Post-test: Polysom

Question 1

Which of the following will assist the RT in predicting sleep apnea?
a. ESS
b. Berlin Questionnaire
c. Inspection of the chest
d. ECG

Answer 1

Correct answer: b — Rationale: The Berlin Questionnaire is a validated tool used to screen and predict risk for obstructive sleep apnea.

Question 2

All of the following are symptoms of OSA in adults, except:
a. Morning headaches
b. Memory loss
c. Hyperactive behavior
d. Depression

Answer 2

Correct answer: c — Rationale: Hyperactivity is more common in pediatric sleep apnea, not adults.

Question 3

In which stage of sleep is “restorative sleep” thought to occur?
a. Stage 1 NREM
b. Stage 2 NREM
c. Stage 3 NREM
d. REM

Answer 3

Correct answer: c — Rationale: Stage 3 NREM (slow-wave sleep) is considered the deepest, most restorative sleep stage.

Question 4

To meet the definition criteria for sleep apnea, how many seconds of airflow cessation during sleep must be documented?
a. 4 seconds
b. 8 seconds
c. 10 seconds
d. 15 seconds

Answer 4

Correct answer: c — Rationale: Apnea is defined as ≥10 seconds of airflow cessation.

Question 5

Which of the following is not a physiologic parameter normally monitored during PSG?
a. SpO₂ monitoring
b. ECG
c. EEG monitoring
d. Routine ABG monitoring

Answer 5

Correct answer: d — Rationale: ABGs are not part of routine PSG; oxygen saturation is monitored noninvasively.

Question 6

According to the Mallampati airway assessment, a class 4 airway indicates:
a. Easy intubation predicted
b. Moderate risk of OSA
c. Increased risk of OSA
d. Minimal risk of OSA

Answer 6

Correct answer: c — Rationale: Mallampati III–IV is associated with increased risk of obstructive sleep apnea.

Question 7

A reduction in airflow greater than 30% for at least 10 seconds during sleep defines:
a. Apnea
b. RERA
c. Arousal
d. Hypopnea

Answer 7

Correct answer: d — Rationale: Hypopnea is defined by ≥30% reduction in airflow with desaturation or arousal.

Question 8

Which defines the presence of moderate sleep apnea?
a. AHI of 3
b. AHI of 12
c. AHI of 20
d. AHI of 44

Answer 8

Correct answer: c — Rationale: AHI 15–30 = moderate OSA; <15 mild, >30 severe.

Question 9

Meaning of “S” in STOP-BANG assessment?
a. Saturation
b. Somnolence
c. Snoring
d. Sleep

Answer 9

Correct answer: c — Rationale: STOP-BANG: Snoring, Tiredness, Observed apnea, Pressure (BP), BMI, Age, Neck circumference, Gender.

Question 10

Which of the following is the first sign of sleep-disordered breathing?
a. CSA
b. Snoring
c. Obesity
d. Hypertension

Answer 10

Correct answer: b — Rationale: Snoring is often the earliest detectable sign of obstructive sleep apnea.

Question 11

In analyzing overnight oximetry data, a desaturation event represents a decrease in SpO₂ of what amount?
a. 2% or more
b. 3% or more
c. 4% or more
d. 5% or more

Answer 11

Correct answer: c — Rationale: A ≥4% drop in SpO₂ is the widely accepted threshold for a clinically significant desaturation event.

Question 12

The ‘H’ in STOP-BANG stands for:
a. Hypoxia
b. Hypercapnia
c. Hypertension
d. Heart rate

Answer 12

Correct answer: c — Rationale: STOP-BANG includes Hypertension as a risk factor for OSA.

Question 13

A patient exhibits three obstructive apnea events during a CPAP titration and has an apnea index of 2 events/hr. What should be done?
a. Switch to BiPAP with EPAP 8 and IPAP 12
b. Increase CPAP to 10 cm H₂O for 5 minutes and observe
c. Discontinue titration trial and place on nasal O₂
d. Decrease CPAP to 6 cm H₂O

Answer 13

Correct answer: b — Rationale: Standard CPAP titration protocol increases pressure 1–2 cm H₂O to eliminate obstructive events.

Question 14

Which patient category is NOT considered at risk for apnea monitoring?
a. Infant at risk for bradycardia
b. Infant with abnormal airway anatomy
c. Infants evaluated for obstructive sleep apnea
d. Infants with diaphragmatic paralysis

Answer 14

Correct answer: c — Rationale: OSA patients typically require sleep studies, not apnea monitoring intended for central apnea risk.

