RPSGT Documentation & Record Keeping 4 — Questions and Answers
Question 1: The European Data Format (EDF/EDF+) is significant in sleep documentation because it:
- Provides a standardized digital file format allowing interoperability between different PSG systems (Correct answer)
- Is required only for pediatric studies
- Stores only video data
- Is the billing format for Medicare claims
Correct answer: Provides a standardized digital file format allowing interoperability between different PSG systems
EDF and EDF+ are universal biosignal formats ensuring PSG data can be read by different scoring software and shared across institutions.
Question 2: When scoring respiratory effort-related arousals (RERAs), documentation must include:
- A sequence of breaths with increasing effort lasting ≥10 seconds leading to an arousal (Correct answer)
- Any arousal following a 3% SpO2 drop
- An apnea of at least 20 seconds duration
- Two consecutive hypopneas
Correct answer: A sequence of breaths with increasing effort lasting ≥10 seconds leading to an arousal
A RERA requires a ≥10-second sequence of increasing respiratory effort culminating in arousal without meeting apnea or hypopnea criteria.
Question 3: A technician documents 'alpha intrusion' in the comments. This finding refers to:
- Alpha frequency activity (8–13 Hz) appearing during NREM sleep stages (Correct answer)
- Alpha waves present only during REM sleep
- Alpha activity confirming full wakefulness
- Alpha bursts associated with K-complexes
Correct answer: Alpha frequency activity (8–13 Hz) appearing during NREM sleep stages
Alpha intrusion is the appearance of alpha rhythms during NREM sleep, often seen in chronic pain or fibromyalgia patients and is clinically noteworthy.
Question 4: Which action is required when a PSG report is amended after the interpreting physician signs it?
- Create an addendum with date, reason for change, and new physician signature—never alter the original (Correct answer)
- Overwrite the original document with the corrected version
- Shred the original and reissue under a new study ID
- Document the change in the billing system only
Correct answer: Create an addendum with date, reason for change, and new physician signature—never alter the original
Amendments to signed medical records must be addenda—the original signed document must remain intact to preserve the audit trail.
Question 5: For pediatric PSG, AASM recommends a minimum paper speed (or display equivalent) of:
- 15 mm/sec (or 15-second epochs for scoring)
- 10 mm/sec (30-second epochs)
- 30 mm/sec (10-second epochs) (Correct answer)
- 60 mm/sec (5-second epochs)
Correct answer: 30 mm/sec (10-second epochs)
AASM pediatric guidelines recommend a display equivalent of 30 mm/sec (10-second epoch view) because pediatric EEG features occur at higher frequencies.
Question 6: The Respiratory Disturbance Index (RDI) differs from the AHI in documentation by including:
- Apneas, hypopneas, AND respiratory effort-related arousals (RERAs) (Correct answer)
- Apneas and central events only
- Hypopneas and SpO2 drops only
- Apneas and arousals unrelated to breathing
Correct answer: Apneas, hypopneas, AND respiratory effort-related arousals (RERAs)
RDI = (apneas + hypopneas + RERAs) ÷ total sleep time in hours, making it a broader measure of respiratory disturbance than AHI alone.
Question 7: When transcribing CPAP titration pressure data into the final report, the technician should document:
- Starting pressure, peak pressure, and final effective pressure with corresponding times (Correct answer)
- Only the highest pressure reached during the night
- The pressure at which the patient fell asleep only
- The pressure recommended by the equipment vendor
Correct answer: Starting pressure, peak pressure, and final effective pressure with corresponding times
A complete titration record includes temporal pressure changes—start, peak, and final effective pressure—to allow the prescribing clinician to choose the optimal setting.
RPSGT Documentation & Record Keeping 4
The European Data Format (EDF/EDF+) is significant in sleep documentation because it: