Polysomnography and EEG Basics Quiz
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Questions and Answers

What is the primary function of the SpO2/SaO2 sensor in polysomnography?

  • To monitor heart rate
  • To record brain wave activity
  • To track sleep stages
  • To measure oxygen saturation in the blood (correct)

Which of the following is NOT a type of audiovisual monitoring required for sleep studies?

  • Audio intercom system
  • Patient-room audio monitoring
  • Heartbeat alarm system (correct)
  • Video recording with infrared lighting

What is the purpose of cleaning and lightly abrading the skin before electrode application?

  • To prevent skin irritation
  • To allow for blood circulation
  • To enhance conductivity for electrical signals (correct)
  • To ensure better adhesion of the electrodes

Which system is primarily utilized for electrode placement in EEG according to international standards?

<p>International 10-20 System (B)</p> Signup and view all the answers

Which of the following substances should NOT be applied after skin abrasion when preparing for electrodes?

<p>Alcohol (D)</p> Signup and view all the answers

Which electrode types are most commonly used for monitoring EOGs (electrooculograms)?

<p>Ag/AgCl electrodes (B)</p> Signup and view all the answers

What aspect is covered in the AASM Technical Specifications for EEG?

<p>Electrode placement and derivations (B)</p> Signup and view all the answers

What is the role of the nasion in the context of electrode placement?

<p>It serves as a landmark for the placement of M1 and M2 electrodes. (A)</p> Signup and view all the answers

Which of the following are examples of bioelectrical signals measured in polysomnography?

<p>EEG (A)</p> Signup and view all the answers

What type of signal is derived from a transducer during polysomnography?

<p>Nasal pressure airflow (D)</p> Signup and view all the answers

Which of the following types of electrodes is primarily used for measuring signals in polysomnography?

<p>Surface electrodes (D)</p> Signup and view all the answers

What frequency does the alternating current (AC) supplied by power lines in the USA typically have?

<p>60 Hz (D)</p> Signup and view all the answers

Which statement about direct current (DC) channels in polysomnography is correct?

<p>They are derived from external diagnostic equipment. (A)</p> Signup and view all the answers

Which of the following scoring methods is acceptable according to AASM accreditation rules?

<p>Accurate scoring of sleep events (D)</p> Signup and view all the answers

What is considered an ancillary device in polysomnography?

<p>Pulse oximeter (D)</p> Signup and view all the answers

According to the International 10-20 System, which is the correct application for electrode placement?

<p>Standardized measurements based on anatomical landmarks (A)</p> Signup and view all the answers

Which of the following tools is NOT commonly used for polysomnography (PSG) procedures?

<p>Hair dryer (B)</p> Signup and view all the answers

What is a key characteristic of electrodes used in electroencephalography (EEG) procedures?

<p>Electrodes must not be mixed materials to avoid artifacts. (B)</p> Signup and view all the answers

Which type of sensor is NOT typically used in polysomnography?

<p>Optical Sensors (D)</p> Signup and view all the answers

What does AASM stand for in the context of sleep facility accreditation?

<p>American Association of Sleep Medicine (B)</p> Signup and view all the answers

What is the classification of rules that can be used interchangeably with recommended rules in sleep facility accreditation?

<p>Acceptable rules (D)</p> Signup and view all the answers

Which of the following materials is NOT commonly used for making EEG electrodes?

<p>Copper (A)</p> Signup and view all the answers

What is an acceptable method for scoring in an AASM accredited sleep facility?

<p>Any method listed as acceptable can be used. (D)</p> Signup and view all the answers

Which item is typically part of personal protective equipment (PPE) required in sleep facilities?

<p>Masks (D)</p> Signup and view all the answers

Match the following tools with their uses in polysomnography:

<p>Scissors = Cutting materials Ruler = Measuring lengths Alcohol Pads = Disinfecting skin Cotton swabs = Cleaning surfaces</p> Signup and view all the answers

Match the following types of personal protective equipment (PPE) with their purposes:

<p>Mask = Preventing inhalation of particles Gloves = Protecting hands from contamination Gowns = Protecting clothing from bodily fluids Face Shields = Protecting the face from splashes</p> Signup and view all the answers

Match the following electrode types with their applications:

<p>Gold cup Ear clip = EEG monitoring Snap-on ECG electrodes = ECG monitoring Respiratory Effort Belts = Measuring respiratory activity Pulse Oximetry = Measuring blood oxygen levels</p> Signup and view all the answers

Match the following electrode materials with their properties:

<p>Gold-plated silver = Low resistance and good conductivity Silver = Commonly used for electrodes Silver/silver chloride = Stable and reliable Copper = Not recommended due to potential artifacts</p> Signup and view all the answers

Match the following types of electrodes with their characteristics:

<p>Snap-on electrodes = Easy application and removal Needle electrodes = Invasive with potential discomfort EEG electrodes = Used for brain activity measurement Metal plate electrodes = Used for EOG and EMG monitoring</p> Signup and view all the answers

Match the following components of sleep facility accreditation with their descriptions:

<p>Recommended rules = Preferred guidelines for scoring Acceptable rules = Alternative methods without risk Optional rules = Additional guidelines to consider Compliance = Requirement for accreditation status</p> Signup and view all the answers

Match the following sleep monitoring devices with their functions:

<p>Snoring Sensors = Detect snoring events Airflow Sensors = Monitor breathing patterns EEG electrodes = Monitor brain wave activity Respiratory Effort Belts = Measure chest and abdominal movements</p> Signup and view all the answers

Match the following tools and supplies with their statuses in a sleep facility:

<p>Abrasive paste (Nu Prep) = Preparation for electrode application Medical Tapes = Securing electrodes to the skin Hair clips = Hair management before EEG Gauzes = Wound care and shielding</p> Signup and view all the answers

Match the types of electrodes with their characteristics:

<p>Gold-plated electrodes = Do not oxidize like silver/silver chloride electrodes Silver/silver chloride electrodes = Require regular chloride bathing Modern silver/silver chloride electrodes = Do not need regular chloride bathing Gold electrodes = Require more care than silver/silver chloride electrodes</p> Signup and view all the answers

Match the types of electrode cups with their descriptions:

<p>Stamped cups = Equally reliable for recording bio-electrical signal Casted cups = More durable and less likely to bend</p> Signup and view all the answers

Match the terms regarding electrode wires with their definitions:

<p>Lead wires = Also known as 'leads' Teflon® coating = Durable but tends to tangle easily Thicker insulation = Tangles less readily but may be less sturdy Insulated wires = Attached to the cup electrodes</p> Signup and view all the answers

Match the types of recordings with their typical use of electrodes:

<p>EEG = Recording brain activity EOG = Recording eye movements Electrode patches = Disposable for convenience Disposable electrodes = Not appropriate for recording EEG data</p> Signup and view all the answers

Match the problems associated with electrodes with their effects:

<p>Chipped electrodes = Create direct current (DC) offset potential Cracked electrodes = Baseline drift of the signal Scratched electrodes = Lead to unreliable recordings Unmaintained electrodes = Affect signal quality over time</p> Signup and view all the answers

Match the sizes of EEG cup electrodes with their intended group:

<p>Adults = 10 mm in diameter Pediatrics = 6 mm in diameter Standard size = Determined by electrode type Diameter specification = Varies based on age</p> Signup and view all the answers

Match the types of coatings for wires with their properties:

<p>Thin Teflon® coating = Tangles more easily Thicker insulation = Less likely to tangle Copper insulation = Conducts signals effectively Rubber insulation = Durable but bulky</p> Signup and view all the answers

Match the types of electrode maintenance with their requirements:

<p>Gold electrodes = Require less care than others Silver/silver chloride electrodes = Need regular chloriding Modern silver/silver chloride electrodes = Minimal maintenance required Regularly maintained electrodes = Ensure signal reliability</p> Signup and view all the answers

Match the following snore microphone types with their characteristics:

<p>Dynamic = Does not require a power source and uses a moveable diaphragm Electret = Requires a power source and uses a dielectric material Piezoelectric = Responds to vibrations near the upper airway and does not require a power source Analog = Converts sound into a small voltage for recording</p> Signup and view all the answers

Match the following body position sensor characteristics with their descriptions:

<p>Must be oriented correctly = To achieve the correct output Monitored using video = An important parameter in sleep studies Secured around the chest = Band placement for effective monitoring Detects subtle changes = Based on gravity influence on the body</p> Signup and view all the answers

Match the following components of the snoring sensor with their functions:

<p>Transducer = Converts sound into voltage Diaphragm = Displaces with sound waves Vibration sensitivity = Increases responsiveness to snoring Output channel = Displays recorded sound data</p> Signup and view all the answers

Match the following terms related to RIP technology with their meanings:

<p>Sum Effort Channels = Recorded using RIP technology Sleep study report = Document that includes body position Snoring sensor = Records vibrations associated with snoring Patient monitoring = Assesses various physiological parameters</p> Signup and view all the answers

Match the following types of sensors with their primary application:

<p>Dynamic microphone = Records sound without needing power Electret microphone = Uses a charged diaphragm and requires power Piezoelectric sensor = Detects vibrations from snoring Body position sensor = Records position changes during sleep</p> Signup and view all the answers

Match the following types of microphones used for snoring detection with their properties:

<p>Dynamic = Uses a movable diaphragm Electret = Permanently electrically charged Piezoelectric = Responds to skin vibrations Transducer = Essential for sound-to-voltage conversion</p> Signup and view all the answers

Match the following statements about snoring microphones with their key features:

<p>Dynamic microphone = Does not need a power source Electret microphone = Offers a wide frequency range Piezoelectric microphone = Designed for enhanced vibration sensitivity Signal interface = Connects microphone output to the recorder</p> Signup and view all the answers

Match the following types of respiratory monitoring techniques with their descriptions:

<p>Piezo electric crystal = Produces sine wave patterns from breathing stress Diaphragmatic EMG = Used to differentiate between respiratory event types Respiratory Inductance Plethysmography = Measures changes in rib cage and abdomen False paradoxing = Phenomenon related to piezo sensor inaccuracies</p> Signup and view all the answers

Match the following aspects of body position recording in sleep studies with their significance:

<p>Orientation = Crucial for detecting accurate position Automated recording = Improves accuracy and reduces manual errors Video monitoring = Provides visual confirmation of body position Gravity data = Key for understanding patient movements</p> Signup and view all the answers

Match the respiratory monitoring techniques with their limitations:

<p>Piezo electric crystal = Accuracy affected by patient movement Diaphragmatic EMG = Limited by improper electrode placement Respiratory Inductance Plethysmography = Can be calibrated or uncalibrated False paradoxing = Caused by piezo sensors during readings</p> Signup and view all the answers

Match the following terms with their correct definitions in respiratory monitoring:

<p>Sine wave pattern = Representation of the breathing cycle Central respiratory events = Events originating from the brain Cross-sectional area = Changes measured by respiratory inductance Calibrated RIP = Represents actual airflow volume</p> Signup and view all the answers

Match the following techniques with their unique features:

<p>Piezo electric crystal = Man-made or natural Diaphragmatic EMG = Electrode placement challenges in obese patients Respiratory Inductance Plethysmography = Creates a magnetic field without current False paradoxical breathing = Not produced by RIP technology</p> Signup and view all the answers

Match the following monitoring methods with their primary outputs:

<p>Piezo electric crystal = Non-linear output waveform Diaphragmatic EMG = Indicates muscle activity for breathing Respiratory Inductance Plethysmography = Voltage output from magnetic changes False paradoxing = Inaccurate representation of breathing effort</p> Signup and view all the answers

Match the following concepts with their associated terms in respiratory effort monitoring:

<p>Electrode placement = Critical for accurate EMG readings Subcutaneous placement = Challenge in obese patients Belt with wire = Used in RIP technology Electrode calibration = Ensures accurate airflow measurement</p> Signup and view all the answers

Match the following respiratory variables with their measurement techniques:

<p>Breathing tension = Measured by piezo electric sensors Rib cage area = Monitored with respiratory inductance plethysmography Central vs. non-central events = Distinguished by diaphragmatic EMG Frequency of current = Changes determined by RIP monitoring</p> Signup and view all the answers

Match the following respiratory measurement features with their corresponding technologies:

<p>Piezo electric sensor = Produces an approximation waveform EMG monitoring = Primarily focused on diaphragm and intercostal muscles Inductance plethysmography = Not influenced by electrode movement False paradoxing phenomena = Specific to piezo electric technology</p> Signup and view all the answers

Match the following monitoring methods with their descriptions:

<p>SpO2/SaO2 sensor = Measures oxygen saturation in the blood Pulse oximeter = Non-invasive device for measuring blood oxygen levels Transcutaneous CO2 = Monitors carbon dioxide levels through the skin EtCO2 = Measures the concentration of carbon dioxide in exhaled air</p> Signup and view all the answers

Match the following video and audio components to their characteristics:

<p>Infrared light source = Necessary for low-light video recording Patient-room audio = One-way communication system for patient monitoring Audio intercom system = Facilitates two-way communication between control and patient rooms Fixed-focus system = Type of video camera with a fixed lens and angle</p> Signup and view all the answers

Match the following skin preparation techniques with their purposes:

<p>Clean and lightly abrade = Prepares skin for better electrode adherence Conducting agents = Enhances the electrical conductivity at electrode sites Impedance measurements = Ensures optimal signal quality from electrodes Location identification = Determines the precise areas for electrode placement</p> Signup and view all the answers

Match the following types of sleep monitoring sensors with their applications:

<p>Hypnogram = Visual representation of sleep stages EEG electrodes = Records brain activity during sleep EOG electrodes = Monitors eye movements during sleep EMG electrodes = Measures muscle activity during sleep</p> Signup and view all the answers

Match the following electrode placement systems to their definitions:

<p>International 10-20 System = Standardized method for EEG electrode placement Derivation = Recording from a pair of electrodes in EEG Electrode application = Process of affixing electrodes to the skin Skin preparation = A process to ensure electrodes function correctly</p> Signup and view all the answers

Match the following types of audiovisual monitoring with their descriptions:

<p>Video = Utilizes various videography equipment Patient-room audio = Always on for constant monitoring Audio intercom system = Enables communication between rooms Pan-tilt zoom camera = Offers adjustable angles and stability for recording</p> Signup and view all the answers

Match these cleaning and preparation steps with their significance:

<p>Clean initially with alcohol = Removes oils from the skin Nu-prep® or Lemon-prep® = Used for abrading dead skin cells Conductive gel or paste = Improves electrical signal transmission Do not use alcohol after abrasion = Prevents interference with conductivity</p> Signup and view all the answers

Match the following parts of the EEG preparation process with their roles:

<p>Site identification = Locates optimal points for electrode placement Application and adherence techniques = Ensures secure electrode placement Conducting agents = Enhance signal quality during recording Impedance measurements = Checks for proper electrical contact</p> Signup and view all the answers

Match the following terms related to impedance with their definitions:

<p>Resistance = Electrical barrier from oil, sweat, and dead skin cells Capacitance = Ability to store an electrical charge Impedance = Combination of resistance and capacitance Balanced impedance = Difference between electrodes less than 2 kiloohms</p> Signup and view all the answers

Match the following eye movements with their effects on recorded potential:

<p>Left gaze = Negative-trending change in potential Right gaze = Positive-trending change in potential Eye at center position = Zero potential difference Electrode near outer canthus = Sees cornea approaching in left gaze</p> Signup and view all the answers

Match the following parts of the eye with their functions:

<p>Cornea = Transparent layer at the front of the eye Retina = Layer containing light-sensitive cells Anterior pole = Positive side of the dipole Posterior pole = Negative side of the dipole</p> Signup and view all the answers

Match the following types of electrode applications with their contexts:

<p>Surface electrodes = Used for recording with impedance Corneal electrodes = Measure eye's position during gaze Myohyoid muscle electrodes = Utilized in Chin EMG EOG electrodes = Specifically for eye movement detection</p> Signup and view all the answers

Match the following components of electrode placement with their roles:

<p>Electrodes = Detect electrical signals Skin preparation = Minimize resistance and ensure good contact Impedance measurement = Ensures balanced connection between electrodes Electrical signal = Potential difference from eye position changes</p> Signup and view all the answers

Match the following types of connectors with their characteristics:

<p>1.5-mm touch proof = Recessed-female connector, prevents incorrect mating RJ11 = Commonly used for telephone connections DIN = Round connector with multiple pins RCA = Used for audio and video connections</p> Signup and view all the answers

Match the following types of jumpers with their functions:

<p>Linked-ear reference = Provides common reference for signals Common reference = Removes artifacts in recordings Signal referencing = Eliminates common artifacts Electrode input = Increases electrode input selection capabilities</p> Signup and view all the answers

Match the following types of cables/connectors with their usage:

<p>Keyhole connector = Secure connection for devices Phone connector = Common in telecommunication RCA connector = Audio and video signal transmission Touch proof connector = Safety feature to prevent electric shock</p> Signup and view all the answers

Match the following types of PPE with their purposes:

<p>Mask = Preventing respiratory exposure Gloves = Protecting hands from contamination Gowns = Protective coverage of clothing Face Shields = Eye and face protection</p> Signup and view all the answers

Match the following materials used for electrodes with their properties:

<p>Gold-plated silver = Low noise and stable Silver = Good conductivity, lower cost Silver/silver chloride = Commonly used, biocompatible Copper = Not typically used, high noise</p> Signup and view all the answers