Question 15

During CPAP titration, a patient displays prolonged hypopneas but remains asleep. What should be recommended?
a. Increase CPAP pressure by 2 cm H₂O
b. Discontinue CPAP and switch to BiPAP
c. Consider a trial of bilevel therapy
d. Switch to auto-CPAP

Answer 15

Correct answer: a — Rationale: Persistent hypopneas during titration are managed by stepwise increases in CPAP.

Question 16

A patient being interviewed for sleep disorder evaluation reports loud snoring, daytime sleepiness, and morning headaches. Which diagnostic test is indicated?
a. Lateral neck X-ray
b. Full PSG
c. Overnight oximetry
d. Chest radiograph

Answer 16

Correct answer: b — Rationale: Symptoms strongly indicate OSA; the gold standard is full in-lab polysomnography.

Question 17

Which of the following is NOT a purpose of PSG?
a. To determine need for CPAP titration
b. To identify respiratory events during sleep
c. To assess severity of insomnia
d. To identify patterns consistent with OSA

Answer 17

Correct answer: c — Rationale: PSG assesses sleep architecture and breathing, not insomnia severity (evaluated with questionnaires).

Question 18

Which of the following may be used to diagnose COPD-related nocturnal desaturation?
a. Overnight oximetry
b. ABG
c. Chest radiograph
d. CPAP titration

Answer 18

Correct answer: a — Rationale: Overnight oximetry is the standard for identifying nocturnal hypoxemia in COPD.

Question 19

COPD patient on long-term oxygen therapy shows SpO₂ dropping from 90% to 84% overnight. What should be recommended?
a. Order a PSG
b. Titrate nocturnal O₂ upward until SpO₂ > 88%
c. Change oxygen from 1 to 2 L/min and reassess daytime ABGs
d. Titrate nocturnal O₂ upward until SpO₂ > 92%

Answer 19

Correct answer: b — Rationale: COPD nocturnal oxygen should be titrated to maintain 88–92%; >92% risks CO₂ retention.

Question 20

A patient suspected of sleep disorder has overnight oximetry for 48 hr showing ODI of 44/hr. What should be recommended next?
a. No action needed
b. Surgical correction of airway obstruction
c. BiPAP with full-face mask
d. Full diagnostic PSG

Answer 20

Correct answer: d — Rationale: ODI > 30 strongly suggests OSA; confirmation requires full polysomnography.

Question 21

A sleep study report should include which of the following?
a. Highest SpO₂ during REM
b. Percent of sleep time with abnormal SpO₂
c. PaCO₂
d. Morning ABG

Answer 21

Correct answer: b — Rationale: Time spent with abnormal desaturation is a key PSG respiratory parameter.

Question 22

Patient with AHI 21 and ODI 48/hr has moderate OSA and desaturation. Recommended therapy?
a. CPAP titration in home setting
b. Full in-lab diagnostic polysomnography
c. BiPAP immediately
d. No treatment needed

Answer 22

Correct answer: b — Rationale: Moderate OSA plus high ODI requires full PSG prior to formal CPAP titration.

Question 23

A patient undergoing CPAP therapy reports persistent daytime sleepiness despite adherence. Which step is appropriate?
a. Refer for behavioral therapy
b. Order repeat PSG with CPAP titration
c. Prescribe nasal steroids
d. Evaluate patient for narcolepsy only

Answer 23

Correct answer: b — Rationale: Residual symptoms with CPAP require repeat titration or evaluation for alternative sleep disorders.

Question 24

For adults, recommended total sleep time per night is:
a. 6–7 hours
b. 7–8 hours
c. 8–9 hours
d. 5–6 hours

Answer 24

Correct answer: b — Rationale: Most adults require 7–8 hours for healthy sleep patterns.

Question 25

Which condition is associated with increased risk of OSA? a. Low blood pressure b. Bronchospasm c. Stroke d. Pneumonia

Answer 25

Correct answer: c — Rationale: Stroke impairs upper airway control and increases OSA risk.

Question 26

Polysomnography reveals 11 apneas/hr; findings are: a. Mild OSA b. Moderate OSA c. Severe OSA d. Indeterminate

Answer 26

Correct answer: a — Rationale: AHI 5–14 = mild OSA; 15–30 moderate; >30 severe.

