Presentaties ISMC - Scoring Sleep
62 important questions on Presentaties ISMC - Scoring Sleep
Can hypopneas be scored in a home sleep apnea test?
- Scoring of hypopneas in a polygraphy (home sleep apnea test) can occur.
- Requires desaturation of greater than or equal to 3%.
What rules exist for scoring breathing events in children?
- Different rules apply for scoring breathing events in children, specifically school-aged kids.
- Interactive methods are employed for better understanding.
- Decision-making uses color coding: Red for NO and Green for YES.
How is the CS-breathing pattern indicated?
- Identification of Cheyne-Stokes (CS) breathing patterns may be assessed.
- Observation required for determining if the pattern is present.
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What are the basic electrode setup rules for scoring leg movements?
- Electrodes placed on m. tibialis anterior.
- Distance of 3 cm apart.
How are scoring methods communicated in interactive presentations?
- Interactive presentations highlight different rules for scoring.
- Color coding (Red=NO, Green=YES) simplifies decision-making.
- Utilized for understanding sleep and breathing event scoring.
What are the key parameters in sleep scoring data?
- TST: Total Sleep Time in minutes.
- Lights out: Clock time.
- TAST: Total Awake State Time.
- Sleep latency: Onset of sleep to sleep start.
- Stage times: Distribution in minutes for stages N3, N2, N1, REM.
What defines a significant leg movement (LM) event?
- Minimum duration: 0.5 sec.
- Maximum duration: 10 sec.
- Minimum amplitude: 8 µV increase.
- Timing ends if below 2 µV for 0.5 sec.
What color coding is used for decision-making in scoring presentations?
- Red indicates NO, while Green indicates YES.
- This method helps clarify whether specific scores or events are correct.
- Used predominantly in scoring assessments for children.
What is hypopnea and how is it identified?
- Hypopnea involves reduced airflow.
- It is characterized by decreased breathing (flow).
- Often identifiable in a 1-minute span on a graph.
Describe the characteristics observed in sleep EEG patterns.
- Sleep Spindle: Short bursts of activity.
- Delta Waves: Slow wave, high amplitude.
- Vertex Wave: Sharp wave, seen in drowsy or light sleep.
How is a Periodic Limb Movement (PLM) series defined?
- Minimum events: 4 consecutive LMs.
- Interval between LMs: 5-90 sec.
- LMs separated by less than 5 sec counted as a single movement.
What is the significance of color in scoring systems for children's sleep?
- Red and Green colors are used to indicate decisions.
- Red means NO and Green means YES.
- Helps in assessing school-age children's sleep scoring.
What are the account events in sleep studies?
- Number of arousals: Quantifies interruptions.
- Arousal index: Calculated using (total number ÷ TST) × 60.
What sleep stages are shown in the EEG recordings from 14-6-2022?
- Epoch 09: Stage N3
- Epoch 10: Stage N3 or uncertain (??)
- Epoch 11: Stage N2
- Epoch 12: Stage R (REM)
- Epoch 13: Stage R (REM)
- Epoch 14: Stage N3
How is central hypopnea defined?
- Defined by a 30% drop in nasal pressure.
- Lasts at least 10 seconds.
- Associated with ≥3% oxygen desaturation or arousal.
- No evidence of obstructive features.
Under what conditions are an arousal and limb movement considered associated in a PLM series?
- Occur together within 0.5 sec.
- Either LM or arousal starts first.
How does one assess scoring correctness using color coding?
- Red signifies incorrect (NO), while Green signifies correct (YES).
- Helps validate scoring by comparing results to known standards.
- Essential in evaluating children's breathing and sleep events.
What are the sleep stages observed on 14-6-2022 across various epochs?
- Epoch 03: N2
- Epoch 04: N2
- Epoch 05: N2
- Epoch 06: R (EM)
- Epoch 07: N3
- Epoch 08: N3
What does the chart of a hypopnea episode depict?
- Two hypopnea episodes are shown.
- Depicts flow reduction.
- Includes chest and abdominal movement.
- Identified in an 68-year-old male.
What is the scoring rule for a limb movement recorded close to arousals, apnea, hypopnea, or RERA events?
