RPSGT Certification Exam — Questions and Answers

Question 1: 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 in-phase (move in the same direction).
Only the ROC channel should show a deflection.
Both channels should show a positive (downward) deflection.
The signals should be out-of-phase (move in opposite directions). (Correct answer)

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 2: 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 artifact by changing the input signal derivation to a back-up exploring electrode (Correct answer)
Re-reference the channel showing the artifact to a back-up reference electrode
Eliminate the artifact by double-referencing the input signal derivation
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 3: The AASM recommended maximum electrode impedance for PSG recordings is:

Less than 1 kΩ
Less than 5 kΩ (Correct answer)
Less than 10 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 4: EEG gold cup electrodes that are reused between patients should be processed using which minimum standard?

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

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 5: An electrode pop artifact is best identified by:

Regular 60 Hz sine waves on one channel
High-frequency muscle activity on all channels
A sudden sharp deflection or step change isolated to a single channel (Correct answer)
Slow undulating waves 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 6: Which brain structure generates sleep spindles through thalamocortical circuits and acts as a relay station for sensory information during sleep-wake transitions?

Hippocampus
Thalamus (Correct answer)
Corpus callosum
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 7: Respiratory inductance plethysmography (RIP) belt artifact is most commonly caused by:

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

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

No additional criteria are needed.
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)

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

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

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

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

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

Protect the patient from injury and maintain an open airway. (Correct answer)
Annotate the start and end of the seizure in the recording.
Administer supplemental oxygen via nasal cannula.
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 12: What is the RECOMMENDED LFF/HFF for an EMG channel?

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

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

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

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

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

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

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 16: 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)
Ask the patient to take deep breaths and try to relax.
Increase the CPAP pressure to improve oxygenation.
Note the event and wait to see if it resolves on its own.

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 17: 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)
Tell the patient that anxiety will ruin the study results.
Dismiss their concerns and proceed with the hookup quickly.
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 18: 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?

Complete an incident report before calling for help.
Help the patient stand up and assist them back to bed.
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.

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 19: 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?

1 minute
30 minutes
15 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 20: According to AASM guidelines, what is the minimum duration for scoring an obstructive apnea in an infant?

The duration of 2 breaths (Correct answer)
The duration of 3 breaths
10 seconds
5 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 21: The preferred method of correcting undesirable artifacts during the recording process is to:

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

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

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

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

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

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

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

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 25: 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?

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

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

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

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

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

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 28: 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:

A normal skin irritation from the paste.
A vasovagal response to the procedure.
An anaphylactic reaction. (Correct answer)
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 29: Which level of disinfection is required for reusable PAP masks and headgear between patients?

Intermediate-level disinfection
High-level disinfection (Correct answer)
Sterilization
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 30: The correct technique to determine whether a suspect signal during scoring is a true physiological event or artifact is to:

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

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 31: 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.
Advise the patient to stop taking it immediately.
Ignore the information as it is not a prescription medication.
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 32: What is the AASM recommended maximum impedance level for EEG and EOG electrodes?

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

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

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

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

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

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 35: 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 36: Latex allergy in a patient undergoing polysomnography requires the technologist to:

Administer an antihistamine before the study begins
Use latex-free supplies and ensure no latex products are present in the testing environment (Correct answer)
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 37: 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 38: Sweat artifact in a PSG EEG recording is characterized by:

Very slow, large-amplitude undulating baseline shifts below 0.5 Hz (Correct answer)
High-frequency irregular activity above 100 Hz
Sudden sharp electrode-pop deflections
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 39: According to AASM guidelines, an epoch is scored as Stage N2 sleep upon the first occurrence of which of the following?

Low-amplitude, mixed-frequency EEG activity for more than 50% of the epoch.
A K-complex or a sleep spindle. (Correct answer)
An EEG arousal.
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 40: What is the primary purpose of an Exposure Control Plan required by OSHA's Bloodborne Pathogen Standard?