Match the following electrode types to their characteristics:

<p>Gold cup Ear clip = Easy to apply and remove Snap on = Repositionable for multiple uses Needle electrode = Invasive, for specific recordings EEG electrodes = Non-invasive brain monitoring</p> Signup and view all the answers

Match the following electrode maintenance types with their requirements:

<p>Cleaning = Removing contaminants from surfaces Inspection = Checking for wear and damage Calibration = Ensuring accurate responses Testing = Verifying performance in use</p> Signup and view all the answers

Match the following electrode wires with their descriptions:

<p>Teflon® coated wires = Durable but tangle more easily Thicker insulated wires = Tangle less readily but may be less sturdy Leads = Also known as electrode wires Insulated wires = Attached to cup electrodes</p> Signup and view all the answers

Match the following types of electrodes with their primary use:

<p>EEG electrodes = Recording brain activity EOG electrodes = Recording eye movements Disposable electrodes = Convenience in usage Cup electrodes = Recording bio-electrical signals</p> Signup and view all the answers

Match the following types of electrodes with their conditions for use:

<p>Electrodes that are chipped = Create DC offset potential Electrodes that are cracked = Can cause baseline drift of signals Gold electrodes = Require less maintenance Modern silver/silver chloride = Do not require regular bathing</p> Signup and view all the answers

Match the following features of electrode cups with their styles:

<p>Stamped cups = Thinner and bigger Casted cups = Less likely to bend Both types = Equally reliable for bio-electrical signals</p> Signup and view all the answers

Match the following classifications of electrodes with their characteristics:

<p>Cup electrodes for adults = 10 mm in diameter Cup electrodes for pediatrics = 6 mm in diameter Casted electrodes = More durable Stamped electrodes = Reward in design</p> Signup and view all the answers

Match the following types of snore microphones with their characteristics:

<p>Dynamic = Does not require a power source Electret = Requires a power source and offers a wide frequency range Piezoelectric = Responds to vibrations on the skin near the upper airway Contact = Records sound through a diaphragm sensitive to air movement</p> Signup and view all the answers

Match the following electrode issues with their corresponding effects:

<p>Chipped electrode = Can create DC offset potential Scratched electrode = Baseline drift can be seen Regularly oxidized electrodes = Need maintenance Gold electrodes = Less prone to maintenance needs</p> Signup and view all the answers

Match the following body position sensors with their functionalities:

<p>Video Monitoring = Monitors body position through recordings Manual Recording = Requires a technician to note position changes Automatic Recording = Records position using sensors Gravity Sensors = Detect subtle changes in body position</p> Signup and view all the answers

Match the following respiratory monitoring techniques with their main characteristics:

<p>Piezo electric crystal = Produces a sine wave pattern from stress and release Diaphragmatic EMG = Limited by proper electrode placement RIP = Measures changes in cross-sectional area during breathing</p> Signup and view all the answers

Match the following types of body position sensors with their placement:

<p>Belt Sensor = Secured around the abdomen or chest Wearable Sensor = Attached to clothing or skin Video Camera = Positioned to capture patient's movements Pressure Sensor = Placed on a flat surface under the body</p> Signup and view all the answers

Match the following limitations with their respective respiratory monitoring techniques:

<p>Piezo electric crystal = Produces false paradoxing phenomenon Diaphragmatic EMG = Difficult electrode placement in obese patients RIP = Calibrated version needed for accurate volume</p> Signup and view all the answers

Match the following components of a snore microphone with their functions:

<p>Transducer = Converts sound into an analog voltage Diaphragm = Displaces to create voltage change Voltage Signal = Interfaced with a recorder for analysis Adapter = Connects microphone to recording devices</p> Signup and view all the answers

Match the following concepts related to RIP technology with their meanings:

<p>Body Position = Important for sleep study analysis RIP Sensor = Detects ribcage movements during respiration Data Recording = Can be manual or automated Patient Monitoring = Tracking of sleep-related parameters</p> Signup and view all the answers

Match the following respiratory monitoring methods with their outputs:

<p>Piezo electric crystal = Voltage output from repeated stress Diaphragmatic EMG = Electromyography signal RIP = Waveform representing airflow changes</p> Signup and view all the answers

Match the following characteristics of snoring sensors with their types:

<p>Dynamic Sensor = Uses a moveable diaphragm Electret Sensor = Charged diaphragm forming a voltage Piezoelectric Sensor = Sensitive to skin vibrations Infrared Sensor = Utilizes light waves to detect movement</p> Signup and view all the answers

Match the following respiratory technique attributes with their descriptions:

<p>Piezo electric crystal = Man-made or naturally occurring RIP = Does not produce false paradoxical signals Diaphragmatic EMG = Primarily for central vs non-central differentiation</p> Signup and view all the answers

Match the respiratory monitoring technology with their reliability issues:

<p>Piezo electric crystal = Sine wave pattern is an approximation Diaphragmatic EMG = Reliability limited by electrode placement RIP = Calibrated version must be used correctly</p> Signup and view all the answers

Match the following statements about respiratory monitoring technologies:

<p>RIP = Only a weak magnetic field is created Diaphragmatic EMG = Primarily utilized for event differentiation Piezo electric crystal = Output not linear</p> Signup and view all the answers

Match the following respiratory monitoring techniques with their output characteristics:

<p>RIP = Changes in magnetic field affecting current frequency Piezo electric crystal = Approximate movement during respiration Diaphragmatic EMG = Electrode placement difficulties</p> Signup and view all the answers

Match the following electrode types with their corresponding monitoring application:

<p>EEG electrodes = Used for brainwave activity monitoring EOG electrodes = Used for eye movement recording EMG electrodes = Used for muscle activity monitoring SpO2 sensors = Used for monitoring blood oxygen levels</p> Signup and view all the answers

Match the following components of the International 10-20 System with their locations:

<p>T3 = Temporal region T4 = Temporal region M1 = Mastoid process M2 = Mastoid process</p> Signup and view all the answers

Match the following recording processes with their descriptions:

<p>Derivation = Recording from a pair of electrodes EEG record = Data obtained from electrode placement Hypnogram = Visual representation of sleep stages Transcutaneous CO2 = Monitors carbon dioxide levels through the skin</p> Signup and view all the answers

Match the following electrodes with their application methods:

<p>Surface electrodes = Applied to the skin's surface Needle electrodes = Inserted beneath the skin Gold-plated electrodes = Enhance signal quality Disposable electrodes = Single-use to reduce contamination</p> Signup and view all the answers

Match the following stages of video equipment with their features:

<p>Fixed-focus system = Stays locked on a single area Pan-tilt zoom = Allows repositioning and focusing Variety of video equipment = Includes various technologies for recording Infrared lighting = Enables visibility in darkness</p> Signup and view all the answers

Flashcards

AASM Sleep Facility Accreditation

Compliance with all rules, definitions, and notes in the AASM accreditation manual.

Acceptable Rules (Accreditation)

Recommended, acceptable, or optional rules are valid scoring methods for accreditation.

Electrode Materials

Electrodes for EEG are made from gold-plated silver, silver, or silver/silver chloride.

Mixing Electrode Materials

Using electrodes from different materials for EEG can cause errors/artifacts.

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PSG Equipment (Analog)

This is older equipment used for sleep studies (poly somnography).

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Electrode Types

Different types of electrodes used for EEG, EOG, Chin EMG, ECG, and Leg EMG, among others.

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PPE in Sleep Studies

Personal Protective Equipment used during sleep studies (masks, gloves, gowns, etc).

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Tools for Electrode Application

Various tools (scissors, rulers, alcohol pads, conductive creams, tapes) used for applying electrodes.

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SpO2/SaO2 Sensor

A sensor that measures the oxygen saturation in the blood, indicating how much oxygen is bound to the hemoglobin.

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Pulse Oximeter

A device that uses a SpO2/SaO2 sensor to measure the oxygen saturation in the blood and heart rate.

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Hypnogram

A graphic representation of sleep stages throughout the night, based on the readings from polysomnography.

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EtCO2

End-tidal carbon dioxide, measured in the exhaled breath, indicating the amount of carbon dioxide in the lungs.

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Transcutaneous CO2

A method for measuring carbon dioxide levels in the blood using a sensor placed on the skin.

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Site Identification - 10-20 System

A standardized system for placing electrodes on the scalp, used for EEG recordings. It helps ensure consistency and accuracy.

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Conductive Agents

Substances like gels or pastes that ensure a good electrical connection between the skin and electrodes.

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Derivation (EEG)

The process of recording electrical activity from a pair of electrodes, creating an EEG channel

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Bioelectrical Signal

Signals generated by the electrical activity of cells, measured by surface electrodes. Examples include EEG, EOG, ECG, and EMG.

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Transduced Signal

Signals converted from one form of energy to another, usually from mechanical to electrical. Examples include respiratory effort belts, nasal pressure, snoring, and body position.

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Ancillary Signal

Processed data from external devices interfaced with the sleep recording system. Examples include end-tidal CO2, pulse oximeter, and PAP devices.

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AC Amplifier

An amplifier designed for high-frequency signals, used to process bioelectrical signals (EEG, EOG, EMG, ECG).

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DC Channel

A channel for signals derived from external diagnostic equipment, usually supplied as DC voltage. Examples include PAP devices and EtCO2 monitors.

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EEG Signal

Bioelectrical signal generated by the brain's electrical activity, measured by electrodes placed on the scalp.

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EOG Signal

Bioelectrical signal generated by the electrical activity of the eye muscles, measured by electrodes placed near the eyes.

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EMG Signal

Bioelectrical signal generated by the electrical activity of muscles, measured by electrodes placed on the chin or other muscles.

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AASM Accreditation

AASM sleep facility accreditation means meeting all rules, definitions, and notes in the AASM manual for scoring sleep studies.

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Acceptable vs. Recommended Rules

The AASM allows centers to use 'acceptable' rules instead of 'recommended' rules, providing flexibility without jeopardizing accreditation.

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What are the essential tools for electrode application?

Tools like scissors, rulers, alcohol pads, and conductive creams are crucial for applying electrodes accurately during a sleep study.

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Why is PPE important during sleep studies?

PPE like masks, gloves, and gowns protects both the technician and the patient from potential contamination and infection.

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Metal Plate Electrodes

Metal plate electrodes are frequently used for EEG, EOG, and Chin EMG recordings during sleep studies.

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Why can't you mix electrode materials?

Using electrodes from different materials for EEG can cause errors and artifacts in the recordings due to inconsistent electrical conductivity.

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Snap-on Electrodes

Snap-on electrodes, often used for ECG and Leg EMG, provide a secure and convenient way to record electrical activity.

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What are Respiratory Effort Belts used for?

Respiratory effort belts measure the effort of breathing by detecting chest and abdominal movements, helping to assess breathing patterns.

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Gold-plated Electrodes

These electrodes are commonly used in polysomnography (PSG) due to their resistance to oxidation. They offer a stable signal and require less maintenance compared to silver/silver chloride electrodes.

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Silver/Silver Chloride Electrodes

These electrodes are also used in PSG. While they are more prone to oxidation, modern sintered versions require less regular chloride bathing.

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Electrode Oxidation

Silver/silver chloride electrodes can oxidize over time, leading to a loss of conductivity. Oxidation affects the signal, producing artifacts in the recording.

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Sintered Silver/Silver Chloride Electrodes

These electrodes are made by baking silver chloride particles onto silver, enhancing its conductivity and reducing the need for regular chloride bathing.

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Electrode Damage (Chipped, Cracked, Scratched)

Damaged electrodes can lead to direct current (DC) offset, resulting in a baseline drift of the signal, making the recording unreliable.