- LM not scored if within 0.5 sec before/after events.
- Period
What characteristics are observed in Alpha rhythms?
- Alpha rhythm is marked by 8-12 Hz frequency.
- Commonly seen during relaxed, wakeful states with closed eyes.
- Prominent in EEG recordings.
Describe the scoring criteria for hypopneas.
- AASM criteria include ≥30% airflow reduction.
- Oxygen desaturation of 3% or arousal is needed.
- Duration of ≥10 seconds.
- Central hypopneas lack respiratory effort.
What characterizes rapid eye movements in REM sleep?
- Conjugate, irregular, sharply peaked movements
- Initial deflection usually lasts < 500 msec
- Saw tooth waves: Sharply contoured, often 2-6 Hz, max in central regions, often preceding these movements
What defines a K complex in Stage N2 sleep?
- A well-delineated negative sharp wave.
- Followed by a positive component.
- Stands out from background EEG.
- Total duration ≥ 0.5 sec.
- Max amplitude in frontal derivation.
What is notable about chin EMG tone during REM sleep?
- Baseline EMG in the chin is not higher than in other stages
- Usually at the lowest level of entire recording
What are saw tooth waves, and when do they occur?
- Saw tooth waves are present during REM sleep.
- Characterized by notched, jagged shapes.
- Associated with dreaming.
How is arousal during sleep scored?
- Arousal is scored during N1, N2, N3, R stages.
- Requires an abrupt EEG frequency shift >16Hz lasting ≥3 sec.
- Minimum 10 sec stable sleep before change.
- REM arousal needs ≥1 sec submental EMG increase.
Describe sleep spindles in Stage N2 sleep.
- Distinct wave train with frequency 11-16Hz.
- Commonly at 12-14Hz.
- Duration ≥ 0.5 sec.
- Usually max amplitude in central derivation.
Describe transient muscle activity in REM sleep.
- Short, irregular burst of EMG activity
- Duration of < 0.25 sec
- Superimposed on low EMG tone
What sleep stage is represented by the designation "W"?
- W signifies wakefulness.
- Characterized by fast, low-amplitude waves.
- Usually corresponds to an alert state.
What are some of the respiratory parameters indicated in the data?
- Breathing Events:
- Apnea Hypopnea Index (AHI)
- RERA Index
- Oxygen Desaturation Index
- Sleep Stages:
- REM Periods With Apnea
- Prolonged Apneas
What are the characteristics of REM arousal?
- Occurs in REM sleep.
- Identified by rapid eye movements and saw tooth waves.
- Requires a concurrent increase in submental EMG lasting at least 1 second.
What defines Stage N3 (SWS) and its slow wave activity?
- Stage N3 when ≥ 20% of an epoch is slow wave activity.
- Slow wave: frequency 0.5-2Hz.
- Peak-to-peak amplitude > 75 µV.
- Measured over frontal regions.
What is stage N1 in sleep, and what are its features?
- N1 is the first stage of non-REM sleep.
- Exhibits theta waves.
- Lightest stage of sleep with slow rolling eye movements.
What defines mixed apnea?
- Meets apnea criteria.
- Absent inspiratory effort initially.
- Resumption of inspiratory effort later.
Describe an obstructive apnea event as shown in the data.
- Obstructive Apnea:
- Upper airway blockage
- Continued respiratory effort
- Leads to pauses in breathing
Describe the features of an arousal in N2 sleep.
- Occurs in N2 stage.
- Displayed as K-complexes followed by abrupt EEG frequency shifts.
- Lasts at least 3 seconds with previous stable sleep of at least 10 seconds.
What are the characteristics of the waking EEG with eyes closed?
- EEG shows low amplitude mixed frequency (LAMF)
- Theta activity (4-7 Hz) prevalent
- More than 50% alpha rhythm is observed
- Eyes closed condition
Describe the components used to measure hypopnea.
- Measure with nasal pressure sensor/alternative sensor.
- Nasal pressure drop ≥30% of baseline.
- Drop lasts at least 10 seconds.
- ≥3% desaturation (1A) or ≥4% (1B).
Describe a mixed apnea event from the data.
