RPSGT Certification Exam — Questions and Answers

Question 1: According to AASM guidelines, an epoch is scored as Stage N2 sleep upon the first occurrence of which of the following?

A K-complex or a sleep spindle. (Correct answer)
An EEG arousal.
Low-amplitude, mixed-frequency EEG activity for more than 50% of the epoch.
Slow wave activity comprising 20% of the epoch.

Correct answer: A K-complex or a sleep spindle.

Stage N2 sleep is defined by the presence of either a K-complex or a sleep spindle. The appearance of one of these events marks the transition from Stage N1 to Stage N2, even if the rest of the epoch resembles Stage N1.

Question 2: To score a 30-second epoch as Stage N3, what percentage of the epoch must contain slow wave activity?

At least 75%
Less than 10%
20% or more (Correct answer)
Greater than 50%

Correct answer: 20% or more

The AASM manual defines Stage N3 (slow-wave sleep) as any epoch in which 20% or more of the epoch consists of slow wave activity. This is defined as waves with a frequency of 0.5-2 Hz and a peak-to-peak amplitude of >75 µV, measured over the frontal regions.

Question 3: The ventrolateral preoptic area (VLPO) promotes sleep onset by:

Increasing cortisol secretion
Releasing GABA and galanin to inhibit wake-promoting nuclei (Correct answer)
Activating orexin neurons in the lateral hypothalamus
Stimulating the ascending reticular activating system

Correct answer: Releasing GABA and galanin to inhibit wake-promoting nuclei

The VLPO releases GABA and galanin to inhibit histaminergic, noradrenergic, and serotonergic wake-promoting regions, acting as a sleep-promoting 'flip-flop switch.'

Question 4: Per AASM scoring rules, a K-complex must have a minimum duration of:

1.0 seconds
0.75 seconds
0.25 seconds
0.5 seconds (Correct answer)

Correct answer: 0.5 seconds

A K-complex must last at least 0.5 seconds and consist of a well-delineated negative sharp wave followed by a positive component, maximal in frontal leads.

Question 5: During physiologic calibrations, a flat line is observed in the C3-M2 channel, but the impedance check was low (under 5 kΩ). What is the most likely cause?

The patient is not relaxed enough.
The amplifier gain is set too low.
A salt bridge has formed between the C3 and M2 electrodes. (Correct answer)
The M2 electrode has detached from the skin.

Correct answer: A salt bridge has formed between the C3 and M2 electrodes.

A 'salt bridge' occurs when conductive paste or gel from two nearby electrodes (like C3 and the reference M2) makes contact. This shunts the electrical potential between them, resulting in a flat line because there is no potential difference to measure, even though the individual electrode impedances are good.

Question 6: A pulse oximetry sensor showing poor signal quality with low-amplitude, irregular waveform is best corrected by:

Increasing the oximeter's gain setting
Repositioning the sensor or applying it to an alternate, better-perfused site (Correct answer)
Increasing the sampling rate
Applying a digital low-pass filter

Correct answer: Repositioning the sensor or applying it to an alternate, better-perfused site

Poor perfusion, nail polish, motion, or cold extremities reduce pulse oximetry signal quality; repositioning the probe or using an alternate site (earlobe, forehead) is the primary corrective action.

Question 7: In a sleep laboratory, electrical safety is critical. Which grounding principle helps protect patients from microshock during polysomnography?

All conductive equipment must be connected to a common ground point (Correct answer)
Using battery-powered amplifiers eliminates all electrical hazards
Ground fault circuit interrupters (GFCIs) are not required near patient areas
Equipment should be grounded to separate circuits to prevent overload

Correct answer: All conductive equipment must be connected to a common ground point

Connecting all conductive equipment to a common ground (equipotential grounding) eliminates voltage differences between devices, preventing microshock through the patient.

Question 8: Approximately what percentage of total sleep time is typically spent in REM sleep in healthy adults?

10–15%
30–35%
5–10%
20–25% (Correct answer)

Correct answer: 20–25%

Healthy adults spend roughly 20–25% of total sleep time in REM sleep, with the proportion increasing across successive cycles.

Question 9: While monitoring the ECG, you observe a sustained run of ventricular tachycardia. The patient is awake but complains of chest pain and dizziness. What is the technologist's most appropriate immediate action?

Activate the facility's emergency response system. (Correct answer)
Increase the CPAP pressure to improve oxygenation.
Note the event and wait to see if it resolves on its own.
Ask the patient to take deep breaths and try to relax.

Correct answer: Activate the facility's emergency response system.

Ventricular tachycardia is a life-threatening cardiac arrhythmia that can rapidly deteriorate into cardiac arrest. The technologist's primary responsibility is to activate the facility's emergency response system (e.g., call a code, call 911) to get immediate advanced medical help for the patient.

Question 10: In a standard polysomnography montage, the derivation 'C4-M1' refers to the electrical potential difference between which two points?

The C3 electrode and the left mastoid (M1) process.
The C4 electrode and the ground electrode.
The C4 electrode and the left mastoid (M1) process. (Correct answer)
The C4 electrode and the right mastoid (M2) process.

Correct answer: The C4 electrode and the left mastoid (M1) process.

A derivation represents the difference in electrical potential between two electrodes. 'C4-M1' means the C4 (right central) electrode is the exploring electrode (Grid 1) and the M1 (left mastoid) electrode is the reference electrode (Grid 2).

Question 11: Obstructive sleep apnea (or OSA) is usually caused when

All of the above (Correct answer)
Something obstructs the airway.
Excess weight causes pressure on the throat/neck.
Muscles that control the tongue and throat relax.

Correct answer: All of the above

Anything that obstructs the airway, including excess weight that causes pressure on the neck or throat and the tongue slipping back into the throat, can cause apnea.

Question 12: Which combination of features is required to score an epoch as Stage R (REM) sleep?

Sleep spindles, low chin EMG, and slow rolling eye movements.
Vertex sharp waves, high chin EMG, and rapid eye movements.
Low-amplitude mixed-frequency EEG, low chin EMG, and rapid eye movements. (Correct answer)
High-amplitude slow waves, high chin EMG, and no eye movements.

Correct answer: Low-amplitude mixed-frequency EEG, low chin EMG, and rapid eye movements.

Stage R is characterized by a unique combination of physiological signals. These include a relatively low-amplitude, mixed-frequency EEG pattern, a low chin EMG tone (atonia), and the presence of rapid eye movements (REMs).

Question 13: The technician observes muscle artifact in a single EEG channel that shares a common reference with other channels. The appropriate response is:

Re-reference the channel showing the artifact to a back-up reference electrode
Eliminate the artifact by double-referencing the input signal derivation
Re-reference the channel showing artifact by changing the input signal derivation to a back-up exploring electrode (Correct answer)
Eliminate the artifact by reducing the high frequency filter to 15Hz

Correct answer: Re-reference the channel showing artifact by changing the input signal derivation to a back-up exploring electrode

Muscle artifact in an EEG channel can occur due to electrical activity generated by muscle movements. Re-referencing the channel to a back-up exploring electrode can help eliminate the artifact by changing the reference point for that channel. This can reduce the influence of muscle activity on the EEG signal and improve the quality of the recording.

Question 14: REM sleep atonia (muscle paralysis) is primarily mediated by which neurotransmitters acting on spinal motor neurons?

Histamine and acetylcholine
Serotonin and adenosine
Dopamine and norepinephrine
Glycine and GABA (Correct answer)

Correct answer: Glycine and GABA

Brainstem REM-on circuits hyperpolarize spinal motor neurons via glycine and GABA, preventing the enactment of dream content.

Question 15: The narcolepsy tetrad includes all the following except

Nocturnal myoclonus (Correct answer)
Sleep paralysis
Cataplexy
Excessive daytime sleepiness

Correct answer: Nocturnal myoclonus

The narcolepsy tetrad refers to the four classic symptoms used in diagnosing narcolepsy: excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. Nocturnal myoclonus, also known as Periodic Limb Movement Disorder (PLMD), involves repetitive limb movements during sleep and is a distinct sleep disorder. While individuals with narcolepsy may experience other sleep disturbances, nocturnal myoclonus is not considered one of the defining symptoms of the narcolepsy tetrad.

Question 16: According to the International 10-20 System, how is the location of the C3 electrode determined?

20% of the distance from the nasion to the inion, measured from the nasion.
10% of the head circumference superior to the left preauricular point.
20% of the nasion-inion distance to the left of the Cz point. (Correct answer)
20% of the distance from the left preauricular point to the right preauricular point.

Correct answer: 20% of the nasion-inion distance to the left of the Cz point.

The C3 electrode is located by first measuring the distance from the nasion to the inion. C3 is then found by moving 20% of this total distance to the left from the Cz (central zero) point, which is at 50% of the nasion-inion distance.

Question 17: Which type of isolation precautions would be most appropriate for a patient with active pulmonary tuberculosis undergoing a sleep study?

Airborne precautions (Correct answer)
Droplet precautions
Contact precautions
Standard precautions only

Correct answer: Airborne precautions

Pulmonary TB is transmitted via airborne droplet nuclei (<5 µm), requiring airborne precautions including an N95 respirator and negative-pressure room.

Question 18: Which agent is classified as an intermediate-level disinfectant and is commonly used for routine cleaning of sleep lab environmental surfaces?

0.5% hydrogen peroxide
Glutaraldehyde 2.4%
Quaternary ammonium compounds (quats)
70% isopropyl alcohol (Correct answer)

Correct answer: 70% isopropyl alcohol

70% isopropyl alcohol is an intermediate-level disinfectant effective against mycobacteria, most viruses, and vegetative bacteria, making it suitable for environmental surface disinfection.

Question 19: Normal REM latency (time from sleep onset to first REM period) in healthy adults is approximately:

20–30 minutes
45–60 minutes
70–100 minutes (Correct answer)
120–150 minutes

Correct answer: 70–100 minutes

Healthy adults typically enter their first REM period 70–100 minutes after sleep onset; REM latency below 20 minutes is a key diagnostic marker for narcolepsy.

Question 20: A patient expresses significant anxiety and fear about being 'hooked up to machines'. What is the technologist's most appropriate initial action?

Show the patient each sensor, explain its purpose, and answer their questions. (Correct answer)
Dismiss their concerns and proceed with the hookup quickly.
Tell the patient that anxiety will ruin the study results.
Offer to call the physician to prescribe a sedative.

Correct answer: Show the patient each sensor, explain its purpose, and answer their questions.

The 'show, tell, do' method is an effective communication technique to alleviate patient anxiety. By showing the patient the sensors, explaining their simple function, and then applying them, the technologist demystifies the process and builds trust.

Question 21: The vertical position of the pens with the polysomnograph amplifiers turned off is referred to as:

Time axis (Correct answer)
Frequency response curve
Electrical baseline
Mechanical baseline

Correct answer: Time axis

The vertical position of the pens (or traces on a digital display) when the polysomnograph amplifiers are turned off represents the mechanical or electrical zero point for each channel. This baseline serves as the time axis against which the amplitude of recorded physiological events is measured. When the recording begins, signals are displayed as deflections from this established baseline, indicating changes in voltage over time.

Question 22: Eye movement artifacts can contaminate frontal EEG channels (F3, F4) because:

Eye movements generate 60 Hz interference
The corneoretinal potential of the eye acts as a voltage dipole whose field spreads to nearby electrodes (Correct answer)
Blinking causes mechanical movement of frontal scalp electrodes
EOG electrodes share amplifier circuits with EEG electrodes

Correct answer: The corneoretinal potential of the eye acts as a voltage dipole whose field spreads to nearby electrodes

The eye's corneoretinal potential (cornea positive, retina negative) creates a dipole; eye rotation changes the orientation of this dipole and induces voltage changes in nearby frontal EEG electrodes.

Question 23: Muscle (EMG) artifact in EEG channels is characterized by:

Regular 60 Hz sine waves
Slow 0.5–2 Hz waves
Sharp K-complex-like deflections at irregular intervals
High-frequency irregular activity typically above 100 Hz that obscures the EEG signal (Correct answer)

Correct answer: High-frequency irregular activity typically above 100 Hz that obscures the EEG signal

Muscle artifact appears as fast, irregular, high-frequency activity (often >100 Hz) that rides on the EEG, making underlying brain activity difficult to score.

Question 24: Which class of fire extinguisher is appropriate for an electrical fire that might occur near sleep lab recording equipment?

Class A
Class B
Class D
Class C (Correct answer)

Correct answer: Class C

Class C fire extinguishers are designed for electrical fires; they use non-conductive extinguishing agents that do not create shock hazards when applied to live electrical equipment.

Question 25: What factors come into play when deciding to enter the patients room to correct artifacts?

Skill at fixing problem without waking patient
All of the above (Correct answer)
Ease at which patient falls asleep
Importance of electrode channel in scoring

Correct answer: All of the above

When deciding to enter the patient's room to correct artifacts, several factors come into play. The importance of the electrode channel in scoring is a crucial factor as it directly affects the accuracy of the data collected. Additionally, the ease at which the patient falls asleep is important as it determines the disruption caused by entering the room. Lastly, the skill at fixing the problem without waking the patient is significant to ensure minimal disturbance to their sleep. Therefore, all of the above factors need to be considered when deciding to enter the patient's room to correct artifacts.

Question 26: Which neurotransmitter, produced by the lateral hypothalamus, is the primary promoter of wakefulness and is deficient in narcolepsy type 1?

Dopamine
Serotonin
Orexin (hypocretin) (Correct answer)
GABA

Correct answer: Orexin (hypocretin)

Orexin (hypocretin) neurons in the lateral hypothalamus stabilize wakefulness, and their loss causes narcolepsy type 1 with cataplexy.

Question 27: When a person stops breathing during sleep for ten seconds, 30 times or more during an hour, he or she has

Moderate sleep apnea.
Severe sleep apnea. (Correct answer)
Mild sleep apnea.

Correct answer: Severe sleep apnea.

When a person stops breathing for ten seconds or more during sleep, 30 times or more during an hour, it indicates a severe case of sleep apnea. Sleep apnea is a sleep disorder characterized by repeated pauses in breathing during sleep. These pauses, known as apneas, can lead to a decrease in oxygen levels in the blood and disrupt normal sleep patterns. Severe sleep apnea is diagnosed when there are frequent and prolonged episodes of apnea, indicating a significant impairment in breathing during sleep.

Question 28: Under OSHA's Bloodborne Pathogen Standard, employers must offer the hepatitis B vaccine series at no cost to which employees?

Only laboratory workers
All hospital employees
Employees with occupational exposure to blood or OPIM (Correct answer)
Employees who request it regardless of exposure risk

Correct answer: Employees with occupational exposure to blood or OPIM

OSHA requires employers to offer hepatitis B vaccination at no cost to all employees who have occupational exposure to blood or other potentially infectious materials (OPIM).

Question 29: The suprachiasmatic nucleus (SCN), which serves as the master circadian pacemaker, is located in which brain structure?

Hypothalamus (Correct answer)
Cerebellum
Thalamus
Brainstem

Correct answer: Hypothalamus

The SCN in the anterior hypothalamus receives light input via the retinohypothalamic tract and coordinates circadian timing throughout the body.

Question 30: According to AASM criteria, delta waves associated with N3 sleep are defined as having a frequency of:

0.5–2 Hz
0.5–4 Hz (Correct answer)
8–13 Hz
4–8 Hz

Correct answer: 0.5–4 Hz

Delta waves are 0.5–4 Hz, high-amplitude (>75 µV in frontal derivations) waves that must constitute at least 20% of an epoch to score N3.

Question 31: Which level of disinfection is required for reusable PAP masks and headgear between patients?

Sterilization
High-level disinfection (Correct answer)
Intermediate-level disinfection
Low-level disinfection

Correct answer: High-level disinfection

Reusable PAP masks and headgear are semi-critical items that contact mucous membranes and require high-level disinfection between patients.

Question 32: When an electrode shows high impedance during PSG, what is the correct first troubleshooting step?

Apply a 60 Hz notch filter
Increase the amplifier sensitivity setting
Replace the entire electrode set
Re-prep the skin, reapply conductive gel, and re-seat the electrode (Correct answer)

Correct answer: Re-prep the skin, reapply conductive gel, and re-seat the electrode

High impedance most commonly results from inadequate skin preparation or insufficient conductive medium; re-abrading the skin and reapplying gel usually resolves it.

Question 33: To verify the function of the chin EMG channels, what command should the technologist give the patient?

Clench your teeth together. (Correct answer)
Flex your left foot.
Blink your eyes five times.
Take a deep breath.

Correct answer: Clench your teeth together.

Asking the patient to clench their teeth or jaw activates the submental muscles. This should produce a high-frequency, high-amplitude burst of activity in the EMG channels, confirming that the electrodes are placed correctly and are detecting muscle tone.

Question 34: What is the primary indication to switch a patient from CPAP to BiLevel PAP during a titration study?

Obstructive respiratory events persist at a CPAP pressure of 15 cm H2O or greater. (Correct answer)
The patient reports dry mouth.
The AHI is less than 5 events per hour on CPAP.
The patient has central apneas at a low CPAP pressure.

Correct answer: Obstructive respiratory events persist at a CPAP pressure of 15 cm H2O or greater.

While CPAP is effective for many, some patients continue to have obstructive events (apneas, hypopneas) even at high pressures (e.g., ≥15 cm H2O). In these cases, or if the patient cannot tolerate the high pressure, switching to BiLevel PAP is indicated to improve efficacy and comfort.

Question 35: The correct technique to determine whether a suspect signal during scoring is a true physiological event or artifact is to:

Apply a high-pass filter and rescore the epoch
Delete the epoch and rescore without it
Mark it as unscorable and continue
Cross-reference the signal with other channels, check its timing, and correlate it with known physiology (Correct answer)

Correct answer: Cross-reference the signal with other channels, check its timing, and correlate it with known physiology

True physiological signals follow predictable patterns and correlate logically with related channels; comparing the suspect signal across EEG, EOG, EMG, and respiratory channels distinguishes real events from artifact.

Question 36: When troubleshooting an intermittent PSG artifact, which approach is most effective?

Observe the artifact's timing, pattern, and correlation with other channels to identify its source (Correct answer)
Replace all electrodes and restart the study immediately
Mark every affected epoch as unscorable and continue
Apply all available filters simultaneously to suppress it

Correct answer: Observe the artifact's timing, pattern, and correlation with other channels to identify its source

Systematic observation of when, where, and in which channels the artifact occurs, and correlation with other physiological channels, is the diagnostic approach that leads to identification and correction of the source.

Question 37: ECG (cardiogenic) artifact in EEG channels is identified by:

High-frequency irregular bursts unrelated to heart rate
Slow undulating baseline drift
Regular sharp deflections that align with QRS complexes on the ECG channel (Correct answer)
A sudden flat isoelectric segment

Correct answer: Regular sharp deflections that align with QRS complexes on the ECG channel

ECG artifact appears as regular spikes in EEG that align precisely with QRS complexes, caused by cardiac electrical activity spreading to scalp electrodes.

Question 38: What is the RECOMMENDED starting pressure for CPAP?

4cm H20 (Correct answer)
6cm H20
3cm H20
5cm H20

Correct answer: 4cm H20

The recommended starting pressure for CPAP is 4cm H20. This pressure setting is commonly used as a starting point for patients using CPAP therapy. It helps to keep the airway open and prevent collapse during sleep, effectively treating sleep apnea.

Question 39: When reviewing a patient's medical history, which condition is most critical to note for a study that may involve a CPAP titration?

Congestive Heart Failure (CHF) (Correct answer)
Gastroesophageal Reflux Disease (GERD)
Asthma
Type 2 Diabetes

Correct answer: Congestive Heart Failure (CHF)

Congestive Heart Failure (CHF) is a significant comorbidity that requires careful consideration during CPAP titration. High pressures can potentially decrease cardiac output in some patients with severe CHF, requiring close monitoring.

Question 40: What is the CDC-recommended duration for routine hand hygiene with soap and water?

At least 60 seconds
At least 20 seconds (Correct answer)
15–20 seconds
5–10 seconds

Correct answer: At least 20 seconds

The CDC recommends scrubbing hands with soap and water for at least 20 seconds to effectively reduce pathogens.

Question 41: An electrode pop artifact is best identified by:

Regular 60 Hz sine waves on one channel
A sudden sharp deflection or step change isolated to a single channel (Correct answer)
Slow undulating waves on all channels
High-frequency muscle activity on all channels

Correct answer: A sudden sharp deflection or step change isolated to a single channel

An electrode pop is caused by a momentary change in electrode impedance, producing a sudden sharp deflection or offset in only the affected single channel.

Question 42: When placing the three chin EMG electrodes, what is the primary physiological activity being measured?

Swallowing and respiratory effort.
Muscle atonia associated with REM sleep. (Correct answer)
Jaw clenching and bruxism.
Snoring vibrations.

Correct answer: Muscle atonia associated with REM sleep.

Chin EMG measures muscle tone (atonia) of the submental muscles. This is a key characteristic used to identify REM sleep, as muscle tone is significantly reduced or absent during this stage.

Question 43: Which hormone, secreted by the pineal gland in response to darkness, signals the circadian system to promote sleepiness?

Adenosine
Histamine
Cortisol
Melatonin (Correct answer)

Correct answer: Melatonin

Melatonin is released by the pineal gland during darkness and acts on SCN receptors to facilitate sleep onset and timing.

Question 44: You hear a loud thud and find that your patient has fallen on the way to the restroom. The patient is conscious but complains of severe pain in their right hip and cannot get up. What is the proper response?

Do not move the patient; make them comfortable and call for emergency medical assistance. (Correct answer)
Bring a pillow and blanket and let them rest on the floor.
Help the patient stand up and assist them back to bed.
Complete an incident report before calling for help.

Correct answer: Do not move the patient; make them comfortable and call for emergency medical assistance.

A fall with a suspected hip fracture is a serious medical situation. The patient should not be moved, as this could worsen the injury. The technologist's role is to make the patient as comfortable as possible without moving them, ensure their safety, and immediately call for emergency medical assistance per facility protocol.

Question 45: A patient arrives for a sleep study with an active MRSA wound infection. Which precautions should be implemented in addition to Standard Precautions?

Reverse isolation
Airborne precautions
Contact precautions (Correct answer)
Droplet precautions

Correct answer: Contact precautions

MRSA is transmitted by direct or indirect contact, so contact precautions (gown and gloves) must be added to Standard Precautions to prevent spread.

Question 46: Glutaraldehyde (e.g., Cidex) used for high-level disinfection of sleep study equipment is considered hazardous because it:

Is carcinogenic at any exposure level
Can cause respiratory irritation, skin sensitization, and mucous membrane damage (Correct answer)
Inactivates all viruses but not bacteria
Must be heated above 60°C to be effective

Correct answer: Can cause respiratory irritation, skin sensitization, and mucous membrane damage

Glutaraldehyde vapors are toxic and can cause significant respiratory irritation, occupational asthma, and skin/mucous membrane sensitization, requiring proper ventilation and PPE.

Question 47: Shortly after applying electrodes using a new brand of conductive paste, the patient develops wheezing, shortness of breath, and hives on their chest and neck. This is most likely:

An anaphylactic reaction. (Correct answer)
A vasovagal response to the procedure.
A normal skin irritation from the paste.
A panic attack due to the PSG setup.

Correct answer: An anaphylactic reaction.

The rapid onset of respiratory symptoms (wheezing, shortness of breath) and skin manifestations (hives) after exposure to a potential allergen is the classic presentation of anaphylaxis. This is a severe, life-threatening allergic reaction that requires immediate emergency medical intervention.

Question 48: Adaptive Servo-Ventilation (ASV) is the recommended treatment for which of the following conditions?

Mild obstructive sleep apnea.
Complex sleep apnea and Cheyne-Stokes Respiration. (Correct answer)
Insomnia.
Primary snoring without apneas.

Correct answer: Complex sleep apnea and Cheyne-Stokes Respiration.

ASV is an advanced PAP therapy specifically designed to treat complex and central sleep apnea syndromes. It is particularly effective for managing Cheyne-Stokes Respiration, treatment-emergent central sleep apnea, and central sleep apnea related to opioid use.

Question 49: What is the primary purpose of an Exposure Control Plan required by OSHA's Bloodborne Pathogen Standard?