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EEG Cup Electrode Size

Adult EEG electrodes are usually 10 mm in diameter, while pediatric electrodes are 6 mm, reflecting the difference in head size.

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Electrode Wires (Leads)

These wires connect the electrode cups to the recording device. They can be made with different insulating materials, affecting their durability and tendency to tangle.

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Disposable Electrode Patches

While convenient, these patches are not suitable for recording EEG data, mainly used for EOG or other PSG recordings.

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Piezoelectric Crystal

A material that produces an electrical charge when pressure is applied. It's used in respiratory effort monitoring to detect changes in chest wall movement.

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Respiratory Inductance Plethysmography (RIP)

A technique that uses a band with a wire to measure changes in the cross-sectional area of the chest and abdomen during breathing. It is a more accurate and reliable method than piezoelectric crystals.

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Linear Signal

A signal that directly corresponds to the actual movement or change being measured, unlike a piezoelectric crystal which produces a complex wave.

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False Paradoxing

A phenomenon where a piezoelectric sensor can incorrectly interpret chest wall movement, creating a false signal. It's not an issue with RIP.

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Calibrated RIP

An RIP system that can accurately measure the actual volume of airflow, allowing for creating a flow-volume loop.

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Diaphragmatic and/or Intercostal EMG

A technique that uses electrodes to measure the electrical activity of the diaphragm and intercostal muscles, helpful in distinguishing central from non-central sleep-disordered breathing.

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Limitations of Diaphragmatic/Intercostal EMG

The reliability of this technique depends on accurate electrode placement, which can be difficult, especially in obese patients.

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Snoring Sensor

A device that records vibrations or sounds produced during snoring. It converts these signals into an electrical voltage that is displayed on a sleep study report.

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Electret Microphone

A type of microphone that uses a permanently charged material as its diaphragm. It's sensitive to a wide range of frequencies and requires a power source.

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Piezoelectric Microphone

A microphone that responds to vibrations on the skin near the upper airway. It's attached to the patient's skin and doesn't require a power source.

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Dynamic Microphone

A microphone that uses a movable diaphragm to convert sound waves into voltage changes. It doesn't require a power source.

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Body Position Sensor

A device that detects changes in a patient's body position during sleep. It can be monitored using video or recorded automatically using sensors.

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Gravity-Based Body Position Sensor

A type of sensor that detects body position based on the force of gravity. It needs to be correctly oriented on the body for accurate readings.

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RIP Sensor Belt

A type of sensor that measures respiratory effort by tracking the movement of the abdomen or chest. It's often used to detect breathing patterns during sleep.

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Sine Wave Pattern

A wave-like pattern often seen in the signal from a RIP sensor belt. It indicates the rhythmic movements of breathing.

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Impedance

A measurement of the resistance and capacitance between an electrode and the skin. It represents the electrical barrier created by skin oils, sweat, and dead cells, as well as the material's ability to store charge.

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Balanced Impedance

When the impedance between two electrodes is similar, usually within 2 kiloohms, ensuring reliable signal quality and accuracy.

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Chin EMG

An electrical signal generated by the activity of the chin muscles, recorded using electrodes placed on the chin. It helps assess muscle tone and identify sleep stages.

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What is the role of the cornea in EOG signal recording?

The cornea, the transparent front layer of the eye, acts as a positive pole in the EOG system. Its movement towards an electrode creates a potential difference, allowing us to measure eye movement.

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EEG Electrode Placement

The International 10-20 system is a standardized method for placing EEG electrodes on the scalp, ensuring consistent and accurate recordings.

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Skin Prep for Electrodes

Cleaning and abrading the skin before applying electrodes is essential for a good electrical connection and accurate signal transmission.

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EEG Derivation

An EEG channel is created by recording electrical activity from a specific pair of electrodes.

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Audiovisual Monitoring

Video and audio recordings are essential components of sleep studies, capturing patient behavior and sleep events.

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Why is AASM accreditation important?

It ensures sleep facilities meet strict standards for conducting sleep studies, contributing to accurate diagnoses and effective treatment.

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What are the three types of accreditation rules?

Recommended rules are the ideal, acceptable rules are acceptable alternatives, and optional rules may be followed in addition to the others.

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What are the essential tools for applying electrodes?

You'll need things like scissors, a ruler, alcohol pads, conductive cream, and tapes to ensure clean, secure electrode placement.

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Why is PPE crucial in sleep studies?

PPE like masks, gloves, gowns, and eye protection protect both the technician and the patient from potential infection and contamination.

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Why can't you mix different electrode materials?

Mixing materials creates inconsistencies in electrical conductivity, resulting in artifacts and errors in the readings.

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What is the role of the cornea in EOG recordings?

The cornea acts as a positive pole, so its movement towards an electrode creates a potential difference, allowing us to measure eye movements.

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What are the common uses of snap-on electrodes?

They're ideal for ECG and Leg EMG recordings, offering a secure and convenient way to monitor electrical activity.

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Why is skin prep important for electrode application?

Cleaning and abrading the skin improves electrical connectivity, ensuring accurate signal transmission.

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What are transducers?

Devices that convert one form of energy into another, such as converting mechanical movement into an electrical signal.

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What are 1.5-mm touch proof connectors?

Recessed-female connectors commonly used in medical equipment, designed to prevent accidental electrical shocks by requiring a specific insertion.

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What are jumpers used for in sleep studies?

Jumpers connect electrodes to create a common reference, reducing artifacts and improving signal quality.

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What are RIP sensors used for?

Respiratory Inductive Plethysmography (RIP) sensors measure chest and abdominal movement for accurate respiratory effort monitoring.

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What are Piezo sensors used for?

Piezo sensors measure chest wall movement by converting pressure into electrical signals.

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What is Impedance?

A measurement of the resistance and capacitance between an electrode and the skin. It represents the electrical barrier created by skin oils, sweat, and dead cells.

