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Sleep Technology (RPSGT) · High-yield review

RPSGT — High-Yield Review

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  1. In 30 seconds
  2. The college version

In 30 seconds

A condensed, exam-focused review of all 23 topics. Verify all scoring rules, specifications, and exam content against the current AASM Scoring Manual and BRPT candidate handbook/blueprint before the examination or clinical application.

The college version

Highest-Yield Facts by Domain

Domain 1 — Instrumentation

  • High yield: The 10-20 system places electrodes by proportional cranial measurements (nasion, inion, preauricular points).
  • High yield: EEG = F3/F4/C3/C4/O1/O2; EOG = eye channels; EMG = chin + legs; reference M1/M2.
  • High yield: Airflow uses BOTH a nasal pressure transducer (hypopneas) and an oronasal thermal sensor (apneas); effort = RIP belts (thoracic + abdominal).
  • High-frequency = low-pass filter; low-frequency = high-pass filter; notch filter removes 50/60 Hz.
  • Nyquist theorem: sampling rate must be at least twice the highest signal frequency (anti-aliasing).

Domain 2 — Scoring

  • High yield: Stages W, N1, N2, N3, R. N2 = spindles + K complexes; N3 = slow-wave delta; R = REM
    • low EMG + rapid eye movements.
  • High yield: Apnea = airflow drop ≥90% ≥10 s; hypopnea = reduced airflow + desaturation/arousal (adult rules 1A/1B); RERA = effort + arousal without meeting apnea/hypopnea.
  • Obstructive = effort continues; central = no effort; mixed = central then obstructive.
  • High yield: AHI = (apneas + hypopneas)/TST-hours; RDI adds RERAs; REI = HSAT respiratory events.
  • PLMS: ≥4 limb movements (leg), amplitude + duration criteria, series/intermovement intervals.

Domain 3 — Clinical Knowledge

  • High yield: Two-process model: Process S (homeostatic drive) + Process C (circadian, suprachiasmatic nucleus, melatonin).
  • ICSD categories: sleep-related breathing, hypersomnolence (narcolepsy), circadian rhythm disorders, parasomnias (NREM vs REM), sleep-related movement (RLS/PLMD), insomnia.

Domain 4 — PAP

  • High yield: CPAP = single continuous pressure; BPAP = IPAP + EPAP (pressure support = IPAP−EPAP); APAP auto-adjusts.
  • Titration targets obstructive apneas, hypopneas, RERAs, and snoring within protocol.

Domain 5 — Specialized Testing

  • High yield: MSLT measures sleepiness (mean sleep latency, SOREMPs) for narcolepsy; MWT measures ability to stay awake (occupational safety).
  • HSAT (Type III/IV) = unattended home testing; limited (no EEG sleep staging); REI not AHI.

Comparison Tables

Do not confuseWithDifference
ApneaHypopnea≥90% airflow drop vs partial reduction
Obstructive apneaCentral apneaEffort continues vs effort absent
AHIRDIApneas+hypopneas vs +RERAs
AHIREIIn-lab (TST) vs HSAT (monitoring time)
PLMSALMA/HFT/EFMLimb series vs alternating legs / foot tremor / fragmentary myoclonus
N1N2Theta/vertex vs spindles + K complexes
CPAPBPAPOne pressure vs IPAP+EPAP
ASVAVAPS/iVAPSServo for central events vs volume-assured support
MSLTMWTMeasures sleepiness vs wakefulness
PSGHSATAttended full montage vs unattended limited channels
AC amplifierDC amplifierAlternating signal vs slow/direct signal
Technologist scoringPhysician interpretationRecognition/quantification vs diagnosis/treatment

Cumulative Self-Check (40 questions)

  1. What is the standard PSG epoch length?
  2. Which two airflow sensors are used, and why both?
  3. Define the Nyquist theorem.
  4. What filter removes 60 Hz interference?
  5. Name the EEG landmarks of Stage N2.
  6. Define the adult apnea duration criterion.
  7. Write the AHI formula.
  8. Differentiate obstructive from central apnea.
  9. Name the five adult sleep stages.
  10. What is a RERA?
  11. Define PLMS series requirements.
  12. Differentiate MSLT from MWT.
  13. What is the SOREMP?
  14. Define CPAP, BPAP, and APAP.
  15. What is pressure support in BPAP?
  16. Name the two processes of the two-process sleep model.
  17. Which structure is the circadian pacemaker?
  18. Define PSG vs HSAT.
  19. What is the difference between AHI and REI?
  20. Name the mastoid reference electrodes.
  21. What does the notch filter target?
  22. Define trace alternant.
  23. Differentiate NREM from REM parasomnias.
  24. What is RLS vs PLMD?
  25. Define sleep efficiency.
  26. What is WASO?
  27. Name the PAP interface types.
  28. What is rainout?
  29. Define treatment-emergent central sleep apnea.
  30. What is ASV contraindicated in?
  31. Define the 10-20 system landmarks.
  32. What is the difference between low-pass and high-pass filters?
  33. Define the M+2 isotope pattern significance.
  34. What is the "time constant" in instrumentation?
  35. Define split-night study.
  36. Name the stages of the cardiac conduction reflected on PSG ECG.
  37. What is periodic limb movement index?
  38. Define actigraphy.
  39. What is the primary safety step in a sleep-lab emergency?
  40. What does "verify current manual" mean for scoring?