To establish dress code policies for the sleep lab
To outline disciplinary procedures for PPE non-compliance
To document employee vaccination records only
To eliminate or minimize employee exposure to bloodborne pathogens (Correct answer)

Correct answer: To eliminate or minimize employee exposure to bloodborne pathogens

An Exposure Control Plan is a written document required by OSHA to identify tasks where exposure may occur and to establish procedures to eliminate or minimize occupational exposure to bloodborne pathogens.

Question 50: According to accepted sleep scoring standards, if other scoring criteria are met, which of the following activities would be considered an event when each is 0.5 seconds in duration? 1. PLM 2. Arousal 3. Spindle 4. K-Complex

2, 3, and 4 only
1, 2, and 4 only
1, 3, and 4 only (Correct answer)
1, 2, and 3 only

Correct answer: 1, 3, and 4 only

According to accepted sleep scoring standards, specific events have minimum duration requirements. While Arousals typically require a minimum of 3 seconds (or 10 seconds for RERAs), Periodic Limb Movements (PLM), Sleep Spindles, and K-Complexes can all be scored with durations of 0.5 seconds or less. Therefore, a 0.5-second duration would qualify for scoring PLMs, Spindles, and K-Complexes, assuming other morphological criteria are met.

Question 51: What is a crucial piece of pre-study education for a patient regarding their activities on the day of the sleep study?

Engage in strenuous exercise an hour before the study.
Avoid all caffeine after 12:00 PM (noon). (Correct answer)
Eat a large meal right before arriving at the lab.
Take a long nap in the afternoon.

Correct answer: Avoid all caffeine after 12:00 PM (noon).

Caffeine is a stimulant that can significantly interfere with sleep onset and architecture, masking the patient's true sleep patterns. Patients should be instructed to avoid caffeine after a certain time, typically noon, on the day of the study.

Question 52: EEG gold cup electrodes that are reused between patients should be processed using which minimum standard?

Intermediate-level disinfection with 70% isopropyl alcohol wipe
High-level disinfection or sterilization (Correct answer)
Simple soap and water wash
Low-level disinfection with a quaternary ammonium compound

Correct answer: High-level disinfection or sterilization

Reusable EEG electrodes are semi-critical items that contact broken skin and require at minimum high-level disinfection or sterilization between patients.

Question 53: When a person stops breathing during sleep for ten seconds, 15 to 30 times during an hour, he or she has

Sever sleep apnea.
Moderate sleep apnea. (Correct answer)
Mild sleep apnea.

Correct answer: Moderate sleep apnea.

When a person stops breathing during sleep for ten seconds, 15 to 30 times during an hour, it indicates moderate sleep apnea. Sleep apnea is a sleep disorder characterized by pauses in breathing or shallow breaths during sleep. Mild sleep apnea would involve fewer episodes of breathing cessation, while severe sleep apnea would involve more frequent and longer pauses in breathing. Therefore, based on the given information, the correct answer is moderate sleep apnea.

Question 54: An MSLT nap starts at epoch 28. The patient never initiates sleep. What epoch should you terminate the nap on?

Epoch 48 (Correct answer)
Epoch 58
Epoch 88
Epoch 65

Correct answer: Epoch 48

According to some specific protocols for MSLT (Multiple Sleep Latency Test), if a patient does not initiate sleep, the nap opportunity may be terminated after 10 minutes. Since each epoch in polysomnography is 30 seconds, a 10-minute nap consists of 20 epochs. If the nap starts at epoch 28, the 20th epoch would be epoch 47 (28 + 19), meaning the nap would be terminated at the conclusion of epoch 47, or on epoch 48.

Question 55: Which disinfectant concentration of sodium hypochlorite (bleach) is appropriate for cleaning blood spills on environmental surfaces?

1:10 dilution (approximately 5,000 ppm) (Correct answer)
1:1,000 dilution (approximately 50 ppm)
Undiluted bleach only
1:100 dilution (approximately 500 ppm)

Correct answer: 1:10 dilution (approximately 5,000 ppm)

A 1:10 dilution of bleach (approximately 5,000 ppm available chlorine) is required for blood spills to ensure effective disinfection.

Question 56: Sinus bradycardia during sleep is typically scored if the heart rate drops below what threshold for adults?

50 bpm
60 bpm
30 bpm
40 bpm (Correct answer)

Correct answer: 40 bpm

While heart rate naturally slows during sleep, a sustained drop below 40 beats per minute (bpm) for at least 30 seconds is considered clinically significant bradycardia in adults and should be scored. This is a common parameter monitored for cardiac abnormalities during a polysomnogram.

Question 57: If 60Hz artifact is observed in one of the channels during the bio-cals process, the appropriate action should be:

Re-evaluate the problem after the patient goes to sleep
Find the problem source and correct it before beginning the study (Correct answer)
Use a 60Hz notch filter to eliminate the artifact
Re-reference to a back-up electrode, then initiate the study

Correct answer: Find the problem source and correct it before beginning the study

If a 60Hz artifact is observed in one of the channels during the bio-cals process, the appropriate action would be to find the problem source and correct it before beginning the study. This is because the artifact could potentially interfere with the accuracy of the study results. By identifying and fixing the problem source, the artifact can be eliminated, ensuring reliable data collection during the study. Re-evaluating the problem after the patient goes to sleep, re-referencing to a back-up electrode, or using a 60Hz notch filter may not address the underlying issue causing the artifact and may not provide a long-term solution.

Question 58: Which procedural adaptation is most critical for ensuring a successful PSG on a 5-year-old child?

Insisting the child sleep alone to avoid parental interference.
Allowing a parent or caregiver to stay overnight in the room. (Correct answer)
Using smaller, adult-sized sensors to ensure a strong signal.
Applying all sensors only after the child has fallen asleep.

Correct answer: Allowing a parent or caregiver to stay overnight in the room.

Allowing a parent or caregiver to co-sleep or stay in the room is a standard and highly recommended practice in pediatric polysomnography. The parent's presence provides comfort and security, which reduces child anxiety, improves cooperation during the hookup process, and leads to a more representative night of sleep.

Question 59: What is the standard placement for the right electrooculogram (ROC) electrode according to AASM guidelines?

Directly on the outer canthus of the right eye.
On the supraorbital ridge of the right eye.
1 cm below and 1 cm out from the outer canthus of the right eye. (Correct answer)
2 cm above the inner canthus of the right eye.

Correct answer: 1 cm below and 1 cm out from the outer canthus of the right eye.

The right EOG (ROC) electrode is placed 1 cm below and 1 cm out from the outer canthus of the right eye. This placement, along with the left EOG electrode, allows for the detection of horizontal and vertical eye movements.

Question 60: What is the minimum duration for scoring an arousal from NREM sleep in a school-aged child?

5 seconds
10 seconds
1.5 seconds
3 seconds (Correct answer)

Correct answer: 3 seconds

The scoring rule for arousals is consistent for adults and children. An arousal is defined as an abrupt shift in EEG frequency (to alpha, theta, and/or frequencies greater than 16 Hz) that lasts for at least 3 seconds, with at least 10 seconds of stable sleep preceding the change.

Question 61: During EOG calibrations, the technologist asks the patient to 'look left, then look right'. What is the expected signal response in the LOC-M2 and ROC-M1 channels?

The signals should be out-of-phase (move in opposite directions). (Correct answer)
The signals should be in-phase (move in the same direction).
Both channels should show a positive (downward) deflection.
Only the ROC channel should show a deflection.

Correct answer: The signals should be out-of-phase (move in opposite directions).

When the eyes move, the cornea (positive potential) moves toward one electrode and away from the other. This creates opposite deflections in the two EOG channels, resulting in an out-of-phase signal, which confirms proper electrode placement and function.

Question 62: During a CPAP titration, after observing two obstructive apneas, three hypopneas, and five RERAs within a 15-minute period, what is the technologist's most appropriate action?

Continue at the current pressure for another 30 minutes.
Switch the patient to BiLevel PAP.
Decrease the CPAP pressure by 1 cm H2O.
Increase the CPAP pressure by at least 1 cm H2O. (Correct answer)

Correct answer: Increase the CPAP pressure by at least 1 cm H2O.