- Mixed Apnea:
- Combination of obstructive and central apnea components
- Initial central aspect followed by obstruction
What does a hypnogram represent in sleep studies?
- Displays stages of sleep over time.
- Shows transitions between Wake (W), REM (R), N1, N2, and N3.
- Useful for visualizing sleep architecture and patterns.
Describe Stage N1 sleep characteristics in EEG.
- Low amplitude mixed frequency (LAMF) EEG
- Theta activity (4-7 Hz)
- Alpha activity:
What characterizes obstructive apnea in sleep studies?
- Obstructive Apnea:
- Apnea observed with respiratory effort.
- Chest and abdominal movements present.
- Airflow is reduced or absent.
- Timeframe is typically 1 minute.
What information is provided in the graphical representation of mixed apnea?
- Depicts flow, chest, and abdominal movements.
- Apnea events shown over 1 minute.
- Illustrates patterns of mixed apnea.
Identify the EEG characteristics required for scoring arousal.
- Abrupt shift to frequencies >16Hz (excluding spindles).
- Requires duration of at least 3 seconds.
- Preceded by minimum 10 seconds of stable sleep.
What are some types of breathing events associated with respiration?
- Apneas
- Obstructive, Central, Mixed
- Hypopneas
- Obstructive, Central
- Respiratory Effort-Related Arousals (RERA)
How is central apnea defined and what are its characteristics?
- Central Apnea:
- Meets apnea criteria.
- No inspiratory effort throughout.
- No chest or abdominal movements.
- Absence of airflow is continuous.
What are the requirements for scoring Stage N2 sleep?
- Begin if one or more K complexes (not associated with arousal) occur
- Or one or more trains of sleep spindles are present
- Must occur during the first or last half of the epoch
What is illustrated on the hypopnea criteria regarding desaturation and arousals?
- 1A: ≥3% desaturation or arousal required.
- 1B: ≥4% desaturation.
- Associated with apnea measurement techniques.
What are the basic EEG frequency bands?
- Beta: ≥13Hz and more
- Alpha: 8-13Hz
- Theta: 4-7Hz
- Delta: ≤4Hz
How is apnea defined in terms of measurement and criteria?
- Measurement: Thermal or alternative sensor, PAP flow.
- Criteria:
- Peak excursion drops by ≥90% of baseline.
- Event lasts at least 10 seconds.
What physical movements are present during obstructive apnea?
- Physical Movements During Obstructive Apnea:
- Chest movement is evident.
- Abdominal movement is evident.
- Effort is present despite airflow reduction.
What is the focus of the Sleep Scoring AASM presentation?
- Sleep stages: Wake, Stage N1-N2-N3, REM
- Breathing related events: Apneas, Hypopneas
- Movement events
- Interactive approach
How are eye movements measured in sleep studies?
- Measured using Electro-oculogram (EOG)
- Displays eye movement directions: Right and Left
What defines obstructive apnea?
- Must meet apnea criteria.
- Continued or increased inspiratory effort throughout the entire absence of airflow.
Describe the airflow during central apnea.
- Airflow During Central Apnea:
- Airflow is absent.
- No inspiratory effort.
- Lack of chest and abdomen movement indicates no breathing effort.
Which version of the AASM manual is used in the presentation?
- Version 2.6 of the AASM manual, dated 2020.
How should EMG electrodes be placed on the chin?
- One electrode: 1 cm above the inferior edge of the mandible and middle
- Second electrode: 2 cm to the right and below
- Third electrode: 2 cm to the left and below
What is noted in Epoch 15 and Epoch 16 regarding sleep stages?
- Epoch 15: Indicated with "W or Z?"
- Epoch 16: Marked as "W" for wakefulness observed.
What system is illustrated in the diagrams within the presentation?
- The 10-20 system is depicted, a standard for electrode placement in EEG assessments.
What is involved in the basics of sleep scoring?
- Combination: EEG, EMG, and EOG
- Epoch: 30 sec
- Hypnogram: Overview of sleep stages
Describe the characteristics of Stage Wake W.
- Irregular eye movements: blinking, reading, rapid
- Eyes closed: alpha activity (8-13Hz) in occipital region
- Eyes open: less activity
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