rate: Oximetry
Desirable:25 hz minimal: 10hz
Sample Rate: Nasal Pressure, EtCO2, PAP
Desirable: 100 hz Minimal: 25 hz
Sample Rate: Body position
Sample Rate: Snore sounds
D: 500hz M:200hz
Sample Rate: Chest/abdominal movements
D: 100 hz M: 25 hz
L: 0.3 hz H: 35 hz
L: 0.3 hz H: 35 hz
L: 10hz H: 100hz
L: 0.3hz H: 70hz
Flow and Respiratory effort Filters
L: 0.1hz H: 15hz
L: 10hz H: 100hz
Respiratory Event Duration
measure from the lowest point before the first wave of an event to the beginning of the first wave of normal breath.
Devices to measure Apnea Duration
Oralnasal thermal sensor or PAP device Flow signal
Devices used to measure Hypopnea Duration
Nasal Pressure or PAP device Flow
Adult Apnea: General parameters
z90% decrease in baseline wave size for z10sec
SpO2 Desaturation is not necessary
Adult Apnea: Obstructive
Meets criteria for Apnea and is associated with continued inspiratory effort during event
Adult Apnea: Central
Meets criteria for Apnea and is associated with ABSENT inspiratory effort
Adult Apnea: Mixed
Meets criteria for apnea and is associated with absent inspiratory effort followed by resumption of effort.
Adult Hypopnea: General parameters
z30% decrease is wave size lasting z10sec with z3% or z4% desaturation or if the event is associated with an arousal (note wether you are using 3% or 4%)
Adult Hypopnea: Obstructive
If Criteria for Hypopnea is met and ANY of the following occur: snoring during the event flattening of the flow signal paradoxical movement in the thoracoabdminal channels during the event
Adult Hypopnea: Central
Criteria for hypopnea is met and NONE of the Obstructive criteria are present..
Adult Respiratory Effort-Related Arousal (RERA)
Must result in an arousal and is characterized by increased respiratory effort or flattening of inspiratory portion of nasal pressure or pap flow. DOES NOT meet criteria for Apnea or Hypopnea.
Increase in arterial PCO2 to a value of >55mmHg for z10mins OR z10mmHg increase during sleep compaired to awake lasting z10min
Episodes of z3 consecutive central apneas/hyponeas separated by a crescendo-decrescendo change in breathing amplitude lasting z40seconds AND z5 central apnea/hypopneas per hour of sleep recorded over z2hours
Ages to use Pediatric Respiratory Scoring rules
Anyone younger than 18. Children z13yr may use adult rules
Children Apena: General Parameters
Drop is signal size by z90% for at least the minimum duration specified by obstructive/central/mixed criteria
Children Apnea: Obstructive
Meets Criteria for apnea and last the same duration as 2 breaths during baseline AND is associated with respiratory effort during absent airflow.
Children Apnea: Central
Meets apnea criteria with absent Inspiratory effort AND one of the follow is present: -event last z20sec -even lasts duration of two normal breaths with z3% desat or and arousal -two breath duration with decrease is heart rate (50BMP for 5sec or 60BPM for 15sec)
Children Apnea: Mixed
meets criteria for apnea for duration of 2 normal breaths and is associated with no effort and effort.
Children Hypopnea: General parameters
Decrease is signal height by z30% for 2 breath duration with z3% desaturation or associated with an arousal
Children Hypopnea: Obstructive
Criteria for hypopnea is met and is any of the following occur: -snoring during the event -inspiratory flattening on nasal pressure or papflow -thoracoabdominal paradox occurs during the event
Children Hypopnea: Central
Hypopnea Criteria is met and NONE of the Obstructive hypopnea criteria is met.
When a sequence of breaths lasting z2 normal breath duration that result in an arousal and are characterized by one of the following: -snoring -increase respiratory effort -flattening of inspiratory part of the Pressure/PAP signal -increase in PCO2 above baseline
When >25% of TST contains a PCO2 of >50mmHg
Children Periodic Breathing
z3 episodes of central pauses in respiration lasting >3sec that are separated by 20 or less seconds of normal breathing.
Multiple Sleep Latency Test: used to measure tendency to fall asleep. May diagnose Narcolepsy and Hypersomnia.