Standard AASM titration guidelines recommend increasing CPAP pressure when a specific pattern of respiratory events is observed. The presence of 2 obstructive apneas, 3 hypopneas, 5 RERAs, or 3 minutes of loud snoring within a defined period are all triggers to increase the pressure.

Question 63: What is the purpose of asking the patient to hold their breath for 5-10 seconds during calibrations?

To test the patient's ability to follow commands.
To verify the snoring sensor is working.
To confirm the function of the respiratory airflow and effort channels. (Correct answer)
To check the function of the EKG electrodes.

Correct answer: To confirm the function of the respiratory airflow and effort channels.

Asking the patient to hold their breath creates a voluntary central apnea. This allows the technologist to verify that the respiratory effort belts (thoracic and abdominal) and the airflow sensor (thermistor/cannula) correctly detect and display the cessation of breathing and effort.

Question 64: What is the RECOMMENDED LFF/HFF for the EOG and EEG channels?

LFF 1 / HFF 15
LFF 0.5 / HFF 25
LFF 1 / HFF 35
LFF 0.3 / HFF 35 (Correct answer)

Correct answer: LFF 0.3 / HFF 35

The recommended LFF/HFF for the EOG and EEG channels is LFF 0.3 / HFF 35. This means that the low-frequency filter (LFF) should be set to 0.3 Hz, and the high-frequency filter (HFF) should be set to 35 Hz. These settings are recommended to ensure that the EOG and EEG channels capture the desired frequency range of signals accurately, filtering out any unwanted noise or interference.

Question 65: What is the typical duration of one complete NREM-REM sleep cycle in healthy adults?

90–110 minutes (Correct answer)
60–75 minutes
120–140 minutes
30–45 minutes

Correct answer: 90–110 minutes

A complete sleep cycle averaging 90–110 minutes repeats 4–6 times per night, with REM periods lengthening in later cycles.

Question 66: When a person stops breathing during sleep for 10 seconds, 5 to 15 times during an hour, he or she has

Moderate sleep apnea.
Mild sleep apnea. (Correct answer)
Severe sleep apnea.

Correct answer: Mild sleep apnea.

When a person stops breathing for 10 seconds, 5 to 15 times during an hour, it indicates mild sleep apnea. Sleep apnea is a sleep disorder characterized by interruptions in breathing during sleep. Mild sleep apnea refers to a less severe form of the condition, where breathing pauses occur relatively infrequently. Moderate sleep apnea would involve more frequent breathing interruptions, while severe sleep apnea would entail even more frequent and prolonged pauses in breathing during sleep.

Question 67: During EOG calibrations, both the LOC and ROC channels deflect downward simultaneously when the patient looks up. What does this indicate?

The patient is not following instructions correctly.
Correct EOG electrode placement and function.
The patient has an unusual type of eye movement.
A possible problem with the reference electrode (M1/M2). (Correct answer)

Correct answer: A possible problem with the reference electrode (M1/M2).

When both EOG channels move in the same direction (in-phase), it typically indicates a common reference issue, most often a referenced M1 or M2 electrode picking up artifact. The eye movements themselves should be out-of-phase. This requires troubleshooting the reference electrode placement or connection.

Question 68: What is the minimum duration for an abrupt shift in EEG frequency to be scored as an arousal during NREM sleep?

1.5 seconds
10 seconds
3 seconds (Correct answer)
0.5 seconds

Correct answer: 3 seconds

An arousal is defined as an abrupt shift in EEG frequency (to alpha, theta, and/or frequencies >16 Hz) that lasts for at least 3 seconds. It must also be preceded by at least 10 continuous seconds of sleep.

Question 69: After a needlestick injury involving a patient's blood, the FIRST action a polysomnographic technologist should take is:

Squeeze the wound to express blood
Wash the site thoroughly with soap and water (Correct answer)
Apply a tourniquet above the wound site
Report the exposure to the supervisor immediately

Correct answer: Wash the site thoroughly with soap and water

The first step after a needlestick or sharps injury is immediate washing of the wound with soap and water to reduce the risk of infection.

Question 70: Which of the following is a primary goal of the pre-study patient interview conducted by the technologist?

To sell the patient additional sleep-related medical equipment.
To determine the final CPAP pressure setting before the study begins.
To build rapport and ensure the patient is comfortable with the procedure. (Correct answer)
To provide a definitive diagnosis of the patient's sleep disorder.

Correct answer: To build rapport and ensure the patient is comfortable with the procedure.

Building rapport is essential for a successful study. A comfortable and trusting patient is more likely to relax, sleep more naturally, and communicate any issues that arise during the night, leading to better quality data.

Question 71: During intake, a patient reports they started taking an over-the-counter sleep aid two nights ago. What is the technologist's most important action?

Cancel the study and reschedule for a later date.
Ignore the information as it is not a prescription medication.
Advise the patient to stop taking it immediately.
Document the medication and notify the medical director or ordering physician. (Correct answer)

Correct answer: Document the medication and notify the medical director or ordering physician.

Any medication, including OTC aids, can affect sleep architecture and must be documented. The technologist should document the medication, dosage, and frequency and also notify the ordering physician or medical director, as it may impact the interpretation of the study.

Question 72: According to AASM guidelines, what is the minimum time a technologist should wait at a specific CPAP pressure before making an increase, assuming scorable events are occurring?

15 minutes
1 minute
30 minutes
5 minutes (Correct answer)

Correct answer: 5 minutes

To properly assess the effectiveness of a given pressure setting, the technologist must allow the patient to sleep at that pressure for a sufficient duration. The AASM guideline specifies a minimum of 5 minutes at a new pressure before increasing it further, allowing time to observe if the events resolve.

Question 73: A 60 Hz artifact appearing simultaneously on ALL EEG channels most likely indicates a problem with which electrode?

The chin EMG electrode
An active scalp electrode (e.g., C3)
The ground or reference electrode (Correct answer)
The leg EMG electrode

Correct answer: The ground or reference electrode

When 60 Hz artifact appears on every channel at once, the common element — the ground or reference electrode — is the most likely source rather than individual recording electrodes.

Question 74: Respiratory inductance plethysmography (RIP) belt artifact is most commonly caused by:

Cardiac pulsations transmitted to the chest wall
High electrode impedance at the belt sensor
Belt displacement or changed belt tension from patient repositioning (Correct answer)
60 Hz power line interference

Correct answer: Belt displacement or changed belt tension from patient repositioning

RIP belts measure changes in cross-sectional area; repositioning shifts the belt or alters its tension, creating artifact that can mimic changes in respiratory effort.

Question 75: What is the AASM recommended maximum impedance level for EEG and EOG electrodes?

10 kΩ
1 kΩ
5 kΩ (Correct answer)
50 kΩ

Correct answer: 5 kΩ

The American Academy of Sleep Medicine (AASM) recommends that impedances for EEG and EOG electrodes be at or below 5 kOhms (5,000 Ohms). High impedances can lead to signal artifact and poor data quality.

Question 76: Which term describes the recurring 90–110 minute NREM-REM cycling pattern that repeats throughout the night?

Ultradian rhythm (Correct answer)
Homeostatic oscillation
REM rebound
Circadian rhythm

Correct answer: Ultradian rhythm

The ultradian rhythm is the within-night cycling of NREM and REM sleep that repeats every 90–110 minutes across 4–6 cycles.

Question 77: Used sharps should be placed in which type of container immediately after use?

A sealed plastic bag
A labeled cardboard box
A puncture-resistant sharps container (Correct answer)
A standard biohazard bag

Correct answer: A puncture-resistant sharps container

OSHA requires immediate disposal of used sharps into a puncture-resistant, leak-proof sharps container to prevent needlestick injuries.

Question 78: Sawtooth waves seen during REM sleep are best described as:

2–6 Hz triangular or notched waves maximal in central leads (Correct answer)
12–14 Hz spindle-shaped bursts
1–3 Hz biphasic K-complex-like deflections
0.5–2 Hz monomorphic high-amplitude waves

Correct answer: 2–6 Hz triangular or notched waves maximal in central leads

Sawtooth waves are 2–6 Hz sharply contoured or triangular waves with a notched appearance, typically most prominent over central derivations during REM sleep.

Question 79: Which brain structure generates sleep spindles through thalamocortical circuits and acts as a relay station for sensory information during sleep-wake transitions?