Question 27

Which movement defines REM sleep? a. Vertical eye movement b. Spindle waves c. K-complex d. Rapid eye movements

Answer 27

Correct answer: d — Rationale: REM sleep is characterized by rapid saccadic eye movements.

Question 28

Infants up to 6 months have sleep classification including: I. Segmented sleep II. Quiet sleep III. Active sleep IV. Indeterminate sleep a. I, II only b. I and II c. I, II, III, IV d. II, III, IV

Answer 28

Correct answer: c — Rationale: Infant sleep includes four recognized categories: quiet, active, indeterminate, segmented.

Question 29

Stage of sleep when brain is most active and dreaming occurs: a. N1 b. REM c. N2 d. N3

Answer 29

Correct answer: b — Rationale: REM sleep is associated with vivid dreaming and heightened cortical activity.

Question 30

In sleep staging, the EEG pattern showing sawtooth waves indicates: a. REM sleep b. N2 sleep c. N1 sleep d. N3 sleep

Answer 30

Correct answer: a — Rationale: Sawtooth waves are characteristic of REM sleep.

Question 31

A simple, eight-item questionnaire that measures daytime sleepiness and is essential in initial screening of sleep disorders is: a. Berlin Questionnaire b. STOP-BANG Questionnaire c. Epworth Sleepiness Scale d. Athens Sleep Questionnaire

Answer 31

Correct answer: c — Rationale: The Epworth Sleepiness Scale quantifies daytime sleepiness and is widely used for OSA screening.

Question 32

Thirty to 40 seconds of apnea in the absence of thoracoabdominal effort defines: a. OSA b. CSA c. MSA d. RERA

Answer 32

Correct answer: b — Rationale: Central sleep apnea is characterized by cessation of airflow WITHOUT respiratory effort.

Question 33

The most common form of sleep-disordered breathing in adults is: a. CSA b. MSA c. OSA d. RERA

Answer 33

Correct answer: c — Rationale: Over 80% of adult sleep-disordered breathing cases are obstructive.

Question 34

Mixed Sleep Apnea (MSA) usually begins as _____ and then becomes obstructive. a. OSA b. CSA c. RERA d. DES

Answer 34

Correct answer: b — Rationale: MSA begins with a central apnea followed by obstructive features.

Question 35

Electrodes for EEG monitoring are placed on the: a. Chin only b. Forehead only c. Scalp and face d. Neck

Answer 35

Correct answer: c — Rationale: EEG leads are placed on the scalp and near facial landmarks per AASM guidelines.

Question 36

Stages used in diagnosing obstructive sleep apnea include: Glasgow Coma Scale Epworth Sleepiness Scale Fatigue Severity Scale Functional outcomes of sleep questionnaire a. 1, 2, 3 b. 2, 3, 4 c. 1, 3, 4 d. 2, 3 only

Answer 36

Correct answer: b — Rationale: Epworth, Fatigue Severity, and FOSQ are validated in sleep disorder assessment; GCS is unrelated.

Question 37

Which of the following may be a disadvantage of in-home portable sleep testing? a. Patient acceptance b. Performed over multiple nights c. Convenient use d. Published scoring standards not as robust

Answer 37

Correct answer: d — Rationale: Home tests have less diagnostic accuracy and fewer validated scoring standards.

Question 38

Finding a sawtooth pattern on the flow-volume loop during PF testing suggests: a. Central sleep apnea b. Obstructive sleep apnea c. Epiglottitis d. Paradoxical breathing

Answer 38

Correct answer: b — Rationale: Sawtooth pattern indicates upper airway flutter common in OSA.

Question 39

How many sleep cycles does an individual typically have during a night? a. 1–2 cycles b. 2–3 cycles c. 4–6 cycles d. 6–8 cycles

Answer 39

Correct answer: c — Rationale: Adults generally cycle through 4–6 complete sleep cycles per night.

Question 40

Delta waves are associated with which sleep stage? a. N1 b. N2 c. N3 d. REM

Answer 40

Correct answer: c — Rationale: N3 (slow-wave sleep) is marked by high-amplitude delta waves.

Question 41

All of the following parameters are typically monitored during PSG except: a. SpO₂ b. EEG c. End-tidal PCO₂ d. Breathing effort

Answer 41

Correct answer: c — Rationale: EtCO₂ is optional and not standard in adult PSG unless hypoventilation is suspected.