Required Optional: all other leads - EEG - EOG - ECG -cEMG
MSLT Procedure: When to start
1.5 - 3hrs after a PSG
MSLT Procedure: Naps
MSLT consists of 5 nap periods separated by breaks that are 2 hours long
MSLT Procedure: PT preparation
- PT should keep a 2 week sleep diary - Stimulants or sleep altering medications should be discontinued 2 weeks prior - PT must put on casual clothes
MSLT Procedure: Before each nap
- PT uses bathroom if needed - no smoking 30 mins before -no exercise 15 mins before - Biocalibrations
MSLT Procedure: During the nap
- PT attempts to fall asleep with lights out while lying in bed - If no sleep is recorded Nap ends after 20 mins (SL is 20mins) - If PT sleeps study ends 15 mins after sleep onset
MSLT Procedures: After each nap
- PT gets out of bed - Lights are on - Monitor PT to prevent sleeping during the break
MSLT Procedure: Ends
After 5th nap is concluded May end after 4 naps if no REM is recorded in any NAP.
Sleep latency averaging 5mins or less means and had at least 2 Sleep Onset REM Periods, then the PT is Narcoleptic.
Maintenance of wakefulness test; Measures PT's ability to stay awake
MWT Procedure: Trials
MWT consists of 4 trials lasting 40 mins each with 2 hour intervals
MWT Procedure: Begins
1.5 to 3 hrs after PT's normal wakeup time
MWT Procedure: Before each trial
- PT uses bathroom if needed - Biocalibrations - PT is seated up right facing away from a dim light source
MWT Procedure: During and End of trial
- PT must stay awake for 40mins - If patient falls asleep, Wake PT and end trial *IF z3 Epochs of N1 or 1 epoch of any other sleep stage occur
Sleep Latency less than 8mins is considered abnormal
A device use to measure changes in volume within an organ or the whole body
PAP compliance data
Data that is transmitted by the PAP device to the doctor or insurance companies so that PAP use can be tracked.
Treatment of an illness or a disease that takes into account the body's natural rhythm and cycles.
act of blowing somthing (gas, powder, vapor) into the body
Sleep State Misperception, PT is getting more sleep than they think.
Increase pressure for oxygenated blood leaving the lungs towards the heart and into the body.
An uncommon EEG pattern that is distinguishable from background EEG and is periodic/almost periodic and associated with PT's with epilepsy
Normal Sleep Latency/Efficiency
<30mins , 80% efficiency
Normal REM Latency
A portable device that continuously monitors the heart
Gain vs Sensitivity
Increasing Gain is when amplitude is added to the input signal from a power source thus creating a higher output signal from an amplifier.
Sensitivity Increases the pen deflection without changed the input/output signal or the time constant (visual size of the wave)
A.K.A. Obesity Hypoventilation Syndrome, PT is unable to breath rapidly enough or deep enough resulting in low oxygen and high CO2.
A harsh Vibrating noise during breathing due to obstruction in the windpipe or lungs
Oral Appliance for OSA
Designed to relieve upper airway obstruction
Oral Appliance: appropriate candidates
- Mild to moderate OSA - Treatment beyond behavior modification (weightloss, abstinence from alcohol, etc.) - PT's the prefer an oral appliance rather than a PAP device - Non-adherence with PAP therapy or non-responsivness to therepay
Oral appliance Advantage
Easier to use, more portable, quiet, require no power source
Oral Appliance Contraindication
-If PT requires rapid initiation of treatment for severe symptomatic OSA, Active Cardiovascular comorbidities. - PT with prolonged low SaO2 - PT with Dental conditions that would prevent appliance retention in the mouth.
Most common oral appliance, Enlarge airway by re positioning anatomical features.
Tongue Retaining device
uses suction to move tongue to enlarge air way.
Esophageal pH Monitoring
Used on PTs with symptoms suggestive of GERD.
Complex Sleep Apnea
During a CPAP titration if Increasing the pressure eliminates Obstructive apnea but Central apneas begin to apear.
Complex sleep apnea treatment
Best choice is switching to ASV mode and if not possible to then use BPAP WITH a backup rate.
When lungs collapse due to negative pressure. Air between the lungs and the chest wall
Lung damage by COPD, Cystic fibrosis or Pneumonia
Scoring system to predict difficult intubation. Looks at size of the tongue and how wide the mouth can open.
Respiratory distress, labored breathing or dyspnea. Feeling of suffocating
Alternating Leg Muscle Activation: A single episode is at least four muscle activations that alternate between the legs .5-3hz
Mercury filled device thats used to measure Respiratory effort
A device that measure respiratory effort by measuring difference between two electrodes placed onto the chest.
alternative to measure effort /OSA
An alternative sensor for detection of effort is:
What is an oronasal thermal sensor?
the sensor to detect absence of airflow for identification of an apnea.