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International 10-20 System

A standardized system for placing electrodes on the scalp for EEG recordings. It ensures consistent and accurate measurements.

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Skin Preparation (Electrodes)

Cleaning and lightly abrading the skin to remove oils, sweat, and dead cells to ensure a good electrical connection for recordings.

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Study Notes

PSG 102 Foundations of Polysomnography

  • Textbooks:
    • Essentials of Polysomnography: A training guide and reference for sleep technicians. By William H. Spriggs.
    • Polysomnography for the Sleep Technologist. By Robertson, Marshall, and Carno (2014)
    • The AASM Manual for the Scoring of Sleep and Associated Events Vol 2.6. Published by the American Academy of Sleep Medicine (2020)

Keywords

  • PSG Hook-up (electrodes/sensors, tools, PPE)
  • The International 10-20 System
  • Parameters to be Reported for PSG: EEG, EOG, Chin EMG, Impedance

Electrode/Sensor placement for Sleep Studies

  • EEG: Cup Electrodes (Ambu Neuraline), Surface Electrodes with Wet Gel
  • EMG: Procedures and placement instructions for surface and/or needle electrodes
  • ECG: Placement instructions for Ambu Blue Sensor Electrodes
  • Additional Sensors: Description and placement of respiratory airflow, respiratory effort, body position, upper airway resistance, limb movement, snoring, etc.

Scoring and Sensor Types

  • Snoring: Microphone and Sensor descriptions
  • Respiratory Airflow: Description of the thermometer used for detecting apnea and hypopnea
  • Respiratory Effort: Description of belts/sensors to monitor chest and abdominal movements during respiration
  • Body Position: Sensor to measure various patient positions
  • Upper Airway Resistance (UARS): Unique sensor for recording upper airway resistance
  • Limb Movement: Sensor for measuring limb movement
  • More Sensors: Descriptions on other sensors are present throughout the notes

Parameters to be Reported

  • Electroencephalogram (EEG) derivations
  • Electrooculogram (EOG) derivations
  • Chin electromyogram (EMG)
  • Leg electromyogram (EMG)
  • Airflow signals
  • Respiratory effort signals
  • Oxygen saturation
  • Body position
  • Electrocardiogram (ECG)
  • Synchronized PSG video

AASM Manuals

  • Several publications of the American Academy of Sleep Medicine (AASM) manuals (e.g., 2007, 2016, 2017, 2018, 2020, 2023) are referenced

Signal Types

  • Bioelectrical: Summed ionic flux generated by groups of cells measured by applying surface electrodes (EEG, EOG, ECG, EMG)
  • Transduced: Derived from transducer (mechanical energy to electrical) e.g., Body position, nasal pressure airflow, snoring, respiratory effort, movement
  • Ancillary: Devices independently processing data (end tidal, pulse oximeter, carbon dioxide monitor)

AC/DC Current

  • Alternating Current (AC): Periodically reversing electric current (60 Hz in USA) used for high-frequency signals
  • Direct Current (DC): Channel derived from diagnostic equipment (e.g., PAP device).

Sleep Facility Accreditation

  • AASM accreditation requires compliance with all rules, definitions, and notes in the manual
  • Recommended, acceptable or optional rules are all acceptable methods to use to allow for scoring flexibility

Tools for Procedure

  • Tools: Scissors, Ruler, China Marker, Alcohol Pads, Tongue depressor, Abrasive paste, Cotton swabs, EEG Conductive cream/paste, Gauzes, Hair clips, Medical Tapes, Razor, Nail polish remover, Posey tapes

PPE

  • Personal Protective Equipment (PPE): Mask, Gloves, Gowns, Face Shields, Hair cover, Booties

Electrodes and Sensors

  • Metal plate electrodes (EEG, EOG, Chin EMG)
  • Snoring Sensors
  • Snap-on ECG electrodes (ECG and Leg EMG)
  • Respiratory Effort Belts
  • Airflow Sensors (thermal and PT)
  • Pulse Oximetry

PSG Equipment

  • Analog PSG equipment is described

Grass Comet-PLUS EEG/PSG Amplifier System

  • The product is described, including its specifications and capabilities.
  • Additional capabilities and features are also listed.

Leads/Electrodes

  • Gold cup ear clips
  • Snap-on electrodes
  • Needle electrodes

EEG Electrodes

  • Tin plated, Tin (pure), Silver, and Silver/Silver chloride, Gold plated

Snap-on Electrodes

  • Descriptions of various snap-on electrodes

Electrode Types

  • Electroencephalography electrodes can be made of various materials (e.g., gold-plated silver, silver, silver/silver chloride)
  • Mixing different material in electrodes causes artifacts

Electrodes (continued)

  • Standard polysomnography (PSG) recordings use gold-plated electrodes most commonly
  • Silver/silver chloride electrodes require a coating and need re-chloriding over time
  • Modern silver/silver chloride electrodes are sintered
  • Gold electrodes, (silver with gold plate) are less prone to oxidizing than silver/silver chloride electrodes and require less care.

Electrodes (Cont.)

  • Do not use electrodes if they are chipped, cracked, scratched, or directly damaged.

Electrode Cups (Types)

  • Various styles: stamped and casted
  • Stamped: thinner in design & bigger cup
  • Casted: thicker walls and smaller cup
  • Reliability for both equally reliable recording of bio-electrical signals.
  • Diameter/sizes: Adults (10mm) and Pediatrics (6mm)

Electrode Wires

  • AKA "leads" or lead wires
  • Small differences in types
  • Teflon® coated wires are durable but tangle easily.
  • Thicker insulation wires tangle less, but may not be as sturdy

Electrode Specific Use

  • Typically used for recording EEG and EOG
  • Disposable electrodes are not suitable for EEG recording

Cables, Connectors, and Jumpers

  • Each cable might use a different connector
  • Transducers convert energy types
  • Connector types for different systems are also different (1.5-mm touch-proof, keyhole, phone, RCA, RJ11, DIN)

Jumpers (continued)

  • Used for linking ear references for common references

Sensors: Thermistor, Thermocouple, Pressure Transducer, and PVDF

  • Various sensor types are depicted alongside photos.