Question 42

Why should patients with obstructive sleep apnea avoid alcohol? a. Alcohol decreases the arousal threshold b. Alcohol increases upper-airway muscle tone c. Alcohol increases the arousal threshold d. Alcohol improves cardiovascular stability

Answer 42

Correct answer: c — Rationale: Alcohol raises the arousal threshold and worsens apneas by relaxing airway muscles.

Question 43

When differentiating central from obstructive sleep apnea, which PSG channel gives vastly different results? a. Airflow b. Heart rate c. Chest wall and abdominal effort d. SpO₂

Answer 43

Correct answer: c — Rationale: OSA shows effort; CSA shows absent effort.

Question 44

Which of the following occur during REM sleep? Dreaming Atonia The diaphragm functions normally Extremity muscles are paralyzed a. 1, 2 b. 1, 3, 4 c. 1, 2, 4 d. 1, 2, 3, 4

Answer 44

Correct answer: d — Rationale: All listed features are associated with REM sleep.

Question 45

Signs and symptoms of sleep apnea include all EXCEPT: a. Excessive daytime sleepiness b. Morning headaches c. Hypertension d. Metabolic alkalosis

Answer 45

Correct answer: d — Rationale: Sleep apnea causes respiratory acidosis or normal ABGs, not alkalosis.

Question 46

Which time period defines sleep onset latency? a. 0–5 minutes b. 5–10 minutes c. 10–20 minutes d. 30–40 minutes

Answer 46

Correct answer: c — Rationale: Normal sleep onset latency is 10–20 minutes; shorter indicates hypersomnolence.

Question 47

Where do you place electrodes for the EOG? a. Chin b. Forehead c. Near the outer canthus of each eye d. Upper lip

Answer 47

Correct answer: c — Rationale: EOG electrodes detect horizontal eye movements, placed at the canthi.

Question 48

The wave that indicates REM is present is the: a. Vertex wave b. Spindle wave c. Sawtooth wave d. K-complex

Answer 48

Correct answer: c — Rationale: Sawtooth waves are a hallmark of REM sleep.

Question 49

Which of the following indicates a respiratory event during sleep? a. Apnea of 4 seconds b. Apnea of 8 seconds c. Apnea of 10 seconds d. Apnea of 15 seconds

Answer 49

Correct answer: c — Rationale: ≥10 seconds defines apnea.

Question 50

What term describes a significant decrease in airflow during sleep but NOT a complete cessation? a. Apnea b. Minor apnea c. Hypopnea d. Dyspnea

Answer 50

Correct answer: c — Rationale: Hypopnea is a partial reduction in airflow with desaturation or arousal.

Question 51

Criteria to define hypopnea include: a. 20% decrease in airflow and 4% oxygen desaturation b. 30% decrease in airflow and 4% desaturation c. 30% decrease in airflow only d. 20% decrease in airflow and 2% desaturation

Answer 51

Correct answer: b — Rationale: Standard AASM criteria: ≥30% airflow reduction + ≥4% desaturation.

Question 52

What pattern describes crescendo–decrescendo respirations with alternating apnea and hyperpnea? a. Biot's b. Kussmaul c. Cheyne–Stokes d. Cluster breathing

Answer 52

Correct answer: c — Rationale: Cheyne–Stokes respiration has cyclic waxing and waning with apnea.

Question 53

Which physical exam finding is associated with OSA? a. Micrognathia b. Macroglossia c. Deviated nasal septum d. Nasal polyps

Answer 53

Correct answer: b — Rationale: Enlarged tongue obstructs airway in OSA.

Question 54

CPAP titration PSG aims to: a. Find CPAP level for maximum muscle relaxation b. Determine lowest CPAP needed to maintain airway patency c. Maintain airway hypertonicity d. Reduce REM sleep percentage

Answer 54

Correct answer: b — Rationale: Goal is to find the lowest effective CPAP that eliminates respiratory events.

Question 55

Interpret the PSG data: No airflow, no effort, desaturation. a. OSA b. CSA c. Hypopnea d. MSA

Answer 55

Correct answer: b — Rationale: Absence of both airflow and effort is diagnostic of central sleep apnea.

Question 56

Interpret the PSG data: No airflow, preserved effort, arousal. a. OSA b. CSA c. Hypopnea d. MSA

Answer 56

Correct answer: a — Rationale: OSA shows cessation of airflow with continued respiratory effort.