Corpus callosum
Hippocampus
Thalamus (Correct answer)
Amygdala

Correct answer: Thalamus

The thalamus gates sensory input and, via thalamocortical networks, generates the 12–14 Hz sleep spindles that characterize N2 sleep.

Question 80: Which of the following best describes the pattern of Cheyne-Stokes Respiration (CSR)?

Periods of rapid, deep breathing followed by an obstructive apnea.
Consistently shallow breathing throughout the night.
A sudden, brief cessation of airflow with continued effort.
A crescendo-decrescendo pattern of breathing with central apneas. (Correct answer)

Correct answer: A crescendo-decrescendo pattern of breathing with central apneas.

Cheyne-Stokes Respiration is a specific pattern of central sleep apnea most often seen in patients with congestive heart failure. It is characterized by a cyclical, waxing and waning (crescendo-decrescendo) pattern of breathing effort and airflow, interspersed with central apneas or hypopneas.

Question 81: According to Standard Precautions, which body fluid does NOT always require PPE protection?

Cerebrospinal fluid
Blood
Semen
Sweat (Correct answer)

Correct answer: Sweat

Standard Precautions do not require PPE for sweat because sweat is not considered an infectious body fluid.

Question 82: An obstructive apnea is scored when there is a drop in the peak signal excursion of airflow by at least 90% for a duration of at least 10 seconds, and which other condition is met?

There is an absence of inspiratory effort.
There is continued or increased inspiratory effort. (Correct answer)
The event is associated with a 4% oxygen desaturation.
The patient is in REM sleep.

Correct answer: There is continued or increased inspiratory effort.

The key feature distinguishing an obstructive apnea from a central apnea is the presence of respiratory effort. Despite the near-complete cessation of airflow, the patient's chest and/or abdomen continue to move, indicating an effort to breathe against a blocked airway.

Question 83: According to AASM guidelines, what is the minimum duration for scoring an obstructive apnea in an infant?

The duration of 2 breaths (Correct answer)
5 seconds
The duration of 3 breaths
10 seconds

Correct answer: The duration of 2 breaths

The AASM manual specifies that for infants and children, an obstructive apnea is scored when there is a cessation of airflow for a duration of at least two missed breaths. This is accompanied by continued or increased inspiratory effort. This rule accounts for the much faster and more variable respiratory rate in infants compared to adults.

Question 84: Double-referencing (A1+A2) may be useful for?

All of the above
Reducing low frequency artifact in EEG channels
Reduce EKG artifact in EEG and EOG Channels (Correct answer)
Reducing 60Hz artifact in EOGs

Correct answer: Reduce EKG artifact in EEG and EOG Channels

Double-referencing (A1+A2) is useful for reducing EKG artifact in EEG and EOG channels. EKG artifact refers to interference caused by electrical activity of the heart, which can contaminate the EEG and EOG signals. Double-referencing involves using two reference electrodes (A1 and A2) instead of a single reference electrode, which helps to cancel out common-mode noise, including EKG artifact. By reducing the EKG artifact, the quality and accuracy of the EEG and EOG signals can be improved.

Question 85: A Respiratory Effort-Related Arousal (RERA) is a sequence of breaths lasting at least 10 seconds that is characterized by increasing respiratory effort and that leads to what?

A significant bradycardia.
An arousal from sleep. (Correct answer)
A central apnea.
A 4% oxygen desaturation.

Correct answer: An arousal from sleep.

A RERA is an event that does not meet the criteria for an apnea or hypopnea but still disrupts sleep. It is defined by a period of increasing respiratory effort (e.g., flattening of the nasal pressure waveform) that culminates in an arousal from sleep.

Question 86: Reference contamination artifact in EEG is characterized by:

60 Hz interference from the amplifier chassis
The same artifact pattern appearing simultaneously on all channels that share the same reference electrode (Correct answer)
Movement artifact isolated to C3 or C4
High impedance at a single active scalp electrode

Correct answer: The same artifact pattern appearing simultaneously on all channels that share the same reference electrode

When the reference electrode (M1 or M2) picks up an artifact (e.g., ECG, movement), that artifact appears identically on every channel referenced to it, distinguishing it from single-electrode problems.

Question 87: Growth hormone secretion is predominantly linked to which sleep stage?

N2 sleep
REM sleep
N1 sleep
N3 (slow-wave) sleep (Correct answer)

Correct answer: N3 (slow-wave) sleep

Growth hormone is released in pulses tightly coupled to N3 slow-wave sleep, particularly in the first sleep cycle of the night.

Question 88: What is the purpose of the low frequency filter?

Calibrating DC amplifiers
Adjusting signal amplitude
Eliminating undesired fast frequencies
Eliminating undesired slow frequencies (Correct answer)

Correct answer: Eliminating undesired slow frequencies

A low frequency filter, also known as a high-pass filter, is designed to block or attenuate frequencies below a specific cutoff point. In polysomnography, its purpose is to eliminate slow-moving artifacts such as sweat artifact, respiration artifact, or movement artifact. By doing so, it ensures that the recorded signals primarily reflect the desired faster physiological events, improving the clarity and diagnostic quality of the tracing.

Question 89: Which artifact in EEG channels is identified by comparing it with the respiratory channels and finding that the EEG waveform cycles at exactly the breathing rate?

Respiratory artifact (Correct answer)
Movement artifact
Reference electrode artifact
Cardiac artifact

Correct answer: Respiratory artifact

Respiratory artifact causes slow rhythmic EEG waveforms that match the breathing frequency seen in respiratory effort or airflow channels.

Question 90: In the two-process model of sleep regulation, which process represents the homeostatic sleep drive that accumulates during wakefulness via adenosine buildup?

Process W
Process S (Correct answer)
Process R
Process C

Correct answer: Process S

Process S (homeostatic sleep pressure) rises during wakefulness as adenosine accumulates and dissipates during sleep as adenosine is cleared.

Question 91: The preferred method of correcting undesirable artifacts during the recording process is to:

Changing the input signal derivations (Correct answer)
Temporarily manipulating amplifier sensitivity or gain on the channels by the artifact
Applying 60Hz notch filters to the artifact channels
Manipulation of low and high filters

Correct answer: Changing the input signal derivations

The preferred method of correcting undesirable artifacts during the recording process is to change the input signal derivations. This means altering the way the signals are obtained or derived from their source. By doing so, it is possible to minimize or eliminate the artifacts that may have been introduced during the recording process. This method is often more effective than manipulating filters or temporarily adjusting amplifier sensitivity or gain, as it directly addresses the root cause of the artifacts.

Question 92: Latex allergy in a patient undergoing polysomnography requires the technologist to:

Use latex-free supplies and ensure no latex products are present in the testing environment (Correct answer)
Administer an antihistamine before the study begins
Use only metal electrodes and avoid all adhesives
Proceed normally as most electrode materials are latex-free

Correct answer: Use latex-free supplies and ensure no latex products are present in the testing environment

Patients with latex allergy require a latex-safe environment, meaning all supplies (electrodes, gloves, adhesives) must be latex-free and latex items must be removed from the room.

Question 93: OSHA's Hazard Communication Standard (HazCom) requires that Safety Data Sheets (SDS) be accessible to employees:

At all times during each work shift (Correct answer)
Quarterly during scheduled safety training
Only during normal business hours upon supervisor request
Only when handling a new chemical for the first time

Correct answer: At all times during each work shift

OSHA requires SDS documents to be readily accessible to employees during every work shift whenever they are in their work area, so they can review hazard information at any time.

Question 94: When must a polysomnographic technologist change gloves during a patient sleep study?

Only when gloves are visibly torn
Only when moving between patients
Once per hour regardless of contact type
Between contact with different body sites on the same patient and between patients (Correct answer)

Correct answer: Between contact with different body sites on the same patient and between patients

Gloves must be changed between contact with different body sites on the same patient to prevent cross-contamination and always between patients.

Question 95: After resolving obstructive apneas with EPAP, a patient on BiLevel PAP continues to have hypopneas. What is the correct action?

Decrease both IPAP and EPAP.
Switch back to CPAP.
Decrease the EPAP.
Increase the IPAP. (Correct answer)

Correct answer: Increase the IPAP.

Once EPAP has resolved obstructive apneas, the IPAP (Inspiratory Positive Airway Pressure) should be increased to treat remaining events like hypopneas, RERAs, and snoring. The difference between IPAP and EPAP is the pressure support, which helps augment ventilation.