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

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

To confirm the function of the respiratory airflow and effort channels. (Correct answer)
To test the patient's ability to follow commands.
To verify the snoring sensor is working.
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 42: What is the minimum duration for an abrupt shift in EEG frequency to be scored as an arousal during NREM sleep?

1.5 seconds
0.5 seconds
3 seconds (Correct answer)
10 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 43: To verify the function of the chin EMG channels, what command should the technologist give the patient?

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

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 44: The glymphatic system, active primarily during sleep, functions to:

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

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 45: 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)
Check the oximeter probe to ensure it is reading correctly.
Increase the CPAP pressure by 4 cm H2O.
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 46: When must a polysomnographic technologist change gloves during a patient sleep study?

Only when moving between patients
Once per hour regardless of contact type
Only when gloves are visibly torn
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 47: 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.
Eat a large meal right before arriving at the lab.
Avoid all caffeine after 12:00 PM (noon). (Correct answer)
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 48: Double-referencing (A1+A2) may be useful for?

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

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

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

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

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.
20% of the distance from the nasion to the inion, measured from the nasion.

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

Directly on the outer canthus 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.
On the supraorbital ridge 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 52: 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:

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

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

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

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 54: 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 55: 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 M2 electrode has detached from the skin.
The amplifier gain is set too low.
A salt bridge has formed between the C3 and M2 electrodes. (Correct answer)
The patient is not relaxed enough.

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

70–100 minutes (Correct answer)
120–150 minutes
45–60 minutes
20–30 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 57: 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 58: Which type of isolation precautions would be most appropriate for a patient with active pulmonary tuberculosis undergoing a sleep study?

Airborne precautions (Correct answer)
Contact precautions
Droplet 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 59: During EOG calibrations, both the LOC and ROC channels deflect downward simultaneously when the patient looks up. What does this indicate?

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

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

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

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

An active scalp electrode (e.g., C3)
The ground or reference electrode (Correct answer)
The leg EMG electrode
The chin 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 62: When placing the three chin EMG electrodes, what is the primary physiological activity being measured?

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

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

Contact precautions (Correct answer)
Airborne precautions
Reverse isolation
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 64: Which class of fire extinguisher is appropriate for an electrical fire that might occur near sleep lab recording equipment?

Class B
Class A
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 65: When troubleshooting an intermittent PSG artifact, which approach is most effective?

Apply all available filters simultaneously to suppress it
Mark every affected epoch as unscorable and continue
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

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 66: 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?

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

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 67: 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 diagnose the patient based on their intake questionnaire.
To explain the detailed risks and benefits of the procedure.
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.

Question 68: The vertical position of the pens with the polysomnograph amplifiers turned off is referred to as:

Time axis (Correct answer)
Electrical baseline
Frequency response curve
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 69: Growth hormone secretion is predominantly linked to which sleep stage?

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

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

All hospital employees
Employees with occupational exposure to blood or OPIM (Correct answer)
Only laboratory workers
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 71: Which term describes the recurring 90–110 minute NREM-REM cycling pattern that repeats throughout the night?

Ultradian rhythm (Correct answer)
REM rebound
Homeostatic oscillation
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 72: A pulse oximetry sensor showing poor signal quality with low-amplitude, irregular waveform is best corrected by:

Repositioning the sensor or applying it to an alternate, better-perfused site (Correct answer)
Increasing the sampling rate
Increasing the oximeter's gain setting
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 73: Glutaraldehyde (e.g., Cidex) used for high-level disinfection of sleep study equipment is considered hazardous because it:

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

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 74: 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.
Low-amplitude mixed-frequency EEG, low chin EMG, and rapid eye movements. (Correct answer)
Vertex sharp waves, high chin EMG, and rapid eye movements.
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 75: 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 76: When a person stops breathing during sleep for ten seconds, 30 times or more during an hour, he or she has

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

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

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

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

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

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 79: 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 80: 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?

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

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

Cerebrospinal fluid
Blood
Sweat (Correct answer)
Semen

Correct answer: Sweat

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

Question 82: According to AASM criteria, delta waves associated with N3 sleep are defined as having a frequency of:

0.5–4 Hz (Correct answer)
4–8 Hz
8–13 Hz
0.5–2 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 83: What is the minimum duration for scoring an arousal from NREM sleep in a school-aged child?