The sensor for detection of respiratory effort is:
Either esophageal manometry or calibrated or uncalibrated inductance plethysmography.
SA Node fires
-The dominant pacemaker of the heart -Sends an electrical impulse at regular intervals through the atria that causes them to depolarize and contract (p-wave)
Transmission time across the atria through AV node
P P-R interval
-When the electrical impulse reaches the the AV node it is slowed, creating a pause, this pause allows the ventricles to have enough time to full up with blood (represented by the flat line following the p-wave)
Bundle of HIS and Bundle Branches
-After being slowed by the AV node, the electrical impulse rapidly moves through the Bundle of HIS and then splits -The impulse then travels down the left and right bundle branches to the terminal ends of Purkinje Fibers and causes the ventricular myocardium to depolarize and contract -Represented by the QRS complex
After a contraction, the heart muscle cells need time to return to their original state in order to initiate a new contraction, this time required to complete this action is the repolarization phase, represented by the ST segment and the T wave
Evaluating A rhythm
1. Is the rhythm regular? 2. Rate? 3. What are atria doing? 4.What are ventricles doing? QRS. 5.Relationship between atria and ventricles
Normal Sinus rhythm
1. PR Interval 0.12-0.20 seconds 2. QRS Complex 0.04-0.10 seconds 3. QT Interval 0.36-0.44 seconds 4. A heart rate of 60-90 beats per minute 5. P waves Uniform and upright in appearance
An abnormal cardiac cycle conduction pattern
Causes of arrhythmias
-Damage to tissues of the conduction system -Replacement of the conduction tissue -Abnormal levels of electrolytes involved in conduction -Hypoxemia
Low oxygen levels
Originate from a single site
Multifocal (multiform) PVCs
Originate from more than one site and have different shapes
2 consecutive PVCs
PVC alternating with a normal beat
PVC occurring every 3rd beat
PVC occurring every 4th beat
Respiratory effort-related arousal
Score a RERA when
1. Breathing for at least 10 seconds shows increasing RIP amplitudes or flattening of the nasal pressure signal followed by an arousal 2. The event is not an apnea or hypopneas
Hypoventilation is scored when
1. End-tidal CO2 or transcutaneous CO2 rises 10 mmHG above the level recorded with patient awake and lying down 2. Low oxygen desaturation is not enough to score hypoventilation
Score Cheyne Stokes breathing when
There are at least 3 cycles of rising and falling breathing amplitude and at least 1 of the following: 1. 5 or more central apneas/hr of sleep 2. The rising and falling pattern lasts at least 10 min
-An abrupt shift in EEG frequency, which may include theta, alpha, or frequencies > than 16 HZ but not spindles, that lasts for 3 or more secs. -Must follow at least 10 secs of sleep -Arousals may be scored from either central or occipital channels
Arousals in REM require an increased in
Physiological changes that may accompany Arousals
-Increased in EEG frequency -K complex followed by a shift in EEG frequency -Increased in chin tone -Hypernea -Increase in heart rate -Eye blinks -Evidence of body movement -Electrode popping
Increases in breathing rate or volume
Score a hypopnea when(1)
1. The nasal pressure amplitude drops by at least 30% of baseline 2. The duration of the drop is at least 10 secs. 3. There is at least a 4% desaturation 4. At least 90% of the event duration meets the amplitude criteria
Score a hypopnea when (2)
1. The nasal pressure amplitude drops by at least 50% of baseline 2. The duration of the drop is at least 10 secs 3. There is at least a 3% desaturation or an arousal 4. At least 90% of the event duration meets the amplitude criteria
A device used to measure movement, usually over long periods of time.
A channel setup based on recording from two exploring electrodes.
A chemical in the brain that is responsible for arousal of the cortex, movement, and responsiveness.
End Tidal CO2
A reading of carbon dioxide levels in the blood as measured by expired air.
GABA (Gamma-Aminobutyric Acid)
A neurotransmitter involved in relation, sleep and decreased emotional reaction and sedation.
Excitatory amino acids that project to the cortex, forebrain and brainstem.
A chemical in the brain responsible for activation of the cortex.
High Frequency Filter (HFF)
A tool or device on a PSG which sets a limitation to the high frequency signals that are allowed to pass through the amplifier.
A display of sleep stages achieved through the sleep period.