Question 96: The glymphatic system, active primarily during sleep, functions to:

Clear adenosine and metabolic waste from brain tissue (Correct answer)
Regulate melatonin release
Generate slow-wave EEG activity
Transmit circadian signals to peripheral organs

Correct answer: Clear adenosine and metabolic waste from brain tissue

The glymphatic system uses cerebrospinal fluid flow to flush adenosine and neurotoxic waste products from the brain, operating most efficiently during slow-wave sleep.

Question 97: According to the AASM Recommended hypopnea rule (1A), a hypopnea is scored when there is a drop in airflow of at least 30% for 10 seconds or more, associated with what?

A ≥3% oxygen desaturation or an arousal. (Correct answer)
Only a ≥4% oxygen desaturation.
An increase in heart rate of 10 bpm.
Only an arousal.

Correct answer: A ≥3% oxygen desaturation or an arousal.

The recommended AASM scoring rule for a hypopnea requires both a significant reduction in airflow (≥30% for ≥10 seconds) and a clear physiological consequence. This consequence is defined as either an oxygen desaturation of at least 3% or an arousal from sleep.

Question 98: Which of the following best describes the purpose of respiratory hygiene and cough etiquette in the sleep lab waiting area?

To comply with Joint Commission aesthetic standards
To eliminate the need for airborne precautions inside testing rooms
To reduce transmission of respiratory infections from patients to staff and other patients (Correct answer)
To prevent patients from sleeping before the study begins

Correct answer: To reduce transmission of respiratory infections from patients to staff and other patients

Respiratory hygiene and cough etiquette (covering coughs, hand hygiene, masking symptomatic patients) are source control measures to prevent respiratory pathogen transmission in the facility.

Question 99: A 30-second epoch contains a single sleep spindle but is otherwise composed of low-amplitude, mixed-frequency activity consistent with Stage N1. How should this epoch be scored?

Stage N3
Stage N2 (Correct answer)
Stage N1
Stage W (Wake)

Correct answer: Stage N2

The presence of a single K-complex or sleep spindle is sufficient to define an epoch as Stage N2. Even if the rest of the epoch appears to be Stage N1, the defining feature of N2 takes precedence.

Question 100: Which of the following sleep stages is scored in infants but NOT in adults?

Stage N1
Stage W
Stage N3
Indeterminate Sleep (Correct answer)

Correct answer: Indeterminate Sleep

Indeterminate Sleep is a unique stage scored in infants when an epoch cannot be clearly defined as Quiet Sleep (N), Active Sleep (R), or Wake. This stage acknowledges the frequent transitional and mixed-state periods that are characteristic of infant sleep architecture development.

Question 101: You observe a flat line (asystole) on the ECG channel. What is the very first step you should take?

Call a "Code Blue" or other emergency response.
Document the finding in the technologist's notes.
Check the patient for responsiveness and verify lead connections. (Correct answer)
Begin chest compressions immediately.

Correct answer: Check the patient for responsiveness and verify lead connections.

Before initiating a full emergency response for asystole, it is critical to rule out a technical cause, which is very common. The first step is to immediately assess the patient for responsiveness (e.g., call their name, shake their shoulder) while simultaneously checking that the ECG electrodes are properly attached. This confirms if the event is clinical or technical.

Question 102: During REM sleep, thermoregulation is suppressed and humans temporarily become:

Hypothermic
Unaffected by ambient temperature
Hyperthermic
Poikilothermic (unable to thermoregulate) (Correct answer)

Correct answer: Poikilothermic (unable to thermoregulate)

REM sleep suppresses hypothalamic thermoregulatory drive, making humans transiently poikilothermic and dependent on ambient temperature.

Question 103: A 60 Hz notch filter is used in PSG recordings to:

Remove slow sweat artifact below 0.5 Hz
Reduce cardiac (ECG) artifact
Selectively eliminate AC power line frequency interference (Correct answer)
Filter muscle artifact above 70 Hz

Correct answer: Selectively eliminate AC power line frequency interference

The 60 Hz notch filter removes electrical interference from AC power lines (60 Hz in the US) while preserving physiologically relevant EEG, EOG, and EMG signals.

Question 104: What cardiac arrhythmia would require immediate intervention?

Bradycardia
Bigeminy
Asystole (Correct answer)
PAC

Correct answer: Asystole

Asystole is a cardiac arrhythmia that refers to the absence of any electrical activity in the heart. It is considered a medical emergency and requires immediate intervention because it represents a complete cessation of heart function. Without intervention, asystole can quickly lead to cardiac arrest and death. Prompt action, such as cardiopulmonary resuscitation (CPR) and the administration of advanced cardiac life support (ACLS) protocols, is necessary to attempt to restore a normal heart rhythm and prevent further complications.

Question 105: Which sterilization method is preferred for heat-sensitive sleep lab equipment such as CPAP circuit tubing?

Steam autoclave at 134°C
Ultraviolet (UV) light exposure
Ethylene oxide (EtO) gas sterilization (Correct answer)
Dry heat at 160°C for 2 hours

Correct answer: Ethylene oxide (EtO) gas sterilization

Ethylene oxide gas sterilization operates at low temperatures and is preferred for heat-sensitive items like plastic CPAP circuit tubing.

Question 106: During a split-night CPAP titration, CPAP pressurized airflow most directly causes artifact on which channels?

EOG channels
EEG channels
Chin EMG channels
Thermistor, nasal pressure, and respiratory effort channels (Correct answer)

Correct answer: Thermistor, nasal pressure, and respiratory effort channels

CPAP pressure alters airflow dynamics at the thermistor and nasal pressure transducer and can affect the appearance of respiratory effort channels during titration.

Question 107: After removing PPE following care of an isolation patient, in which order should items be removed to minimize self-contamination?

Gloves → goggles/face shield → gown → mask/respirator → hand hygiene
Gloves → gown → goggles/face shield → mask/respirator → hand hygiene (Correct answer)
Mask → gloves → gown → goggles → hand hygiene
Gown → gloves → goggles/face shield → mask/respirator → hand hygiene

Correct answer: Gloves → gown → goggles/face shield → mask/respirator → hand hygiene

CDC recommends removing gloves first (most contaminated), then gown, then goggles/face shield, and finally the mask/respirator, with hand hygiene after removing gloves and again after all PPE is removed.

Question 108: The circadian nadir of core body temperature and peak sleepiness in a normal sleeper typically occurs at approximately:

11 PM – 1 AM
2 AM – 4 AM (Correct answer)
6 AM – 8 AM
12 PM – 2 PM

Correct answer: 2 AM – 4 AM

The circadian trough of alertness and core body temperature falls between approximately 2–4 AM in individuals maintaining a conventional sleep schedule.

Question 109: A completely flat (isoelectric) signal in a single EEG channel while all other channels show normal activity most likely indicates:

A disconnected lead, broken wire, or complete loss of electrode contact (Correct answer)
Severe cerebral ischemia
Successful application of a high-pass filter
The patient has entered very deep N3 sleep

Correct answer: A disconnected lead, broken wire, or complete loss of electrode contact

An isoelectric single channel with normal surrounding channels almost always represents a hardware fault — disconnected wire, broken lead, or electrode that has completely lost contact.

Question 110: A patient is observed to have a generalized tonic-clonic seizure. The technologist's first priority is to:

Annotate the start and end of the seizure in the recording.
Administer supplemental oxygen via nasal cannula.
Protect the patient from injury and maintain an open airway. (Correct answer)
Immediately call the on-call physician.

Correct answer: Protect the patient from injury and maintain an open airway.

During a seizure, the immediate priority is to prevent physical injury. The technologist should protect the patient from falling or hitting hard objects and, if possible, gently roll them onto their side to maintain a clear airway and prevent aspiration. All other actions, like annotating the record or calling a physician, are secondary to immediate patient safety.

Question 111: If a patient has a lot of hair and measuring the nasion-inion distance is difficult, what is a common procedural step to ensure accuracy?

Estimate the distance based on the patient's head size.
Use a piece of string to follow the scalp contour, then measure the string. (Correct answer)
Use a flexible tailor's tape measure and press down firmly.
Place the electrodes based on visual landmarks only.

