Clinical Overview
20%of exam
Study Prep + Performance
27%of exam
Scoring + Reporting
25%of exam
Treatment + Intervention
27%of exam
Quick Facts
- Exam
- RPSGT
- Body
- BRPT
- Questions
- 175 total
- Scored
- 150 scored
- Pretest
- 25 unscored
- Time
- 180 min
- Pass
- 350 scaled
- Vendor
- Pearson VUE
- Credential
- Valid 5 years
Exam Facts
- Blueprint
- Effective Sept 2023
- Domains
- Four weighted areas
- Items
- 175 multiple-choice
- Scored
- 150 count
- Pretest
- 25 hidden
- Pass
- 350 scaled
- Scale
- 200-500
- Authorization
- BRPT approval
Patient Intake
- Order
- Verify indication
- History
- Sleep + medical
- Meds
- Affect architecture
- ESS
- Sleepiness scale
- STOP-BANG
- OSA risk screen
- Diary
- Sleep-wake pattern
- Shift work
- Schedule usual sleep
- Consent
- Risks + refusal
Clinical Risk
- CHF
- Cardiac caution
- COPD
- Oxygen risk
- Seizures
- Video safety
- RBD
- Protect environment
- Pediatrics
- Guardian support
- Pregnancy
- Position comfort
- Mobility
- Fall precautions
- Allergy
- Adhesive check
Study Flow
Prepare, calibrate, acquire, document
Prepare hookupCalibrate channelsAcquire dataDocument changes
PSG vs HSAT
PSG
- Attended lab
- EEG sleep time
- Complex cases
HSAT
- Home test
- Recording time
- OSA focused
Full study vs screening
Protocol Picker
- Suspected OSA→Diagnostic PSG
- High OSA probability→HSAT
- Moderate-severe early→Split-night
- Daytime sleepiness→MSLT
- Fitness-for-duty→MWT
- Dream enactment→Video PSG
- Pediatric symptoms→Pediatric PSG
- Shift worker→Usual sleep time
Hookup
- 10-20
- EEG landmarks
- EEG
- Sleep stage
- EOG
- Eye movement
- Chin EMG
- Tone + REM
- Leg EMG
- Limb movements
- ECG
- Cardiac rhythm
- Position
- Supine effect
- Video
- Behavior evidence
MSLT vs MWT
MSLT
- Sleep tendency
- Narcolepsy support
- Nap trials
MWT
- Stay awake
- Safety roles
- Wake trials
Sleepiness vs alertness
Respiratory Sensors
- Thermistor
- Apnea signal
- Nasal pressure
- Hypopnea signal
- Thorax belt
- Chest effort
- Abdomen belt
- Belly effort
- Snore mic
- Vibration sound
- SpO2
- Oxygen saturation
- TcCO2
- Ventilation trend
- PAP flow
- Titration airflow
Artifact vs Event
Artifact
- Signal problem
- Fix sensor
- Document repair
Event
- Physiologic pattern
- Score criteria
- Document finding
Noise vs physiology
Instrumentation
- Impedance
- Skin contact
- Gain
- Signal size
- Sensitivity
- Display amplitude
- LFF
- Slow filter
- HFF
- Fast filter
- Sampling
- Digital resolution
- Calibration
- Known response
- Artifact
- Nonphysiologic signal
Stage Order
W N1 N2 N3 R
Wake alphaN1 thetaN2 spindlesN3 deltaREM atonia
Apnea vs Hypopnea
Apnea
- >=90% drop
- Thermistor/PAP
- Classify effort
Hypopnea
- >=30% drop
- Nasal pressure
- Desat/arousal
Near-stop vs partial
Scoring Picker
- Thermistor drops→Score apnea
- Nasal pressure drops→Score hypopnea
- Effort continues→Obstructive
- Effort absent→Central
- Flow limits arouse→RERA
- Spindles appear→N2
- Slow waves dominate→N3
- Low chin + REM→REM
Sleep Staging
- Epoch
- 30 seconds
- Wake
- Alpha + blinks
- N1
- Theta transition
- N2
- Spindle/K-complex
- N3
- Slow-wave sleep
- REM
- Low chin tone
- SOREMP
- Early REM
- Arousal
- Abrupt EEG shift
Respiratory Effort
Effort present means obstructive
Present: obstructiveAbsent: centralReturns: mixed
Obstructive vs Central
Obstructive
- Effort present
- Airway blocked
- CPAP target
Central
- Effort absent
- Drive reduced
- Caution therapy
Blocked vs no drive
Respiratory Events
- Apnea
- >=90% drop
- Hypopnea
- >=30% drop
- Obstructive
- Effort continues
- Central
- Effort absent
- Mixed
- Central then obstructive
- RERA
- Flow limit arousal
- Desat
- Oxygen drop
- RDI
- AHI + RERA
Indexes
- TST
- Actual sleep
- TIB
- Lights-out span
- Sleep efficiency
- TST/TIB percent
- Sleep latency
- Lights-out to sleep
- REM latency
- Sleep to REM
- AHI
- Apneas + hypopneas
- ODI
- Desats per hour
- PLMI
- Limb index
PAP Pressure
EPAP splints, IPAP ventilates
EPAP: obstructionIPAP: ventilationPS: difference
CPAP vs BiPAP
CPAP
- Single pressure
- OSA first-line
- Simpler titration
BiPAP
- Two pressures
- Pressure intolerance
- Ventilation support
One pressure vs two
Treatment Picker
- Routine OSA→CPAP
- Pressure intolerance→BiPAP
- Uncomplicated home OSA→APAP
- Central events emerge→Consult order
- Hypoventilation→NIPPV
- Low SpO2 persists→Oxygen per order
- Large leak→Refit mask
- Claustrophobia→Desensitize mask
PAP Modes
- CPAP
- One pressure
- APAP
- Auto pressure
- BiPAP
- IPAP + EPAP
- S/T
- Backup rate
- ASV
- Servo ventilation
- AVAPS
- Volume assured
- EPAP
- Expiratory pressure
- IPAP
- Inspiratory pressure
Interventions
- Mask fit
- Seal + comfort
- Leak
- Therapy loss
- Humidifier
- Dryness relief
- Ramp
- Comfort start
- Oxygen
- Treat hypoxemia
- Oral appliance
- Mandible advance
- Positional
- Avoid supine
- HNS
- Hypoglossal stimulation
Common Traps
Diagnosis vs documentation
Physician diagnoses ≠ Tech documents
Thermistor vs nasal pressure
Thermistor scores apnea ≠ Pressure scores hypopnea
TST vs TIB
TST is sleep ≠ TIB includes wake
MSLT vs MWT
MSLT measures sleepiness ≠ MWT measures alertness
Central vs obstructive
Central lacks effort ≠ Obstructive keeps effort
Oxygen vs PAP
Oxygen raises saturation ≠ PAP treats obstruction
Leak vs pressure
Fix leak first ≠ Then adjust pressure
Last Minute
- 1.Weights: 20 / 27 / 25 / 27
- 2.150 scored; 25 pretest
- 3.Pass = 350 scaled
- 4.PSG records EEG sleep
- 5.HSAT lacks sleep staging
- 6.Thermistor = apnea signal
- 7.Nasal pressure = hypopnea signal
- 8.Effort present = obstructive
- 9.Effort absent = central
- 10.CPAP one pressure; BiPAP two
- 11.Tech documents; physician diagnoses
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