A state of excessively fast breathing, resulting in decreased CO2 levels and increased O2 levels in the blood.
A treatment for insomnia in which a patient learns to control biological activity.
WHAT MONTAGE IS GENERALLY USED FOR THE MSLT
THE CORE CHANNELS; 2 EOG, 4 EEG, CHEIN EMG, EKG
HOW MANY MINUTES AFTER LIGHTS OUT (IF NO SLEEP IS SEEN) IS THE STANDARD MSLT TERMINATED?
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?
WHEN DOES SLEEP ONSET OCCUR WHEN SCORING AN MSLT?
THE TIME FROM LIGHTS OUT TO THE FIRST EPOCH SCORED AS SLEEP
INFANT BREATHING PATTERN THAT ALTERNATES REGULAR BREATHING WITH 5-10 SECONDS OF APNEA.
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 OXYGEN SATURATION LEVEL.
NORMAL ARTERIAL pCO2 VALUE
IF THE CIRCUMFERENCE MEASUREMENT OF THE HEAD IS 60 CM, WHAT IS THE DISTANCE OF T4 ELECTRODE FROM THE Fp2 ELECTRODE?
WHAT IS THE MINIMUM PAPER SPEED RECOMMENDED TO ALLOW CLEAR VISUAL RESOLUTION OF ALPHA AND SLEEP SPINDLES?
LIST THE 4 SKULL LANDMARKS USED IN THE 10-20 SYSTEM OF ELECTRODE PLACEMENT
NASION, INION, RIGHT PREAURICULAR, AND LEFT PREAURICULAR
THE DEGREE TO WHICH AN AMPLIFIER WILL REJECT A COMMON MODE SIGNAL IS EXPRESSED AS WHAT?
COMMON MODE REJECTION RATIO
NREM SLEEP IN THE INFANT IS KNOWN AS?
Reflux is identified in the distal esophagus by a drop in the pH to below what?
A patient is susceptible to shock when
ALL the equipment is not connected to a common ground.
What are the effects of chronic alcoholism on sleep?
Reduction of delta sleep and REM sleep.
REM percentage of sleep for a neonate at term?
Thermoregulatory responses such as sweating and panting are noted in NREM or REM sleep?
NREM. They are absent in REM sleep because of Poikilothermia.
What are anatomic abnormalities that predispose to OSA?
Selectively attenuate undesirable fast frequencies
In polysomnography, the recording of eye movements is based on
The electrical potential difference between the cornea and the retina of each eye
Score Hypoventilation in Adults
If EITHER: A) There is an increase in the arterial PCO2 (or surrogate) to a value >55mmHg for >than or = to 10 min. B) There is > than or = to 10mmHg increase in arterial PCO2 (or surrogate) during sleep (in comparison to an awake supine value) to a value exceeding 50mmHg for > than or = to 10 min.
Score Hypoventilation in Children
During sleep when >25% of the tst as measured by either the arterial PCO2 or surrogate is spent with a PCO2 > 50 mm Hg.
Score Periodic Breathing
If there are > than or = to 3 episodes of central pauses in respiration (absent airflow and inspiratory effort) lasting >3 seconds separated by less than or equal to 20 seconds of normal breathing.
Score Cheyne-Stokes Breathing
If BOTH: A) There are episodes of > than or = to 3 consecutive central apneas/or central hyponeas separated by a crescendo/decrescendo change in breathing amplitude with a cycle length of greater than or equal to 40 sec. B) There are > than or = to 5 central apneas and/or central hypopneas per hour of sleep associated with the crescendo/decrescendo breathing pattern recorded over > than or = to 2 hours of monitoring.
Score RERA in Adults
If there is a sequence of breaths lasting > than or = to 10 seconds characterized by increasing respiratory effort or by flattening of the inspiratory portion of the nasal pressure (diagnostic study)for Pap flow device (in titration) waveform leading to arousal from sleep when the sequence of breaths does not meet criteria for an apnea or hypopnea.
Score RERA in Children
If there is a sequence of breath laughing greater than or equal to 2 breaths (or the duration of two breaths during Baseline breathing) that do not meet criteria for an apnea or hypopnea and lead to in arousal from sleep. The breathing sequence can be characterized when one or more of the following is present: a) increasing respiratory effort b) flattening of the inspiratory portion of the nasal pressure (diagnostic study) or Pap device (titration study) waveform c) snoring d) An elevation in the end-tidal PCO2 above pre-election baseline