Correct answer: Use a piece of string to follow the scalp contour, then measure the string.

Using a non-stretchy material like string or thread allows the technologist to follow the contour of the scalp accurately through the hair. The string can then be laid flat against a tape measure for a precise measurement, which is more reliable than using a flexible tape measure directly on the head.

Question 112: When scoring a pediatric study, you observe frequent, brief central apneas (5-10 seconds long) followed by a few large breaths, primarily during sleep onset. The infant is otherwise healthy. This pattern is most likely:

Periodic breathing, a normal finding in many infants. (Correct answer)
Pathological central sleep apnea requiring intervention.
A sign of congenital central hypoventilation syndrome.
Obstructive hypoventilation.

Correct answer: Periodic breathing, a normal finding in many infants.

Periodic breathing is a common and usually benign pattern in infants, characterized by cycles of brief central apneas followed by periods of normal breathing. It is defined as three or more central apneas lasting >3 seconds separated by no more than 20 seconds of normal breathing. It is most common in premature infants but can be seen in healthy term infants as well.

Question 113: A patient on CPAP titration develops severe, sustained oxygen desaturation to 78% with visible cyanosis. The patient is difficult to arouse. Which action should be taken first?

Remove the CPAP mask and activate the emergency response system. (Correct answer)
Increase the CPAP pressure by 4 cm H2O.
Check the oximeter probe to ensure it is reading correctly.
Switch the patient to Bi-level therapy with a backup rate.

Correct answer: Remove the CPAP mask and activate the emergency response system.

A patient who is unresponsive and cyanotic with severe desaturation is in critical distress. The first step is to remove the PAP interface to rule it out as a source of obstruction and to facilitate assessment of spontaneous breathing. This should be followed immediately by activating the emergency response system.

Question 114: What is the primary purpose of performing physiologic calibrations (biocals) before starting a sleep study recording?

To diagnose the patient's sleep disorder before the study begins.
To determine the correct CPAP pressure for the patient.
To ensure the patient is comfortable with the electrodes.
To verify the integrity and proper response of all recorded signals. (Correct answer)

Correct answer: To verify the integrity and proper response of all recorded signals.

Biocals are essential to confirm that all electrodes and sensors are working correctly and responding appropriately to the patient's physiological changes. This process verifies signal integrity, confirms correct channel derivations, and ensures high-quality data will be collected.

Question 115: When titrating BiLevel PAP, the EPAP is primarily increased to treat which events?

Periodic limb movements
Central apneas
Hypopneas and snoring
Obstructive apneas (Correct answer)

Correct answer: Obstructive apneas

In BiLevel therapy, EPAP (Expiratory Positive Airway Pressure) functions similarly to CPAP by splinting the upper airway open. Therefore, EPAP is the primary setting adjusted to eliminate obstructive apneas.

Question 116: When scoring an arousal during Stage R sleep, what additional criterion must be met besides the 3-second EEG frequency shift?

A concurrent leg movement.
A concurrent oxygen desaturation of at least 3%.
A concurrent increase in submental EMG for at least 1 second. (Correct answer)
No additional criteria are needed.

Correct answer: A concurrent increase in submental EMG for at least 1 second.

Scoring an arousal during REM sleep has a stricter requirement than in NREM. In addition to the abrupt 3-second EEG frequency shift, there must be a concurrent increase in the submental (chin) EMG lasting for at least 1 second.

Question 117: The AASM recommended maximum electrode impedance for PSG recordings is:

Less than 5 kΩ (Correct answer)
Less than 10 kΩ
Less than 1 kΩ
Less than 25 kΩ

Correct answer: Less than 5 kΩ

AASM guidelines specify that electrode impedances should be below 5 kΩ to minimize signal distortion and artifact in PSG recordings.

Question 118: What is the RECOMMENDED LFF/HFF for an EMG channel?

LFF 0.3 / HFF 70
LFF 0.3 / HFF 35
LFF 10 / HFF 100 (Correct answer)
LFF 35 / HFF 100

Correct answer: LFF 10 / HFF 100

The recommended LFF/HFF for an EMG channel is LFF 10 / HFF 100. This means that the low-frequency filter (LFF) should be set to 10 Hz and the high-frequency filter (HFF) should be set to 100 Hz. These filter settings are chosen to ensure that the EMG signal is captured accurately while filtering out any unwanted noise or interference.

Question 119: A central sleep apnea event is characterized by a cessation of airflow for at least 10 seconds and what defining feature?

Absence of inspiratory effort. (Correct answer)
Loud snoring preceding the event.
Continued paradoxical respiratory effort.
A concurrent 3% oxygen desaturation.

Correct answer: Absence of inspiratory effort.

Unlike an obstructive apnea where effort continues, a central apnea is defined by the absence of inspiratory effort throughout the entire period of airflow cessation. This indicates that the brain did not send the signal to breathe.

Question 120: Movement artifact during PSG is best identified by:

Its presence exclusively on EEG channels
A regular periodic pattern at the respiratory rate
Simultaneous large-amplitude irregular deflections across multiple channel types coinciding with body movement (Correct answer)
Its presence only on limb EMG channels

Correct answer: Simultaneous large-amplitude irregular deflections across multiple channel types coinciding with body movement

Movement artifact characteristically produces simultaneous, large-amplitude, irregular deflections across multiple channel types (EEG, EMG, respiratory) at the same moment the patient moves.

Question 121: Sweat artifact in a PSG EEG recording is characterized by:

Sudden sharp electrode-pop deflections
High-frequency irregular activity above 100 Hz
Very slow, large-amplitude undulating baseline shifts below 0.5 Hz (Correct answer)
Regular 60 Hz sinusoidal waves

Correct answer: Very slow, large-amplitude undulating baseline shifts below 0.5 Hz

Sweat artifact produces very slow, large-amplitude baseline undulations below 0.5 Hz as ionic changes in perspiration alter electrode potential.

Question 122: An apneic event occurs when a person stops breathing during sleep for four seconds or more.

FALSE (Correct answer)
TRUE

Correct answer: FALSE

An apneic event occurs when breathing stops for 10 seconds or more.

Question 123: A central apnea in a child (older than 1 year) is scored if there is a cessation of airflow and effort lasting at least:

10 seconds
15 seconds and associated with a 4% desaturation
20 seconds, OR a shorter duration if associated with an arousal or ≥3% desaturation (Correct answer)
The duration of 2 breaths

Correct answer: 20 seconds, OR a shorter duration if associated with an arousal or ≥3% desaturation

For children over 1 year, a central apnea requires a duration of at least 20 seconds. Alternatively, it can be scored if it has a shorter duration (but must last for at least 2 breaths) and is associated with either an arousal or a 3% or greater oxygen desaturation.

Question 124: A patient's EKG tracing shows an irregular R-R rhythm without alterations to the P, QRS, and T waves. Which of the following arrhythmias fits this description?

Second Degree AV block
Third Degree AV block
Premature atrial contractions
Sinus arrhythmia (Correct answer)

Correct answer: Sinus arrhythmia

Sinus arrhythmia is a normal physiological variation where the heart rate changes with the respiratory cycle, leading to an irregular R-R interval. During inspiration, the heart rate typically increases, and during expiration, it decreases. Crucially, in sinus arrhythmia, the P, QRS, and T waves remain morphologically normal, indicating that the electrical impulse originates from the sinus node and follows the normal conduction pathway without any blocks or abnormal beats.

Question 125: During the patient intake process, what is the technologist's primary responsibility regarding the informed consent form?

To obtain the initial consent without physician involvement.
To explain the detailed risks and benefits of the procedure.
To diagnose the patient based on their intake questionnaire.
To verify the patient understands the procedure and to witness their signature. (Correct answer)

Correct answer: To verify the patient understands the procedure and to witness their signature.

The technologist's role is to ensure the patient understands the procedure and to witness the signature. The physician is responsible for explaining the risks, benefits, and alternatives, but the technologist confirms this understanding before the study begins.

RPSGT Certification Exam

The Registered Polysomnographic Technologist (RPSGT) exam administered by the BRPT certifies competency in sleep study preparation, polysomnographic data scoring, patient assessment, and therapeutic intervention for sleep disorders.

175

Questions

180 min

Time Limit

70%

To Pass

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