RIP and Piezo Sensors

  • Respiratory Inductive Plethysmography (RIP): description and components
  • Piezo sensor belts: description

Monitoring Respiratory Effort

  • Respiratory inductive plethysmography (RIP)
  • Piezo technology
  • Diaphragmatic and intercostal EMG

Monitoring Respiratory Effort (Continued)

  • Piezo electric crystal: man-made or natural crystals that produce charge, produce a sine wave, not perfectly linear
  • Limitations: inaccuracies when the patient moves, produces a false paradox phenomenon because of movement

Monitoring Respiratory Effort (Cont.)

  • EMG: Primarily used to differentiate between central and non-central respiratory events
  • Reliability Issues: Difficulty in proper electrode placement (e.g., obese patients)

Respiratory Inductance Plethysmography (RIP)

  • Measures changes in rib cage and abdominal cross-sectional areas during the breathing cycle
  • The belt uses wire woven or sewn along its entire length
  • Changes in rhythmic respirations stretch and relax; this modifies the magnetic field and consequently, the frequency of electrical current
  • Measure changed and converted to a voltage, producing the waveform.

Respiratory Inductance Plethysmography (RIP) (Cont.)

  • Linear signal
  • No current passes through the patient, only a weak magnetic field is created.
  • Doesn't produce false paradoxical signals like piezo sensors
  • Calibrated or uncalibrated, the calibrated system outputs values representative of airflow. Used to create a flow-volume loop.

Sine Wave Pattern in RIP Sensor Belt

  • Graphic depiction of sine wave patterns in RIP sensor belt

Sum Effort Channels Recorded using RIP technology

  • Graphic display of sum effort channels and waves.

Snoring Sensor

  • Snoring sensor, description, and related waveforms

Snore Microphones and Sensors

  • Most widely used method for recording snoring
  • Records vibrations/sounds associated with snoring
  • Snore microphone: sound to analog voltage transducer, interfaced with the recorder, displayed on a channel (employ electret, piezoelectric, and dynamic types)

Snore Microphone (continued)

  • Dynamic: Uses a movable diaphragm that displaces due to sound waves and creates a voltage change in response. Power source not needed
  • Electret: Uses a permanently charged dielectric material that creates voltage changes from movement away from the conductive plate. Requires a power source

Snore Microphones (Cont.)

  • Piezoelectric: Responds to vibrations on the skin near the upper airway or the patient's upper airway itself. Does not require a power source

Body Position Sensor

  • Detects subtle changes in the patient's position
  • Provide data based on gravity

Recording Patient Body Position

  • Important parameter recorded during sleep studies
  • Monitored using video equipment
  • Recorded manually or automatically using body sensors

Body Position Sensors

  • Detect subtle changes in position, data provided based on gravity
  • Must be oriented on the body correctly. Securely attached.

SpO2/SaO2 Sensor

  • Sensors to measure oxygen saturation, including display units and clip attachments provided in related photographs.

Pulse Oximeter

  • Device that measures pulse oximetry

Hypnogram

  • Sleep hypnogram displays time, epoch, oxygen saturation (%SaO2), and carbon dioxide (TcCO2)

EtCO2

  • End tidal CO2 signal (EtCO2) and Respiration (RESP) (impedance from electrocardiography); also Nasal-oral microstream CO2 monitoring; waveforms are plotted with respect to time.

SpO2 and EtCO2

  • Display of SpO2 (oxygen saturation) and EtCO2 (end-tidal carbon dioxide) on a multi-channel monitor

Transcutaneous CO2

  • Sensor application on a patient's face for recording transcutaneous CO2.

Audiovisual Monitoring and Recording

  • Essential for sleep study, includes video and audio
  • Video: Infrared light needed, variety of system/equipment available
  • Audio: Most centers provide patient room audio (one-way communication), audio intercom system for between control room and patient rooms.

Electrode application

  • Identification system for EEGs, EOGs, and EMGs
  • Application and adherence techniques for related sensors
  • Respiratory monitoring sensors

Skin Preparation

  • Location identification
  • Clean and lightly abrade
  • Conducting agents
  • Impedance measurements

AASM Technical Specifications for EEG

  • Specific EEG derivations are described (e.g., recommended and acceptable)

Derivation

  • EEG derivation is defined by recording from a pair of electrodes in an EEG channel
  • The resulting EEG record is obtained by this process

International 10-20 System

  • Determines EEG electrode position. Illustrations and descriptions of the system are provided.

"The Ten Twenty Electrode System of the International Federation"

  • Measured locations
  • Common nomenclature
  • Sequenced measurements

AASM Scoring Manual

  • Definitions for EEG and EOG derivations and explanations are given.

Mastoid Processes

  • Mastoid bone and process are defined and illustrated.

Recording with Surface Electrodes (Continued)

  • Cleaning
  • Skin preparation is described
  • Removal of dead skin cells (e.g., using Nu-prep® or Lemon-prep®) is described
  • Conductive gel/paste is described

Impedance (Continued)

  • Impedance is defined as the combination of resistance and capacitance
  • Resistance is due to electrical barriers (sweat, oil, dead skin cells)
  • Capacitance is a material's ability to store electric charge. Difference in impedance between electrode pairs should be less than 2 kiloohms.

Chin EMG

  • Three electrode placement methods for recording chin EMG are defined.
  • Use of backup electrodes is mentioned

Digastric and Myohyoid Muscle

  • Anatomical diagrams and associated descriptions are provided

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Test your knowledge on polysomnography and EEG standards with this quiz. Questions cover the functions of sensors, electrode placements, and technical specifications relevant to sleep studies. Challenge yourself and enhance your understanding of sleep monitoring techniques.

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