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

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

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

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 85: 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 86: To score a 30-second epoch as Stage N3, what percentage of the epoch must contain slow wave activity?

At least 75%
20% or more (Correct answer)
Less than 10%
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 87: When an electrode shows high impedance during PSG, what is the correct first troubleshooting step?

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

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

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

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

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

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

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

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 91: 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?

Use a flexible tailor's tape measure and press down firmly.
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)
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 92: After removing PPE following care of an isolation patient, in which order should items be removed to minimize self-contamination?

Gown → gloves → goggles/face shield → mask/respirator → hand hygiene
Gloves → gown → goggles/face shield → mask/respirator → hand hygiene (Correct answer)
Mask → gloves → gown → goggles → hand hygiene
Gloves → goggles/face shield → gown → 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 93: A completely flat (isoelectric) signal in a single EEG channel while all other channels show normal activity most likely indicates:

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

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 94: What is the RECOMMENDED starting pressure for CPAP?

5cm H20
4cm H20 (Correct answer)
3cm H20
6cm 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 95: Reference contamination artifact in EEG is characterized by:

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

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

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

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

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

Correct answer: Poikilothermic (unable to thermoregulate)

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

Question 98: When a person stops breathing during sleep for ten seconds, 15 to 30 times during an hour, he or she has

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

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 99: 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, 3, and 4 only (Correct answer)
1, 2, and 4 only
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 100: 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?

Movement artifact
Reference electrode artifact
Respiratory artifact (Correct answer)
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 101: The suprachiasmatic nucleus (SCN), which serves as the master circadian pacemaker, is located in which brain structure?

Brainstem
Cerebellum
Hypothalamus (Correct answer)
Thalamus

Correct answer: Hypothalamus

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

Question 102: Eye movement artifacts can contaminate frontal EEG channels (F3, F4) because:

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

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

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

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

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

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

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

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 106: What cardiac arrhythmia would require immediate intervention?

Asystole (Correct answer)
Bradycardia
Bigeminy
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 107: 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?

An arousal from sleep. (Correct answer)
A significant bradycardia.
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 108: Which of the following best describes the pattern of Cheyne-Stokes Respiration (CSR)?

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

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

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

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

Find the problem source and correct it before beginning the study (Correct answer)
Use a 60Hz notch filter to eliminate the artifact
Re-evaluate the problem after the patient goes to sleep
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 111: The narcolepsy tetrad includes all the following except

Sleep paralysis
Nocturnal myoclonus (Correct answer)
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 112: Which sterilization method is preferred for heat-sensitive sleep lab equipment such as CPAP circuit tubing?

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

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

120–140 minutes
90–110 minutes (Correct answer)
60–75 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 114: Obstructive sleep apnea (or OSA) is usually caused when

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

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 115: 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)
A concurrent 3% oxygen desaturation.
Continued paradoxical respiratory effort.
Loud snoring preceding the event.

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

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

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 117: Sawtooth waves seen during REM sleep are best described as:

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

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

0.25 seconds
1.0 seconds
0.75 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 119: Which neurotransmitter, produced by the lateral hypothalamus, is the primary promoter of wakefulness and is deficient in narcolepsy type 1?

Serotonin
Dopamine
GABA
Orexin (hypocretin) (Correct answer)

Correct answer: Orexin (hypocretin)

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

Question 120: 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)
Type 2 Diabetes
Asthma

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 121: What is the purpose of the low frequency filter?

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

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

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

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

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

Correct answer: Process S

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

Question 124: Which hormone, secreted by the pineal gland in response to darkness, signals the circadian system to promote sleepiness?

Cortisol
Histamine
Melatonin (Correct answer)
Adenosine

Correct answer: Melatonin

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

Question 125: REM sleep atonia (muscle paralysis) is primarily mediated by which neurotransmitters acting on spinal motor neurons?

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

Correct answer: Glycine and GABA

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

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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