Answers and Rationales

  1. 30 seconds — the AASM staging epoch.
  2. Nasal pressure (hypopneas) + oronasal thermal (apneas) — each detects different event types.
  3. Sample at ≥2× the highest signal frequency — prevents aliasing.
  4. Notch filter — removes 50/60 Hz power-line interference.
  5. Sleep spindles + K complexes — defining N2 features.
  6. ≥90% airflow drop, ≥10 seconds — adult apnea.
  7. AHI = (apneas + hypopneas) / TST-hours.
  8. Obstructive = effort continues; central = effort absent.
  9. W, N1, N2, N3, R.
  10. Respiratory effort-related arousal — effort + arousal without apnea/hypopnea criteria.
  11. ≥4 leg movements with duration/amplitude criteria, separated by defined intervals.
  12. MSLT measures sleepiness; MWT measures wakefulness.
  13. Sleep-onset REM period — REM within 15 min of sleep onset (MSLT).
  14. CPAP = one pressure; BPAP = IPAP+EPAP; APAP = auto-adjusting.
  15. IPAP − EPAP.
  16. Process S (homeostatic) + Process C (circadian).
  17. Suprachiasmatic nucleus (SCN).
  18. PSG = attended full montage; HSAT = unattended limited channels.
  19. AHI uses TST (in-lab); REI uses HSAT monitoring time.
  20. M1 and M2 (A1/A2 historical terminology).
  21. 50/60 Hz power-line artifact.
  22. Infant EEG pattern — discontinuous, alternating high/low amplitude (quiet sleep).
  23. NREM (sleepwalking, terrors) vs REM (RBD, nightmares).
  24. RLS = urge to move; PLMD = periodic limb movements on PSG.
  25. TST/TRT × 100.
  26. Wake after sleep onset.
  27. Nasal, oronasal/full-face, nasal pillows, total-face.
  28. Condensation in tubing from humidification.
  29. Central apneas emerging during PAP.
  30. Heart failure with reduced LVEF (contraindication screening).
  31. Nasion, inion, preauricular points.
  32. Low-pass blocks high frequencies; high-pass blocks low frequencies.
  33. Halogen (Cl/Br) isotope signature.
  34. Filter response time constant (low-frequency behavior).
  35. Diagnostic PSG followed by titration in one night.
  36. P/QRS/T on modified lead II.
  37. PLMS events per hour of sleep.
  38. Movement recorder used for circadian/sleep-wake estimation.
  39. Follow facility emergency policy and designated response system.
  40. Confirm current AASM/BRPT criteria before applying any rule.

Last-Minute Review

  • Montage: F3/F4/C3/C4/O1/O2, M1/M2, EOG, chin+leg EMG, airflow (nasal pressure + thermal), effort (RIP), SpO2, ECG, snore, position.
  • Signal quality: impedance, filters (low-pass/high-pass/notch), sampling (Nyquist), calibration (biocalibration maneuvers), artifact recognition (50/60 Hz, sweat, ECG, electrode pop).
  • Staging: W/N1/N2/N3/R; pediatric trace alternant/active-quiet sleep.
  • Events: apnea/hypopnea/RERA; obstructive/central/mixed; PLMS/ALMA/HFT/EFM/bruxism.
  • Calculations: AHI, RDI, REI, PLMI, PLMAI, sleep efficiency, WASO, sleep/REM latency.
  • Disorders: OSA/CSA, narcolepsy, circadian disorders, parasomnias, RLS/PLMD, insomnia.
  • PAP: CPAP/BPAP/APAP/ASV/AVAPS; interfaces; leak; humidification; adherence.
  • Specialized tests: MSLT vs MWT vs PSG vs HSAT.

Related

  • Subject overview
  • Topic 06 — Adult Sleep Staging
  • Topic 08 — Respiratory Event Scoring
  • Topic 11 — PSG Report Generation and Sleep Calculations

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