4.4 Reporting & Data Verification

The End Product of the Scoring Domain

The end product of the Scoring domain is a defensible polysomnography (PSG) report. The RPSGT exam tests what belongs in the report, who is responsible for each part, and how data quality is verified before sign-off. Scope-of-practice questions appear repeatedly: the technologist scores and verifies, the physician interprets.

The Polysomnography Report

A complete diagnostic report typically includes:

• Sleep architecture - total sleep time, sleep efficiency, sleep latency, REM latency, wake after sleep onset, and the percentage of TST in N1, N2, N3, and R.
• Respiratory summary - AHI and RDI overall and broken out by body position (supine vs. non-supine) and by sleep stage (NREM vs. REM), plus apnea/hypopnea counts and longest event.
• Oxygenation - baseline SpO2, nadir SpO2, time or percentage of sleep below 88-90%, and the oxygen desaturation index.
• Arousals - arousal index with respiratory, limb-movement, and spontaneous breakdowns.
• Limb movements - PLMI and PLM arousal index.
• Cardiac findings - average and range of heart rate, and any significant arrhythmias.
• Technologist narrative - patient behavior, interventions, body position, and study limitations.

Roles: Technologist vs. Interpreting Physician

The technologist acquires, scores, and verifies the study and summarizes objective findings. The interpreting physician - typically a board-certified sleep medicine specialist - reviews the scored data and provides the final interpretation, diagnosis, and recommendations. A technologist who issues a diagnostic interpretation or communicates a diagnosis to the patient is acting outside the scope of practice, which the exam treats as a clear error.

Data Verification

Before a study is finalized, the technologist verifies:

• Montage and derivations match the protocol and AASM recommendations.
• Calibrations and biocalibrations (eye movements, blinks, chin EMG, leg EMG, breath hold, snore) were performed and documented.
• Signal quality - minimal artifact, correct sensitivities and filters, and timely electrode replacement.
• Epoch alignment - 30-second epochs aligned and events time-stamped correctly.
• Scored events meet AASM numeric criteria - stage thresholds, the 90% apnea and 30% hypopnea rules, and arousal duration.

Unverified or artifact-corrupted data must be flagged, not silently scored, because the interpreting physician relies on the verified record.

Quality Assurance

Quality assurance keeps scoring consistent and defensible. Common elements include inter-scorer reliability comparisons with target agreement levels for staging and event scoring, AASM accreditation standards, routine equipment biocalibration and maintenance logs, and periodic re-scoring audits. High inter-scorer reliability is the operational evidence that a lab applies the AASM Manual uniformly across technologists and shifts.

MSLT and MWT Scoring Basics

The Multiple Sleep Latency Test (MSLT) is a daytime study of 5 nap opportunities (a 4-nap protocol is acceptable in some cases) spaced about 2 hours apart, used mainly to evaluate hypersomnia and narcolepsy. Each nap is scored for sleep latency (lights out to the first epoch of any sleep) and for a sleep-onset REM period (SOREMP) - REM occurring within 15 minutes of sleep onset. A nap is ended after about 15 minutes of cumulative sleep, or after 20 minutes if no sleep occurs. The reported results are the mean sleep latency and the number of SOREMPs; a short mean latency with two or more SOREMPs supports narcolepsy.

The Maintenance of Wakefulness Test (MWT) uses 4 trials of about 40 minutes each, spaced about 2 hours apart, in which the patient is instructed to stay awake while seated in a dim room. The technologist scores sleep onset (commonly the first epoch of more than 15 seconds of cumulative sleep, per protocol). A trial ends at unequivocal sleep or at 40 minutes. The MWT measures the ability to remain awake, not the speed of falling asleep, and is often used for fitness-for-duty assessment.

Exam stems frequently contrast MSLT (measures how fast you fall asleep, counts SOREMPs) with MWT (measures how well you stay awake), and test the boundary between technologist scoring/verification and physician interpretation.

MSLT Pre-Conditions and Common Confounders

A valid MSLT depends on the preceding overnight PSG documenting at least about 6 hours of sleep, and on documentation that the patient is off REM-suppressing medications (such as many antidepressants) for an adequate washout, typically about two weeks. A urine drug screen and a sleep diary or actigraphy for the prior 1-2 weeks confirm an adequate sleep schedule. If a SOREMP appears on the preceding overnight study, it can count toward the SOREMP total for narcolepsy criteria. The technologist verifies these pre-conditions are met and documented; an invalid MSLT cannot be salvaged after the fact.

Putting the Report Together

The finalized report flows from verified raw data to scored events to summary indices to the physician's interpretation. The technologist's job ends at a complete, accurate, verified dataset and an objective summary. Common report-quality errors the exam flags include unflagged artifact, missing biocalibration documentation, mismatched montage, a technologist-authored diagnosis, and indices computed against the wrong denominator (for example dividing by recording time instead of total sleep time for the AHI).

When in doubt, the safe answer is almost always to verify the data and route the study to the interpreting physician rather than to act outside the technologist scope of practice.

Quick Reference: Who Owns What

Knowing this division cold turns most scope-of-practice stems into instant points.